Transmission of seasonal outbreak of childhood enteroviral aseptic meningitis and hand-foot-mouth disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.

Obesity does not preclude safe and effective myeloablative hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) in adults

The incidence of excessive adiposity is increasing worldwide, and is associated with numerous adverse health outcomes. We compared outcomes by body mass index (BMI) for adult patients with acute myelogenous leukemia (AML) who underwent autologous (auto, n = 373), related donor (RD, n = 2041), or unrelated donor (URD, n = 1801) allogeneic myeloablative hematopoietic cell transplantation (HCT) using bone marrow or peripheral blood stem cells reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2004. Four weight groups by BMI (kg/m(2)) were defined: underweight <18 kg/m(2); normal 18-25 kg/m(2); overweight >25-30 kg/m(2); and obese >30 kg/m(2). Multivariable analysis referenced to the normal weight group showed an increased risk of death for underweight patients in the RD group (relative risk [RR], 1.92; 95% confidence interval [CI], 1.28-2.89; P = .002), but not in the URD group. There were no other differences in outcomes among the other weight groups within the other HCT groups. Overweight and obese patients enjoyed a modest decrease in relapse incidence, although this did not translate into a survival benefit. Small numbers of patients limit the ability to better characterize the adverse outcomes seen in the underweight RD but not the underweight URD allogeneic HCT patients. Obesity alone should not be considered a barrier to HCT.

Hepatic and extra-hepatic sequelae, and prevalence of viral hepatitis C infection estimated from routine data in at-risk groups

Background

Concerns about the hepatitis C virus (HCV) are due to the high risk of chronic liver disease and poor treatment efficacy. Synthesizing evidence from multiple data sources is becoming widely used to estimate HCV-infection prevalence. This paper aims to estimate the prevalence of HCV infection, and the hepatic and extrahepatic sequelae in at-risk groups, using routinely collected data in the Lazio region, Italy.

Methods

HCV laboratory surveillance and dialysis, hospital discharge, and drug-user registers were used as information sources to identify at-risk groups and to estimate HCV prevalence and sequelae.

Full name and birth date were used as linkage keys for the various health registries. Prevalence was estimated as the percentage of cases within the general population and the at-risk groups, with 95% confidence intervals (95% CI) from 1997 to 2001. The risk of sequelae was estimated through a follow-up of hospital discharges up to December 31, 2004 and calculated as the prevalence ratio in HCV-positive and HCV-negative people, within each at-risk group, with 95% CI.

Results

There were 65,127 HCV-infected people in the study period; the prevalence was 1.24% (95%CI = 1.23%-1.25%) in the whole population, higher in males and older adults. Drug users (35.1%; 95%CI = 34.6-35.7) and dialysis patients (21.1%; 95%CI = 20.2%-22.0%) showed the highest values. Medical procedures with little exposure to blood resulted in higher estimates, ranging between 1.3% and 3.4%, which was not conclusively attributable to the surgical procedures. Cirrhosis, hepatocellular carcinoma and encephalopathy were the most frequent hepatic sequelae; cryoglobulinaemia and non-Hodgkin's lymphoma were the most frequent extrahepatic sequelae.

Conclusions

Synthesising data from multiple routine sources improved estimates of HCV prevalence and sequelae in dialysis patients and drug users, although prevalence validity should be assessed in survey and sequelae need a well-defined longitudinal approach.

Dietary habits of Greek adults and serum total selenium concentration: the ATTICA study

PURPOSE

The trace element selenium is an essential micronutrient for human health, and its low levels in serum are implicated in the pathogenesis of several chronic diseases. The determination of total serum selenium levels may contribute to the assessment of the health status of all populations. Since the serum selenium levels are highly affected by diet, we assessed its association with the dietary habits of Greek adults.

METHODS

Serum selenium levels were determined with inductively coupled plasma mass spectrometry in a cohort of 506 participants (men: 296, women: 210) aged 18-75 from the ATTICA study. Food consumption was evaluated with a validated food-frequency questionnaire.

RESULTS

Evaluation of the relationship between serum total selenium with major food groups and beverages by multi-adjusted analysis revealed that serum selenium was positively correlated with the consumption of red meat (2.37 ± 0.91, p = 0.01) while the consumption of other selenium-containing foods (i.e., fish, cereals, dairy products, vegetables) did not demonstrate such a relationship. Moreover, principal component analysis revealed that the adoption of a vegetarian type of diet is inversely correlated with total selenium (-3.94 ± 2.28, p = 0.08).

CONCLUSIONS

Among the dietary habits that were examined, red meat seems to be the major determinant of serum selenium in Greek adults.

Using the reference framework for good measles management in practice--a case study from North Rhine-Westphalia

In 2005, WHO Europe reconfirmed the objective of eradicating measles and fixed a strategy plan for the years 2005 up to 2010. While a downward trend of measles infections in Germany between 2001 and 2004 could be observed, as many as 780 cases of measles were reported in 2005 and in 2006 even 2.281 cases. These high figures in 2006 were almost exclusively caused by an outbreak in the German region of North Rhine-Westphalia. This case study describes how a reference framework for good health management of measles prevention was applied for this region. As a result, various recommendations for action could be given, among them the recommendation to implement individual vaccination reminder systems for parents and bonus systems for parents. Based on these results, a comprehensive policy concept has been drawn up and has become the subject of a political agreement process in this region. Thus this case study shows a paradigm how reference frameworks for good health management can be utilised in practice.

Health-related quality of life in overweight and obese youths: results of a multicenter study

BACKGROUND

We examined treatment-seeking overweight and obese youths to better understand the gender, age, and treatment modality differences in generic and disease-specific health-related quality of life (HRQOL).

