Impact of age on the prevalence of poor-quality dietary variety, associated lifestyle factors, and body composition profile (low body muscle mass and high body fat mass) in older people residing in Colombo district, Sri Lanka

Aims

To assess the impact of age on the prevalence of poor-quality dietary variety, associated lifestyle factors, and body composition profile (low body muscle mass and high-fat mass) in older Sri Lankans.

Methods

In this population-based cross-sectional study, older people of 60 years or above were selected using a multistage cluster sampling technique probability proportionate to the size. They were classified into 3 groups; 60-64, 65-69 and > 70-years. The poor-quality dietary variety was defined based on food variety, dietary diversity and dietary serving scores assessed using 24-h dietary recall. Body composition was measured using bio-electrical impedance. The impact of age on determinants of poor-quality dietary variety and being at risk of low muscle mass and high-fat mass were assessed by using multivariable logistic regression models.

Results

Eight hundred older participants with a mean (SD) 68.1(5.8) years were included. There were 28.4%(n = 227), 36.2%(n = 290) and 35.4%(n = 283) in the 60-64, 65-69 and ≥ 70-year age groups, respectively. The prevalence of poor-quality dietary variety was similar across age groups. The urban living environment, and getting nutritional advice from the GP/hospital were found to have a significant negative association only in the 60-64 age group. A poor-quality dietary variety was significantly associated with no education or up to the primary level in the 65-69 age group and having diabetes or hypertension in the ≥70-year group. Odds of low muscle mass and high-fat mass were 2.43(1.46-4.03) and 2.17(1.30-3.63) respectively among the≥70-year age group compared to the 60-64-year group, after controlling for confounders.

Conclusions

The prevalence of poor-quality dietary variety was similarly high in all age groups. Increasing age was associated with higher odds of low body muscle and high body fat mass despite similar dietary variety, indicating the need for special dietary attention.

Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis

BACKGROUND

Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population.

OBJECTIVES

To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s).

DESIGN

Systematic review and meta-analysis.

SETTING(S)

Nursing homes, aged care, or long-term care facilities.

PARTICIPANTS

Older people, 60 years and older.

METHODS

Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression.

RESULTS

3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection.

CONCLUSION

The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries.

REGISTRATION NUMBER

PROSPERO CRD42022328367.

TWEETABLE ABSTRACT

Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.

Prevalence and Distribution of Known Associated Factors of Burnout among Military Personnel of Sri Lanka Army: A Descriptive Cross-Sectional Study

INTRODUCTION

Burnout is a psychological condition that has a detrimental effect on occupational and mental health. The military is a known community that is vulnerable to burnout. Burnout risk may have increased over the past 10 years due to the accumulation of recognized burnout correlates in the Sri Lankan military context. Sri Lanka Army is acknowledged as the country's main defense force to combat any impending threat. Therefore, it is crucial to recognize and control mental health issues like burnout. This study aims to describe the prevalence and distribution of recognized factors associated with burnout among Sri Lankan Army soldiers.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted among 1692 Army personnel to describe the known associated factor profile and prevalence of burnout. The multistage sampling method that contained random, cluster, and systematic sampling steps was used. Validated Maslach burnout inventory-General Survey (MBI-GS) Sinhala version, Coping Orientation to Problems Experienced Inventory (Brief-COPE), and a structured questionnaire on associated factors of burnout were included in a self-administered questionnaire. Sizes of each associated variable were calculated as frequency and percentage. Relevant central tendencies (mean or median) and distributions (confidence interval or interquartile range) of important variables were calculated. Crude and adjusted prevalence was calculated using validity properties obtained from prior criterion validity assessment.

RESULTS

The response rate was 94% (n = 1490). The mean age was 30.7 (SD ± 6.23) years. The female participant percentage was 9.4% (n = 149). Half of participants (n = 813, 51.1%) were Lance corporals and Corporals. Nearly 80% (n = 1324, 83.2%) of study population gets less than Sri Lankan Rupees (SLR) 50,000 as final monthly salary, and three-fourth (n = 1187, 74.7%) did not have money savings. Faced difficulty because of resource deficiency (n = 1099, 69.1%), poor job control (n = 669, 42.1%), job ambiguity (n = 869, 55%), intention to leave (n = 842, 53%), and history of been absent (n = 298, 18.7%) were found to be much prevalent. The crude prevalence of probable burnout among military personnel of Sri Lanka Army was estimated to be 28% (95% CI, 23.13-32.87), and the adjusted prevalence of burnout was 23.2% (95% CI, 18.9-27.5).