METHODS

This multicenter study included 1,916 patients (mean = 12.6 years; 57% females; mean zBMI = 2.4) who started treatment for overweight and obesity in 48 treatment facilities between July 2005 and October 2006. The facilities offered either inpatient treatment or outpatient programs. Prior to treatment, all participants completed the generic KIDSCREEN-27 HRQOL-questionnaire, the self-perception subscale of the generic KIDSCREEN-52 and the disease-specific obesity module of the KINDLR.The patients' HRQOL was compared to the KIDSCREEN reference sample from the general population by one-way analyses of variance, adjusting for age, gender, and socioeconomic status. Independent t-tests were conducted to compare disease-specific HRQOL scores between patients by gender and age group. Significant mean differences in HRQOL between inpatients and outpatients were explored by one-way analyses of variance, adjusting for age, gender, and zBMI. Effect sizes 'd' were calculated employing the estimated marginal means and the pooled standard deviation (m(treatment) - m(norm)/SD(pooled)).

RESULTS

The patients' HRQOL scores were impaired relative to German norms, with effect sizes up to d = 1.12. The pattern of impairment was similar in boys and girls as well as in children and adolescents. In each of the analyses, at least three of six KIDSCREEN subscales were affected. Regardless of gender and age group, the highest impairments were found in self-perception and physical well-being. Because of the strong decrease in HRQOL in the general population during adolescence, compared to age-specific norms, adolescents were less impaired than were children. However, overweight and obese adolescents (especially females) reported the lowest absolute HRQOL scores. HRQOL varied with the intensity of treatment. Inpatients had significantly lower scores than did outpatients, even after adjusting for age, gender and zBMI.

CONCLUSIONS

The results suggest the presence of differences in HRQOL with regard to gender, age, and treatment modality in treatment-seeking overweight and obese youths. Research and clinical practice must consider the particular impairments of inpatients as well as the impairments of (especially female) adolescents.

Physical activity levels of children living in different built environments

OBJECTIVE

To review the available literature assessing differences in physical activity levels of children living in different built environments classified according to land use within developed countries.

METHODS

A systematic review of published literature up to March 2009. Online searches of five databases yielded 18 studies which met inclusion criteria. Studies provided data on n=129446, 5-18 years old (n=117544 from the United States).

RESULTS

From 13 assessments of differences in physical activity between rural and urban children one showed that rural children were significantly more active than urban children. In studies where the built environment was sub-divided further, suburban and small town children showed the highest levels of physical activity, followed by rural, then urban children. Differences in types of physical activity undertaken were evident, showing that rural children spent more time outdoors, involved in unstructured play compared with urban children. These findings were mainly restricted to children <13 years old.

CONCLUSIONS

The literature does not show major differences in the physical activity levels between children from rural or urban areas. Where studied, the suburban built environment appears most conducive to promoting physical activity. Further research should use at least a trilateral division of the built environment and should also account for socioeconomic status, racial factors and seasonal effects.

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study

OBJECTIVE

To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.

DESIGN

Cross-sectional.

SETTING

Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status.

SUBJECTS

During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey.

RESULTS

Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0.01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0.004), as well as financial status (P = 0.001).

CONCLUSIONS

Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

Nutritional approach to sun protection: a suggested complement to external strategies

The increasing incidence of skin cancer despite the use of externally applied sun protection strategies, alongside research showing that nutrients reduce photo-oxidative damage, suggest nutritional approaches could play a beneficial role in skin cancer prevention. Penetrating photo-oxidative ultraviolet A radiation reduces skin and blood antioxidants and damages cell components, including DNA. Dietary antioxidant vitamins, minerals, and phytochemicals in addition to n-3 polyunsaturated fatty acids, n-9 monounsaturated fatty acids, and low pro-inflammatory n-6 polyunsaturated fatty acids, have demonstrated protective properties. The presence of these elements in the traditional Greek-style Mediterranean diet may have contributed to the low rates of melanoma in the Mediterranean region despite high levels of solar radiation. This suggests a potentially relevant model for studying dietary/nutritional supplementation for lifelong internal support of sun-protection mechanisms, which could complement external strategies.

The chemical chaperone 4-phenylbutyrate inhibits adipogenesis by modulating the unfolded protein response

Recent studies have shown a link between obesity and endoplasmic reticulum (ER) stress. Perturbations in ER homeostasis cause ER stress and activation of the unfolded protein response (UPR). Adipocyte differentiation contributes to weight gain, and we have shown that markers of ER stress/UPR activation, including GRP78, phospho-eIF2, and spliced XBP1, are upregulated during adipogenesis. Given these findings, the objective of this study was to determine whether attenuation of UPR activation by the chemical chaperone 4-phenylbutyrate (4-PBA) inhibits adipogenesis. Exposure of 3T3-L1 preadipocytes to 4-PBA in the presence of differentiation media decreased expression of ER stress markers. Concomitant with the suppression of UPR activation, 4-PBA resulted in attenuation of adipogenesis as measured by lipid accumulation and adiponectin secretion. Consistent with these in vitro findings, female C57BL/6 mice fed a high-fat diet supplemented with 4-PBA showed a significant reduction in weight gain and had reduced fat pad mass, as compared with the high-fat diet alone group. Furthermore, 4-PBA supplementation decreased GRP78 expression in the adipose tissue and lowered plasma triglyceride, glucose, leptin, and adiponectin levels without altering food intake. Taken together, these results suggest that UPR activation contributes to adipogenesis and that blocking its activation with 4-PBA prevents adipocyte differentiation and weight gain in mice.

Dietary meat fats and burden of cardiovascular disease risk factors, in the elderly: a report from the MEDIS study

Dietary fats have long been associated with human health, and especially cardiovascular disease (CVD). Some observational studies have shown that reduction in dietary fats, and particularly cholesterol is associated with lower cardiovascular risk; however, other prospective studies or randomized controlled trials of dietary fat reduction or modification have shown varying results on CVD morbidity and mortality. In this work we evaluated the relationships between dietary fats and a cluster of CVD risk factors (i.e., diabetes, obesity, hypercholesterolemia, hypertension), among elderly individuals without known CVD. In particular, dietary and clinical data from 1486 elderly (aged 65 to 100 years) men and women living in Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Syros, Naxos, Corfu and Zakynthos islands, and participated in the MEDIS study, were analysed. Data analysis revealed that 18.5% of males and 33.3% of females had three or four cardiovascular disease risk factors; the major source of fat was olive oil (mean intake for men and women 50.0 +/- 19.3 g/day and 46.0 +/- 16.8 g/day, p < 0.001). In addition it was observed that a 5% increase in energy adjusted fat intake from meat was associated with a 21% increase in the likelihood of having one additional CVD risk factor (95%CI 6%-39%); no significant associations were observed regarding the other types of fat consumed by the elderly participants. These findings may state a hypothesis that the consumption of fat only from meat or its products seems to increase the burden of CVD risk factors among CVD-free, elderly people.