CONCLUSION

High prevalence and high density of known associated factors of burnout would adversely influence the achievement of organizational goals of Sri Lanka Army. Early attention and proper action are strongly recommended.

Serological Evidence of Zika virus Circulation with Dengue and Chikungunya Infections in Sri Lanka from 2017

Introduction

Arbovirus diseases remain a public health threat in Sri Lanka. Dengue is endemic and two outbreaks of chikungunya infections have been reported. There is limited data on Zika virus (ZIKV) infections in Sri Lanka, and this could be due to a lack of comprehensive ZIKV surveillance. Our aim was to determine the presence of antibodies to dengue, chikungunya, and Zika infections in adults from a suburban population in Sri Lanka.

Methods

A total of 149 healthy adult volunteers over 18 years of age (mean age: 43±14 years, males - 43%), with no prior diagnosed arboviral infections and no history of overseas travel, participated in the study. ELISA and neutralization assays were carried out to detect past dengue, chikungunya, or Zika infections.

Results

A total of 94.6% (141/149) of the participants demonstrated dengue IgG antibodies, 37.5% (56/149) were positive for chikungunya IgG, and 5.3% (8/149) were positive for anti-ZIKV IgG antibodies. Neutralization assays confirmed ZIKV-specific antibodies in 6.7% (10/149), when 40/149 of the participating population were tested.

Conclusion

This clearly demonstrated past ZIKV infections in this population. In addition, this study indicates that >90% of individuals had asymptomatic dengue but no serious symptoms. These results provide a cross-sectional view on the DENV, ZIKV, and CHIKV epidemic status and demonstrate a need for the implementation of enhanced surveillance and more effective measures against the spread of these arbovirus diseases.

Education Intervention Has the Potential to Improve Short-Term Dietary Pattern among Older Adults with Undernutrition

Low-cost educational interventions to improve dietary pattern is a pragmatic solution to prevent undernutrition in low- and middle-income countries. A prospective nutritional education intervention was conducted among older adults aged 60 years or above with undernutrition with 60 people in each intervention and control group. The objective was to develop and evaluate the efficacy of a community-based nutrition education intervention to improve the dietary pattern of older adults with undernutrition in Sri Lanka. The intervention consisted of two modules to improve the diversity, the variety of diet, and the serving sizes of food consumed. The primary outcome was the improvement of the Dietary Diversity Score (DDS) and the secondary outcomes were the Food Variety Score and Dietary Serving Score, which was assessed using the 24 h dietary recall. The mean difference in scores between the two groups was compared using the independent sample t-test at baseline, two weeks and three months post-intervention. Baseline characteristics were comparable. After two weeks, only the difference in DDS between the two groups was statistically significant (p = 0.002). However, this was not sustained at three months (p = 0.08). This study concludes that nutrition education interventions have the potential for short-term improvement in dietary patterns in older adults in a Sri Lanka setting.

Health seeking behaviours, dengue prevention behaviours and community capacity for sustainable dengue prevention in a highly dengue endemic area, Sri Lanka

INTRODUCTION

Dengue has become a major health problem in globally as well as locally. The delay in health-seeking is significantly associated with complications leading to severe dengue and active engagement of communities needs to minimize the delays in management to control epidemics. The aim of the study was to evaluate the relationship between sociodemographic characteristics and householders' Health-Seeking Behaviours (HSB), Dengue-Prevention Behaviours (DPB), and Community Capacities (CC) for sustained dengue prevention in Sri Lanka, a country with a high dengue endemicity.

METHODS

A cross-sectional analytical study was carried out in a district with the highest dengue endemicity from January to April 2019. Of the householders, 532 were chosen randomly. A pre-tested, validated, and interviewer-administered questionnaire was used to assess HSB and DPB. The HSB was assessed using three aspects, initial response for fever management, the duration of blood testing and initial response if suspected dengue. The DPB assessment was evaluated using 'waste, outdoor water container, indoor water container, roof gutter and water storage management'. 'Dengue Community Capacity Assessment Tool', with 14 key items was used to assess the level of community capacity for dengue prevention. Out of the total, ≥ 50% was considered as an "adequate" HSB, DPB and CC. Multiple logistic regression was performed to control confounding effects. The results were expressed as adjusted Odds-Ratios (aOR) and 95% Confidence Intervals (CI).