The height-, weight-, and BMI-for-age of Polish school-aged children and adolescents relative to international and local growth references

Background

The growth of children is an indicator of health and society's wellbeing. Growth references are useful in monitoring a child's growth, which is a very important part of child care. Poland's growth references are not updated regularly. Although several growth reference ranges have been developed in Poland over recent years, sampling was restricted to urban populations of major cities. The aim of this study was to assess how well Polish children match with, or diverge from, regional charts and to compare them with international growth references.

Methods

Four Polish and two international (WHO 2007 and USCDC2000) growth references were used to calculate the height, weight and BMI z-scores in a recent, large, population-representative sample of school-aged children and adolescents in Poland. The distributions of z-scores were analysed with descriptive and inferential statistical methods.

Results

Mean height z-scores calculated with the use of the WHO 2007 and USCDC2000 references were positive and significantly different from zero over the entire age range. The mean height z-score was closest to zero in the Poznan reference for boys (0.05) and Warszawa reference for girls (0.01). Median weight z-scores were positive under all weight references over the entire age range with only the exception of 18-year-old girls' weight z-score calculated relative to USCDC2000. Median BMI z-scores were positive in males in early childhood, decreasing with age. In the case of girls, the median BMI z-score calculated using WHO 2007 and USCDC2000 was close to zero in early childhood, decreased in adolescents and reached minimum values at age 18 years. Median BMI z-scores calculated with the use of the Lodz reference fluctuated between 0.05 and 0.2 over the studied age range.

Conclusions

In this contemporary sample of Polish school-aged children, distributions of height, weight and BMI differed from those of children from the international growth references. These differences should be considered when using the references. There exist certain limitations to the analysis of height, weight, and BMI z-scores when Polish regional references are used.

Accidents in the context of study among university students--a multicentre cross-sectional study in North Rhine-Westphalia, Germany

Knowledge about prevalence and patterns of accidents among university students is scarce. The aims of the present health survey were to assess the general prevalence of accidents among university students, to describe the specific kinds of accidents, and to analyse associated factors. A multicentre cross-sectional health survey was conducted at 12 universities and 4 universities of applied sciences in North Rhine-Westphalia (NRW), Germany. The response rate was 88%. The self-administered questionnaire covered multiple areas of health, behaviours and a specific module for accidents. In total, 252 (8.8%) out of 2855 students (aged 17-26 years) had experienced an accident in the context of their studies. Contusions, compressions and strains constituted more than 50% of all kinds of injuries, while fractures, irritations, burns or acid burns were reported less frequently. The cumulative risk of experiencing an accident was increasing linearly with the study duration, indicating an absence of a specific vulnerable period. Nearly 60% of all accidents took place during study-related sports activities, and about a quarter of all accidents occurred on the way to or from university. Only few accidents occurred on university floors, in lecture rooms or on stairways. Further studies are needed to assess more in depth the causes of accidents and the situation immediately preceding the event before making specific recommendations for prevention.

Epidemiology of hepatitis C and human immunodeficiency virus infections among injecting drug users in Hungary – what’s next?

Jelenleg hazánkban az injektáló kábítószer-használók körében a hepatitis C (HCV) előfordulási aránya Budapesten 35% körüli, vidéken pedig 20% alatti, és verifikált emberi immunhiányt okozó vírus (HIV) -fertőzést nem regisztráltak körükben. Matematikai modellek szerint a HCV és a HIV járványtana ebben a kockázati csoportban egybefonódik: amíg a HCV előfordulása körülbelül 35% alatti, a HIV-járvány valószínűsége nagyon csekély, e határ átlépése után viszont egyre terjedő HIV-járványra számíthatunk. E modellek szerint a hazai, főleg a fővárosi, injektáló kábítószer-használók körében egyre nő egy átfogó HIV-járvány valószínűsége. Négy fő módon lehet egy ilyen HIV-járványt késleltetni, illetve minimalizálni: 1. helyettesítő kezelési programokkal; 2. injektáló eszközök legális hozzáférésével; 3. tanácsadással egybekötött, ingyenes, anonim HIV- és HCV-gyorsteszteléssel; és 4. higiénikus injektálási körülmények biztosításával. Az injektáló kábítószer-használók jelenlegi HCV-járványtani helyzete nemcsak mielőbbi széles körű és átfogó megelőzési választ kíván az előrejelzéseken alapuló HIV-járvány elkerülése érdekében, főleg a fővárosban, hanem a járványtani helyzet rendszeres monitorozását is. A megelőzési programok sikeressége két kulcstényezőn múlik: 1. széles körű hozzáférhetőség és 2. folyamatos állami finanszírozás.

Umbilical waist-to-height ratio and trunk fat mass index (DXA) as markers of central adiposity and insulin resistance in Argentinean children with a family history of metabolic syndrome

Central adiposity is increasing in childhood. To find a simple index of central fatness that accurately predicts insulin resistance we studied 55 obese children and 53 siblings, aged 6-16 years. We recorded the family metabolic score, calculated clinical and DXA-derived fat distribution indexes and HOMA-IR. Umbilical waist-to-height ratio (W-to-Ht) had the best combination of ROC area (0.99, IC95: 0.93 to 1.0), Youden's index (0.976), coefficient of variation (4.9) and correlation with HOMA-IR (r = 0.58, p < 0.0001); it also correlated (p < 0.001) with BMI (r = 0.95) and DXA-trunk fat mass index (r = 0.93). It was the best predictor of insulin resistance in a multiple regression model (p < 0.0001). Odds ratios for insulin resistance were 9.33 when the family score was >10 (p < 0.01) and 14.35 when umbilical W-to-Ht was >0.54 (p < 0.0001). Umbilical W-to-Ht, a simple marker of central adiposity, strongly relates to children's DXA-trunk fat mass index and insulin resistance.

Association study of a functional catechol-O-methyltransferase polymorphism and smoking in healthy Caucasian subjects

Tobacco smoking is a global health problem. The association of a functional common polymorphism in the catechol-o-methyltransferase gene (COMT Val158Met) with smoking behavior has been extensively studied, but with divergent findings. In the present study the frequency of COMT genotypes and alleles was evaluated in 578 male and a smaller group of 79 female unrelated, medication-free Caucasian healthy subjects of Croatian origin. Smokers were classified as subjects smoking <or=10 cigarettes per day, while subjects who never smoked in their life were regarded as nonsmokers. A chi(2)-test with standardized residuals and Bonferroni correction revealed significant (P=0.017) differences in Met/Met, Met/Val or Val/Val genotype frequency between male smokers and nonsmokers. This significant association between COMT Val158Met polymorphism and smoking was not detected in female subjects, due to the small number of women, which represents a limitation of the study. Our results confirmed the significant association between COMT variants and smoking, which was due to the higher frequency of Val/Val homozygotes in male smokers compared to male nonsmokers. These results suggest that carriers of the high activity COMT variant are more prone to develop a higher level of nicotine dependence, or that they release more dopamine than carriers of Met/Met or Met/Val genotypes.

Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial

BACKGROUND

Metabolic syndrome, a constellation of metabolic risk factors for type 2 diabetes and cardiovascular disease, is one of the fastest growing disease entities in the world. Weight loss is thought to be a key to improving all aspects of metabolic syndrome. Research studies have suggested benefits from diets rich in vegetables and fruits in helping individuals reach and achieve healthy weights.

OBJECTIVE

To evaluate the effects of a ready to serve vegetable juice as part of a calorie-appropriate Dietary Approaches to Stop Hypertension (DASH) diet in an ethnically diverse population of people with Metabolic Syndrome on weight loss and their ability to meet vegetable intake recommendations, and on their clinical characteristics of metabolic syndrome (waist circumference, triglycerides, HDL, fasting blood glucose and blood pressure).A secondary goal was to examine the impact of the vegetable juice on associated parameters, including leptin, vascular adhesion markers, and markers of the oxidative defense system and of oxidative stress.

METHODS

A prospective 12 week, 3 group (0, 8, or 16 fluid ounces of low sodium vegetable juice) parallel arm randomized controlled trial. Participants were requested to limit their calorie intake to 1600 kcals for women and 1800 kcals for men and were educated on the DASH diet. A total of 81 (22 men & 59 women) participants with Metabolic Syndrome were enrolled into the study. Dietary nutrient and vegetable intake, weight, height, leptin, metabolic syndrome clinical characteristics and related markers of endothelial and cardiovascular health were measured at baseline, 6-, and 12-weeks.

RESULTS

There were significant group by time interactions when aggregating both groups consuming vegetable juice (8 or 16 fluid ounces daily). Those consuming juice lost more weight, consumed more Vitamin C, potassium, and dietary vegetables than individuals who were in the group that only received diet counseling (p < 0.05).

CONCLUSION

The incorporation of vegetable juice into the daily diet can be a simple and effective way to increase the number of daily vegetable servings. Data from this study also suggest the potential of using a low sodium vegetable juice in conjunction with a calorie restricted diet to aid in weight loss in overweight individuals with metabolic syndrome.

How do I look? Body image perceptions among university students from England and Denmark

This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception (as "too thin", "just right" or "too fat"), and the association of related factors with body image perception (nutrition behaviour, social support, perceived stressors and quality of life). The proportions of students who perceived themselves as "too thin", "just right", or "too fat" were 8.6%, 37.7%, and 53.7% respectively. Multi-factorial logistic regression analysis showed that students who perceived themselves as "too fat" were more likely to be from the British university, to be females, to be older than 30 years, to report stress due to their financial situation and were less likely to have a high quality of life. The findings highlight the need for interventions with focus on healthy food choices whilst acknowledging financial stressors and quality of life.

Is the health and wellbeing of university students associated with their academic performance? Cross sectional findings from the United Kingdom

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one University in the UK during 2008-2009. The first survey was a general health survey; the second survey measured students' satisfaction with different aspects of their learning and teaching experience. Students' registration numbers linked the responses of both questionnaires together, and subsequently linked the questionnaires to the university database to import the grades that students actually achieved in their studies. Generally, on average, students (N = 380) exhibited medium to high satisfaction with their educational experiences. In the multivariate regression analyses, students' satisfaction with their educational experiences was not associated with any of the three indicators of educational achievement (actual module mark; perceived own performance; importance of achieving good grades). The associations of educational satisfaction, health, health behaviours, heath complaints and financial parameters with the three outcomes of educational achievement did not differ between male and female students. Each of the health, health behaviours, health complaints and financial parameters were selectively associated with only some but not all three indicators of student educational achievement. We conclude that the findings support a conceptual framework suggesting reciprocal relationships between health, health behaviour and educational achievement. Comprehensive health promotion programmes may have the potential to influence relevant predictors of educational achievement in university students.

Trends and stabilization up to 2022 in overweight and obesity in Switzerland, comparison to France, UK, US and Australia

In Switzerland a rapid increase in the total overweight population (BMI ≥ 25) from 30.3% to 37.3% and in the obese segment (BMI ≥ 30) from 5.4% to 8.1% was observed between 1992 and 2007. The objective of this study is to produce a projection until 2022 for the development of adult overweight and obesity in Switzerland based on four National Health Surveys conducted between 1992 and 2007. Based on the projection, these prevalence rates may be expected to stabilize until 2022 at the 2007 level. These results were compared with future projections estimated for France, UK, US and Australia using the same model.