RESULTS

The response rate was 93.2% (n = 496). Among them, 44.6% (n = 221) had adequate overall HSB, and 19.2% (n = 95) had adequate DPB. Householders who have ≤ 4 family members are 1.74 times (aOR = 1.74; 95% CI: 1.17 - 2.61) more likely to have adequate HSB and 1.85 times (aOR = 1.85; 95% CI: 1.11 - 3.09) more likely to have adequate DPB. The age group of 46 to 70 years' individuals (aOR = 1.74; 95% CI:1.12 - 2.92), and who engaged in employment (aOR = 1.68; 95% CI: 1.05 - 2.67) were more likely to have adequate DPB than the group of 18 to 45 years and the non-employed individuals respectively. Of them, 24.6% (n = 122) perceived that they have adequate CC. The householders who have per-capita income < USD 50 are 1.95 times (aOR = 1.95; 95%CI:1.11 - 3.40) more likely to have adequate CC.

CONCLUSION

The HSB, DPB and CC need to be improved to change the behaviour for sustainable dengue prevention and community capacity-building programmes need to be conducted in the Kurunegala district, Sri Lanka.

The impact of peer-led support groups on health-related quality of life, coping skills and depressive symptomatology for women with PCOS

Support groups can be a powerful medium in providing psychological support to women with Polycystic Ovary Syndrome (PCOS). The study evaluated the impact of peer support group on Health-Related Quality of Life (HRQoL), depressive symptomatology and coping strategies among women with PCOS. The pre- and post-test experimental design was used. Women with PCOS not receiving psychiatric medication and attending clinics of a teaching hospital in Colombo were recruited. They were randomly allocated based on clinic days to the experimental (n = 20) and control (n = 22) groups. The Intervention group participated in the specific peer support program for 10 weeks, while the control group received general health reading material for 10 weeks through the post. The Modified Polycystic Ovary Syndrome Questionnaire (M-PCOSQ), Centre for Epidemiologic Studies Depression Scale (CES-D) and Brief COPE inventory were administered to both groups before and 1 month after completing the intervention. Before the intervention, there was no significant difference between the two groups regarding the scores of HRQoL, depressive symptomatology and coping skills. One month after the intervention, the support group exhibited improvement in HRQoL, depressive symptomatology and coping skills (p < 0.01) compared to the control group. The peer support group is an effective intervention to uplift the psycho-social wellbeing of women with PCOS through receiving emotional support from those similarly afflicted.

Incidence management system of the healthcare institutions for disaster management in Sri Lanka

BACKGROUND

Incident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May-September 2019 using a validated interviewer administered questionnaire which was based on 'CO-S-TR Model' for ICS assessment including 'Clear need for increased capacity (≤25%), Basic level (26 - 50%), Moderate level (51 - 75%) and High level (>75%)'.

RESULTS

Focal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of 'staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation'. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management.

CONCLUSION

Coordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.

Determinants of Undernutrition and Associated Factors of Low Muscle Mass and High Fat Mass among Older Men and Women in the Colombo District of Sri Lanka

Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity.

Sinhala translation of the Perinatal Anxiety Screening Scale: a valid and reliable tool to detect anxiety disorders among antenatal women

BACKGROUND

Anxiety disorders during pregnancy are not routinely assessed in Sri Lanka despite being common and being associated with adverse pregnancy outcomes. Screening can facilitate early detection and management of anxiety and improve pregnancy outcomes. Our aim was to determine the validity of the Sinhala translation of the Perinatal Anxiety Screening Scale (PASS) to detect anxiety among Sri Lankan pregnant women.