Novel and emerging approaches to combat adolescent obesity

Overweight and obesity continue to be health concerns facing today’s adolescent population. Along with metabolic and physical problems associated with obesity, today’s obese adolescents also face many psychological issues such as high rates of depression, anxiety, and social discrimination. Obesity is commonly recognized as having many causes, such as genetic, lifestyle and environmental. There are four major modalities for management of overweight and obesity in adolescents: dietary management, increasing physical activity, pharmacological therapy, and bariatric surgery. The purpose of this study was to conduct a review of novel and emerging approaches for preventing and managing adolescent obesity. It was found that while not always the case, theory driven approaches are being better utilized in newer interventions especially by those directed toward prevention. New theories that are being used are the theories of reasoned action, planned behavior, intervention mapping, and social marketing. Schools are found to be the most common place for such interventions, which is appropriate since virtually all children attend some form of private or public school. Limitations found in many studies include the underuse of process evaluations, the low number of studies attempted, environmental or policy changes, and that not all studies used a similar control group for comparison.

Epidemiological Investigation of Metabolic Syndrome and Analysis of Relevant Factors in North-Eastern China

This epidemiological study was conducted to investigate the prevalence of metabolic syndrome and associated risk factors in Chinese subjects from Dehui in northeastern China. Using a random sampling method, a questionnaire was completed by 3785 permanent residents aged 18-72 years and relevant clinical data were collected from each subject. Binary multivariate logistic regression analysis was used to identify factors that were significantly associated with metabolic syndrome. Based on the International Diabetes Federation definition, the prevalence of metabolic syndrome was 22.4%, which is higher than that of the general Chinese population. Metabolic syndrome occurred more frequently in females and the prevalence gradually increased with age. Living in an urban setting and being female, > 50 years old, overweight, having total cholesterol ≥ 5.18 mmol/l, low-density lipoprotein cholesterol ≥ 3.1 mmol/l, and a fatty liver were significant risk factors associated with metabolic syndrome.

HIV and people over 50 years old in Europe

OBJECTIVE

The aim of the study was to report on HIV and older people in the European Region, including new data stratified by subregion and year.

METHODS

Data were collected from the 2008 World Health Organization Regional Office for Europe, Communicable Diseases Unit survey on HIV/AIDS and health systems.

RESULTS

It was found that 12.9% of newly reported cases of HIV infection in Western Europe in 2007 were in people aged 50 years or older. In Central Europe, almost one-in-10 newly reported cases of HIV infection were in older people, while the proportion in Eastern Europe was 3.7% in 2007.

CONCLUSIONS

The issue of HIV infection among older people is of increasing concern as more people age with HIV infection as a result of the availability of combination antiretroviral therapy.

Relationship between perceived body weight and body mass index based on self- reported height and weight among university students: a cross-sectional study in seven European countries

BACKGROUND

Despite low rates of obesity, many university students perceive themselves as overweight, especially women. This is of concern, because inappropriate weight perceptions can lead to unhealthy behaviours including eating disorders.

METHODS

We used the database from the Cross National Student Health Survey (CNSHS), consisting of 5,900 records of university students from Bulgaria, Denmark, Germany, Lithuania, Poland, Spain and Turkey to analyse differences in perceived weight status based on the question: "Do you consider yourself much too thin, a little too thin, just right, a little too fat or much too fat?". The association between perceived weight and body mass index (BMI) calculated from self-reported weight and height was assessed with generalized non-parametric regression in R library gam.

RESULTS

Although the majority of students reported a normal BMI (72-84% of males, 65-83% of females), only 32% to 68% of students considered their weight "just right". Around 20% of females with BMI of 20 kg/m2 considered themselves "a little too fat" or "too fat", and the percentages increased to 60% for a BMI of 22.5 kg/m2. Male students rarely felt "a little too fat" or "too fat" below BMI of 22.5 kg/m2, but most felt too thin with a BMI of 20 kg/m2.

CONCLUSIONS

Weight ideals are rather uniform across the European countries, with female students being more likely to perceive themselves as "too fat" at a normal BMI, while male students being more likely to perceive themselves as "too thin". Programs to prevent unhealthy behaviours to achieve ill-advised weight ideals may benefit students.

Prevalence of oral soft tissue lesions in Vidisha

Background

The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software.

Findings

8.4 percent of the population studied had one or more oral lesions, associated with prosthetic use, trauma and tobacco consumption. With reference to the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers, 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 patients were found to have significant mucosal lesions. Of these, 216 cases agreed to undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral submucous fibrosis, 9 showed smoker's melanosis, 6 patients had lichen planus, 17 had dysplasia, 2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis.

Conclusions

The findings in this population reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Tick-borne encephalitis from eating goat cheese in a mountain region of Austria

We report transmission of tick-borne encephalitis virus (TBEV) in July 2008 through nonpasteurized goat milk to 6 humans and 4 domestic pigs in an alpine pasture 1,500 m above sea level. This outbreak indicates the emergence of ticks and TBEV at increasing altitudes in central Europe and the efficiency of oral transmission of TBEV.

Risk factors for childhood overweight: shift of the mean body mass index and shift of the upper percentiles: results from a cross-sectional study

BACKGROUND

The worldwide increasing prevalence of childhood overweight seems to be due to an increasing proportion of extremely high body mass index (BMI) values rather than to a shift of the entire BMI distribution. These findings might be attributed to incremental exposure to risk factors particularly affecting overweight children.

OBJECTIVE

To assess the possible differences in associations of several risk factors by subgroups of children's BMI distribution.

METHODS

We applied quantile regression to cross-sectional data on 9698 German preschoolers (5-6 years) collected in 1999 and 2002. Sex- and age-specific BMI standard deviation scores (BMI-SDSs) were used as the outcome variable, and maternal BMI, maternal smoking during pregnancy, exclusive formula feeding, child's weight gain from birth to 2 years of life and low parental education as explanatory variables.

RESULTS

All risk factors except formula feeding contributed to a positive shift in mean BMI-SDS. The estimated effects of all risk factors on BMI-SDS were greatest for children with the highest BMI-SDS value. For example, high television (TV) viewing (>2 h day(-1)) had an effect of 0.46 (95% confidence interval (CI): 0.46, 0.46) SDS units on overweight children (90th percentile), but only a 0.22 (95% CI: 0.11, 0.33) SDS effect on normal-weight children (50th percentile).

CONCLUSIONS

For well-known risk factors of childhood overweight, stronger associations in children with higher BMI values were observed. These findings might possibly help to explain the secular shift in the upper BMI percentiles in children.

Current use of smokeless tobacco among adolescents in the Republic of Congo

BACKGROUND

Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT).

METHODS

Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS) of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking). Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) were used to measure magnitudes of associations.

RESULTS

Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females) reported having used smokeless tobacco (chewing tobacco, sniff or dip) in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]). Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes). Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]). Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]).

CONCLUSIONS

Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of tobacco use. The teenagers environment at home, at school and at leisure must also be factored in order to prevent their uptake or maintenance of tobacco use.

Human enterovirus 71 and hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.

Assessment of factors associated with dental caries in rural communities in Rakai District, Uganda

To assess factors associated with dental caries in rural communities in Rakai District, Uganda. This was a cross-sectional survey in 18-62 year olds, randomly selected from three sub-counties: Kyalurangira (n = 121), Kabira (n = 133), and Kacheera (n = 67). The participants were clinically examined for caries using Decayed Missing Filled Teeth (DMFT) index and were administered to a structured questionnaire. In the whole material, caries prevalence (DMFT score > 0) was 57.3% and the mean DMFT score was 2.3. The M-component contributed 61% of the DMFT scores. Using bivariate analyses, age, consumption of sugared snacks and tobacco smoking were directly and significantly associated with development of dental caries. Tooth cleaning and previous dental visits were indirectly and significantly associated with dental caries. In binary logistic regression analyses, the participants who were older were four times and those who consumed sugared snacks were 11 times more likely to develop dental caries as compared to their counterparts. The participants who cleaned their teeth or who had visited the dentists were less likely to develop dental caries as compared to their counterparts. The odds ratios were 0.6 and 0.5, respectively. Based on stepwise multiple linear regression analyses, age, previous dental treatment, consumption of sugared snacks, tooth cleaning and tobacco smoking explained a total of 46% of the variations in DMFT scores. Caries prevalence and severity were relatively low in this population. Although a number of independent variables were significantly associated with caries they gave a modest overall multivariate model.

Colocteral cancer management and prevention policies in Greece

Despite lower cancer mortality rates in Greece compared to other European countries, colorectal cancer (CRC) is the third most important cause of cancer mortality. Given the significant economic and societal impact of CRC in Greece, this paper focuses on CRC data resources, disease management and the existing prevention policies. Numerous initiatives have taken place for the collection of data and the creation of cancer registries, however, they currently remain incomplete. Despite universal access of the Greek population to health services provision, structural problems of the national health system have imposed organisational barriers to the geographical distribution of health resources. National invitational CRC screening programmes focusing on early detection of the disease as well as guidelines for its management are missing. All novel cancer treatments are fully reimbursed. Post-treatment surveillance guidelines for high-risk patients are very limited and depend solely on health providers' decisions. A National Cancer Plan (NCP) had been announced during the 2008-2012, but is still in the planning phases. Under the proposed NCP, the longevity of cancer data collection seems to be the critical step in monitoring and improving the performance of the health system. Detailed epidemiological data will give the possibility of constructing an effective prevention policy, will reduce socio-economic inequalities in the access to CRC treatment and lighten the differences observed in health outcomes. The full implementation of the NCP constitutes the most significant investment in cancer management that has ever taken place in Greece.

Overall and central obesity incidence in an urban Portuguese population

OBJECTIVE

To provide overall and central obesity incidence estimates by gender, age and educational level in an urban Portuguese population.

METHODS

As part of the EPIPorto study, 1,621 Porto, Portugal adult residents were evaluated in 1999-2003 and 2005-2008. Overall obesity was defined by a BMI > or = 30.0 kg/m(2) and central obesity by a WC >88.0 cm in women and >102.0 cm in men. Relative risks (RR) and 95% confidence intervals (95% CI) were computed using Poisson regression. Survival analysis was also performed.

RESULTS

The age-adjusted incidence rates/100 person-years of overall and central obesity were, respectively, 1.70, 95% CI: 1.34-2.19 and 5.97, 95% CI: 5.09-7.03 in women; 1.08, 95% CI: 0.73-1.64 and 2.38, 95% CI: 1.81-3.20 in men. In multivariate analysis, older women presented a higher risk of overall obesity. Moreover, a significant inverse association was found between obesity and education in women (>11 vs. <5 years: RR=0.43, 95% CI: 0.22-0.84, for overall obesity; RR=0.45 95% CI: 0.29-0.69, for central obesity). For overall obesity, 10.1% of women and 5.1% of men became obese during the 5-year study period. Higher proportions were observed regarding central obesity, 29.1% and 11.4% for women and men, respectively.

CONCLUSIONS

Over time, individuals developed central obesity faster than overall obesity. Our results support that increasing levels of education limit this ongoing development of obesity, particularly among women.