METHODS

A cross-sectional study was conducted in antenatal clinics of a teaching hospital in Colombo District. The PASS was translated to Sinhala using the standard translation/ back-translation method. Pregnant women (n = 221) were sequentially recruited and assessed by a psychiatrist until 81 women with anxiety disorder were diagnosed using the International Classification of Diseases-10 criteria (gold standard). The Sinhala translation of the PASS (PASS-S) was administered to all recruited women, including 140 women without anxiety. Receiver-Operating- Characteristic (ROC) analysis was performed, the optimal cut-off score for PASS-S was determined, and its validity was assessed using sensitivity, specificity, predictive values and positive and negative likelihood ratios. Internal consistency was assessed using Cronbach's alpha. Test-retest and inter-rater reliability for PASS-S score and anxiety classification were assessed using intra class correlation coefficient (ICC) and Cohen's kappa (k), respectively.

RESULTS

The mean age (±SD) of women was 30(±5.8) years, and 53.7% were multiparous. A psychiatrist diagnosed anxiety disorder was made in 37.0% of women, while the PASS-S, at its optimal cut-off of ≥20, classified 37.5% of women as having anxiety disorders. The area under the ROC curve for the PASS-S was 0.96 (95%CI 0.94-0.99). Sensitivity, specificity and positive and negative predictive values of the PASS-S were 0.93 (95% CI 0.84-0.97), 0.90 (95% CI 0.83-0.94), 0.85 (95% CI 0.75-0.90) and 0.95 (95% CI 0.89-0.98), respectively. Positive and negative likelihood ratios were 8.8 (95% CI 5.3-14.5) and 0.08 (95%CI 0.04-0.18), respectively, and the internal consistency was high (Cronbach's alpha 0.95). Four-factor structures obtained by exploratory factor analysis were "acute anxiety and adjustment", "social anxiety, specific fears and trauma", "perfectionism and control" and "general anxiety".Test-retest reliability was high for the PASS-S score (ICC 0.85[95% CI 0.65-0.96]) and anxiety classification (k 0.77[95% CI 0.34-1.2]). Inter-interviewer reliability was also high (ICC 0.92[95% CI 0.81-0.97] for the PASS-S score and (k0.86 [95% CI 0.59-1.1] for anxiety classification).

CONCLUSION

The Sinhala translation of the PASS is a valid and reliable instrument to screen for anxiety disorders among antenatal women in Sri Lanka.

'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus

Background

‘Screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START)’ criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka.

Method

Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka.

Results

Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country.

Conclusion

A list of ‘Modified STOPP/START criteria for Sri Lanka’ was developed. These criteria are currently being validated through a multi-centre study.

Sero-prevalence of virus neutralizing antibodies for rabies in different groups of dogs following vaccination

Background

Mass vaccination of dogs is considered fundamental for national rabies control programmes in Sri Lanka, as dog is the main reservoir and transmitter of the disease.

Methods

Dogs were followed to determine the sero-prevalence of antibodies to the rabies virus. Altogether 510 previously vaccinated and unvaccinated dogs with owners (domestic dogs) and dogs without owners (stray dogs) of the local guard dog breed in different age groups recruited from Kalutara District, Sri Lanka. The dogs were vaccinated with a monovalent inactivated vaccine intramuscularly and serum antibody titres on days 0, 30, 180 and 360 were determined by the Rapid Fluorescent Focus Inhibition Test (RFFIT).

Results

The results indicated, a single dose of anti-rabies vaccination fails to generate a protective level of immunity (0.5 IU/ml) which lasts until 1 year in 40.42% of dogs without owners and 57.14% of previously unvaccinated juvenile (age: 3 months to 1 year) dogs with owners. More than one vaccination would help to maintain antibody titres above the protective level in the majority of dogs. The pattern of antibody titre development in annually vaccinated and irregularly vaccinated (not annual) adult dogs with owners is closely similar irrespective of regularity in vaccination. Previously vaccinated animals have higher (2 IU/ml) antibody titres to begin with and have a higher antibody titre on day 360 too. They show a very good antibody titre by day 180. Unvaccinated animals start with low antibody titre and return to low titres by day 360, but have a satisfactory antibody titre by day 180.

Conclusions

A single dose of anti-rabies vaccination is not sufficient for the maintenance of antibody titres for a period of 1 year in puppies, juvenile dogs with owners and in dogs without owners. Maternal antibodies do not provide adequate protection to puppies of previously vaccinated dams and puppies of previously unvaccinated dams. Immunity development after vaccination seems to be closely similar in both the groups of puppies.