Eleven-year prevalence trends of obesity in Greek children: first evidence that prevalence of obesity is leveling off

We examined 11-year (1997-2007) trends in underweight, overweight, and obesity in Greek children. Population data derived from a yearly, school-based health survey carried out between 1997 and 2007 in >80% of all Greek schools. Height and weight measurements from 651,582 children, aged 8-9 years (boys: 51.2%) were analyzed. The gender- and age-specific BMI cutoff points by the International Obesity Task Force (IOTF) were used in order to define underweight, normal weight, overweight, and obesity. Trend analysis showed an increase in the prevalence of obesity from 7.2 +/- 0.2% in 1997 to 11.3 +/- 0.2% in 2004 for girls (P < 0.001) and from 8.1 +/- 0.2% in 1997 to 12.3 +/- 0.2% in 2004 for boys (P < 0.001). An apparent leveling off in obesity rates was observed during 2004-2007 for both boys and girls. The prevalence of overweight rose between 1997 and 2007 from 20.2 +/- 0.2% to 26.7 +/- 0.2% for girls (P < 0.001) and from 19.6 +/- 0.2% to 26.5 +/- 0.2% for boys (P < 0.001). The overall prevalence of thinness in the same period remained constant in both sexes. The presented population-based data revealed that the prevalence of overweight and obesity among 8- to 9-year-old Greek children is alarmingly elevated, with the overweight rates rising continuously. However, an apparent leveling off in obesity rates for the past 4 consecutive years was documented for the first time in both genders.

Early exposure to nicotine during critical periods of brain development: Mechanisms and consequences

Tobacco use during pregnancy continues to be a major problem with more than 16% of pregnant women in the United States continuing to smoke during pregnancy. Tobacco smoke is known to contain more than 4,000 different chemicals, and while many of these compounds have the potential to interfere with proper neurodevelopment, there is direct evidence that nicotine, the major psychoactive substance present in tobacco, acts as a neuroteratogen. Nicotine activates, and subsequently desensitizes, neuronal nicotinic acetylcholine receptor subtypes (AChRs), which are expressed in the developing central nervous system (CNS) prior to the in-growth of cholinergic neurons. Nicotinic AChRs are present by the first trimester of development in both humans and rodents, and activation of these receptors by acetylcholine is thought to play a critical role in CNS development. The purpose of the current review is to provide an overview of the role that nicotinic AChRs play in the developing CNS and to describe the effects of nicotine exposure during early development on neuronal cell biology, nicotinic AChR expression and neurotransmitter system (e.g., dopamine, norepinephrine, serotonin) function. In particular, differences that occur as a result of the timing and duration of nicotine exposure will be discussed. Emphasis will be placed on preclinical studies examining particular periods of time which correspond to periods of prenatal development in humans (i.e., first, second and third trimesters). Finally, the effects of early nicotine exposure on neurobehavioral development as it pertains to specific disorders, i.e., attention deficit hyperactivity disorder (ADHD), depression and addiction, will be discussed.

Exposure assessment of breast-fed infants in the Czech Republic to indicator PCBs and selected chlorinated pesticides: area-related differences

The aim of our study was to obtain data on the exposure of breast-fed infants to polychlorinated biphenyls (PCBs) and selected organochlorine pesticides (OCPs) in different urban areas of the Czech Republic. The PCB and OCP levels were determined in 90 human milk samples collected in seven urban areas in 1999-2000 according to the WHO protocol. The estimated daily intake (EDI) was calculated for each of the analytes and compared with the respective tolerable daily intake (TDI). Significant local differences in the sum of 35 PCB congeners analyzed (total PCBs) as well as in the most prominent indicator congeners 138, 153, and 180 values were observed, with the highest levels being found in breast milk samples from mothers living in the vicinity of a former plant using PCBs in Uherské Hradiste (median and ranges 3410 and 1448-13,754 ng g(-1)lipid weight (lw)). Non-exposed mothers from the same area had about threefold lower levels (median and ranges 1073 and 757-2139 ng/g lw, respectively). The lowest levels of total PCBs were found in Telc (median and ranges 480 and 293-731 ng g(-1)lw, respectively). In all study areas, EDIs for PCBs in breast-fed infants exceeded the TDI of 0.4 microg kg(-1)bwd(-1) recommended in the Czech Republic. EDI for HCB exceeded the recommended TDI of 0.16 microg kg(-1), EDI for DDT was slightly below TDI of 10 microg kg(-1) bw d(-1) and HCHs EDI was negligible. The database of analytical results from this study was used for Bayesian modeling of breast-fed infant exposure to PCBs and OCPs during the recommended 6 months of exclusive breastfeeding.

Analysis of long term care in the context of social and health services in social institutional facilities in Slovakia

OBJECTIVES

Long-term care for people with chronic illnesses and disabilities present an urgent challenge around the world. Existing systems of care, which typically rely on unpaid family members, are not by themselves enough to meet growing demands. This analysis includes survey on the structure of services provided in selected social facilities in Slovakia.

METHODS

The survey on structure of provided services includes social facilities providing services to the target groups involved in this analysis: Elderly people in retirement age; Disabled and chronically ill citizens in working age. For data collection from social facilities we used questionnaire method. The data were obtained from the managements of these facilities (n=405).

RESULTS

In social facilities, the age range of clients was 76-85 years (31%); the length of stay of a patient in a social facility was in 36% patients 11 years and longer. The most frequently performed activities in employees were related to services and activities (31%) and social care (30%). For 52% social facilities is waiting time 1 year and longer. The length of stay of patient in social facilities is affected in 83% by combination of health and social problems and as to the diagnosis structure the most prevalent conditions are ischemic heart diseases, heart attack, hypertension (39%), locomotor disease (36%). In 2006 the budget resources of social facilities were in 72% contributions from the state budget.

CONCLUSION

Long-term care is closely interlinked with other programmes and systems, which can reduce the need for long-term care or which complement it.

Smoking estimates from around the world: data from the first 17 participating countries in the World Mental Health Survey Consortium

OBJECTIVE

To contribute new multinational findings on basic descriptive features of smoking and cessation, based upon standardised community surveys of adults residing in seven low-income and middle-income countries and 10 higher-income countries from all regions of the world.

METHODS

Data were collected using standardised interviews and community probability sample survey methods conducted as part of the WHO World Mental Health Surveys Initiative. Demographic and socioeconomic correlates of smoking are studied using cross-tabulation and logistic regression approaches. Within-country sample weights were applied with variance estimation appropriate for complex sample survey designs.

RESULTS

Estimated prevalence of smoking experience (history of ever smoking) and current smoking varied across the countries under study. In all but four countries, one out of every four adults currently smoked. In higher-income countries, estimated proportions of former smokers (those who had quit) were roughly double the corresponding estimates for most low-income and middle-income countries. Characteristics of smokers varied within individual countries, and in relation to the World Bank's low-medium-high gradient of economic development. In stark contrast to a sturdy male-female difference in the uptake of smoking seen in each country, there is no consistent sex-associated pattern in the odds of remaining a smoker (versus quitting).

CONCLUSION

The World Mental Health Surveys estimates complement existing global tobacco monitoring efforts. The observed global diversity of associations with smoking and smoking cessation underscore reasons for implementation of the Framework Convention on Tobacco Control provisions and prompt local adaptation of prevention and control interventions.

Dietary habits in three Central and Eastern European countries: the HAPIEE study

BACKGROUND

The high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic.

METHODS

The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons.

RESULTS

Total energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake.

CONCLUSION

This first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.

Genetik der androgenetischen Alopezie

Die androgenetische Alopezie (AGA, erblich- bzw. hormonbedingter Haarausfall [MIM 109200; MIM 300710; MIM 612421]) ist die häufigste Form des Haarverlusts beim Menschen, wobei die Prävalenz stark altersabhängig ist. Im Alter von über 70 Jahren sind über 80% der europäischen Männer betroffen, bei Frauen liegt die AGA-Häufigkeit mit 30–40% deutlich niedriger. Die AGA führt, v. a. bei betroffenen Frauen, zu einer erheblichen psychologischen Belastung und entfaltet dabei Krankheitswert. Der Haarverlust geht auf einen veränderten Haarzyklus und eine Miniaturisierung des Haarfollikels zurück. Die Pathogenese ist androgenabhängig, und die genetische Anlage ist wesentliche Voraussetzung für den Phänotyp. In mehreren Studien konnten der Androgenrezeptor-/Ektodysplasin-A2-Rezeptor(EDA2R)-Locus auf dem X-Chromosom als stärkster beitragender Faktor und durch genomweite Assoziationsuntersuchungen ein weiterer Locus auf Chromosom 20p11 identifiziert werden. Das zum Assoziationssignal nächstgelegene in der Kopfhaut exprimierte Gen ist „paired box 1“ (PAX1). Zwischen PAX1 und dem Androgensignalweg gibt es keine offensichtliche Verbindung, jedoch sind die dem Assoziationssignal auf Chromosom 20p11 zugrunde liegenden pathophysiologischen Prozesse noch nicht geklärt. Bis heute ermöglichen die zur Verfügung stehenden medikamentösen Therapien der AGA bestenfalls ein Aufhalten des Haarverlusts. Mit der Identifizierung der AGA-assoziierten Gene und der Aufklärung ihrer Funktionen wird man die biologischen Ursachen der AGA schrittweise erschließen. Damit ist die Hoffnung auf die Entwicklung neuer Therapien verbunden.

Roles, perceptions and control of infant feeding among low-income fathers

OBJECTIVE

Introduction of solid foods before the recommended age of 4-6 months is a common practice in the USA, and appears to be especially prevalent among infants who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Currently, little is known about how fathers influence early infant feeding decisions, outside the decision to breast- or formula-feed. The purpose of the current study was to explore how fathers perceive the role they play in feeding and caring for their infants.

DESIGN

Participants were twenty-one male caregivers, who were fathers or partners of the mothers of WIC income-eligible infants residing in two rural East Tennessee counties. In-depth, audio-taped telephone interviews were completed. Interviews were transcribed, coded and analysed according to standard grounded theory procedures to identify emergent concepts. These concepts were explored and linked together to become themes.

RESULTS

Three themes emerged: (i) fathers' roles; (ii) fathers' perceptions; and (iii) control. Concepts within the theme of fathers' roles included physical and emotional support for both mother and infant, validation of maternal decisions, and financial support. In the present study, fathers' perceptions were primarily shaped by their own experiences, advice from those with experience, and information sought by the fathers. The theme of control appears to be the linkage between the fathers' attempts to modify infant behaviour and infants' response.

CONCLUSIONS

A final conceptual model was created to explain the interrelated nature of the themes and may be helpful to those who work with fathers and/or families of new infants.

Immunosuppressive cytokine Interleukin-10 (IL-10) is up-regulated in high-grade CIN but not associated with high-risk human papillomavirus (HPV) at baseline, outcomes of HR-HPV infections or incident CIN in the LAMS cohort

Bypassing the local immunological defense reactions in the cervix is one of the prerequisites for human papillomaviruses (HPV) infections to progress to intraepithelial neoplasia (CIN). The role of potent immunosuppressive cytokines, e.g., interleukin-10 (IL-10), depressing these local virus-specific immunological responses is incompletely studied. To assess, whether IL-10 expression in cervical HPV lesions has any implications in the outcome of HPV infections or disease progression to CIN. Baseline cervical biopsies from 225 women of the LAMS study sub-cohort were analyzed for IL-10 expression using immunohistochemistry, to assess its associations with CIN grade, and high-risk HPV (HR-HPV) at baseline, as well as in predicting outcomes of HR-HPV infections, and development of incident CIN1+ and CIN2+ in this longitudinal setting. Expression of IL-10 in cervical lesions was up-regulated most often in high-grade CIN, and IL-10 over-expression retained its value as independent predictor of CIN2+ (odds ratio (OR) = 4.92) and CIN3+ (OR = 7.51) also in multivariate model, including HR-HPV and several known covariates of IL-10 expression. Up-regulation was not related to HR-HPV detection, and showed no relationship to HR-HPV viral loads. Using longitudinal predictive indicators (SE, SP, PPV, NPV), IL-10 expression was of no value in predicting (1) the outcomes of HR-HPV infections, or (2) the surrogate endpoints (incident CIN1+, CIN2+) of progressive disease. IL-10 over-expression (along with HR-HPV) was one of the independent covariates of CIN2/3. This immunosuppressive cytokine might play an important role in creating a microenvironment that favors progressive cervical disease and immune evasion by HR-HPV.