Molecular detection and partial characterization of Tomato Yellow Leaf Curl Virus in Sri Lanka

Tomato Yellow Leaf Curl Virus (TYLCV) is an important plant virus on one of the economically most important vegetable crops; tomato (Lycopersicon esculentum Mill.). This had not been molecularly detected before, in Sri Lanka. TYLCV-GN-SL was isolated from apparently infected tomato plants using modified Cetyltrimethyl Ammonium Bromide (CTAB) method in Gannoruwa. Associated Begomoviruses were detected using Deng 541/Deng 540 and AV 494/AC 1048 primer pairs. TYLCV was detected for the first time in tomato in Sri Lanka using P1V/P4C, TYLCV specific primer pair. Nucleotide sequence of coat protein of isolated TYLCV-GN-SL proved that the Indian strain of ToLC virus was closely related to Tomato Leaf Curl Sri Lanka Virus (TLCV-SL: 97%) and Tomato leaf curl Geminivirus (TLCGV: 93%) through direct sequencing data. TLCV-SL was confirmed as TYLCV isolate. TYLCV was molecularly detected from major tomato growing districts like Badulla, Nuwara-Eliya, Kandy and Matale in Sri Lanka.

Processes involved in assisted reproduction technologies significantly increase sperm DNA fragmentation and phosphatidylserine translocation

Sperm preparation techniques in assisted reproduction technologies (ART) are potential generators of exogenous stresses that cause additional DNA damage. DNA fragmentation tests, such as the sperm chromatin structure assay, involve freezing sperm samples in the absence of cryoprotectant. Thermal, oxidative stress (OS) and freezing are detrimental to sperm DNA fragmentation and phosphatidylserine (PS) translocation. The primary aim of this study was to subject mature sperm to environmental insults that normally occur during ART. We tested the hypotheses that OS, thermal stress and freeze-thawing caused sperm nuclear and membrane damage and that a positive correlation exists between PS translocation and DNA fragmentation. Sperm DNA integrity deteriorates in semen samples from men with advancing age and a sperm concentration of <15 m ml(-1) . The significant increase in sperm DNA fragmentation at 37 °C after merely 1 h is important clinically as semen liquefaction and short-term sperm storage in an ART cycle involve incubating samples at this temperature. Freezing without a cryoprotectant significantly increases the level of sperm nuclear damage, so it is important not to freeze neat semen prior to DNA fragmentation testing. This study highlights the importance of minimising the production of exogenous stresses during sperm preparation in ART.

Breast-feeding and atopic disease: a cohort study from childhood to middle age

BACKGROUND

The literature regarding the association between breast-feeding and atopic diseases has been contradictory.

OBJECTIVE

We have assessed the relationship between breast-feeding and atopic disorders in a cohort followed into middle age.

METHODS

The Tasmanian Asthma Study is a population-based prospective cohort study that has followed participants from the age of 7 to 44 years. Exclusive breast-feeding in the first 3 months of life was examined as a risk factor for atopic diseases by using multiple logistic regression and generalized estimating equation analyses.

RESULTS

At age 7 years, exclusively breast-fed children with a maternal history of atopy had a marginally lesser risk of current asthma than those not exclusively breast-fed (odds ratio [OR], 0.8; 95% CI, 0.6-1.0). However, after age 7 years, the risk reversed, and exclusively breast-fed children had an increased risk of current asthma at 14 (OR, 1.46; 95% CI, 1.02-2.07), 32 (OR, 1.84; 95% CI, 1.06-3.3), and 44 (OR, 1.57; 95% CI, 1.15-2.14) years. Exclusively breast-fed children also had a reduced risk of food allergy at age 7 years but an increased risk of food allergy (OR, 1.26; 95% CI, 1.1-1.5) and allergic rhinitis (OR, 1.2; 95% CI, 1.0-1.3) at 44 years.

CONCLUSION

Exclusively breast-fed babies with a maternal history of atopy were less likely to develop asthma before the age of 7 years, but more likely to develop asthma after the age of 7 years.

CLINICAL IMPLICATIONS

The current recommendation to breast-feed high-risk infants for protection against early wheezing illness can be confirmed. However, the recommendation should be reconsidered for protection against allergic asthma and atopy in the longer term.