Marine phytoplankton community data and corresponding environmental properties from eastern Norway, 1896-2020

Time series are essential for studying the long-term effects of human impact and climatic changes on the natural environment. Although data exist, no long-term phytoplankton dataset for the Norwegian coastal area has been compiled and made publicly available in a standardised format. Here we report on a compilation of phytoplankton data from inner Oslofjorden going back more than a century. The database contains 605 sampling events from 1896 to 2020, and environmental data has also been provided when available. Although the sampling frequency has varied over time, the high taxonomic quality and relatively similar methodology make it very useful. For the last 15 years (2006-2020), the sampling frequency has been almost monthly throughout the year. This dataset can be used for time series analysis to understand community structure and changes over time. It can also be used to study common taxa' responses to environmental variables and changes, seasonal or annual species diversity and be useful for developing ecological indicators.

Line ferries and cargo ships for the monitoring of marine contaminants of emerging concern: Application along a Europe-Arctic transect

Contaminants of emerging concern (CEC) are a focus in marine protection. Several CECs are released with wastewater effluents to coastal environments and their offshore occurrence has been recently documented. Routine monitoring is key for implementing marine protection acts, however infrastructural, financial, and technical limitations hinder this task along broad spatial transects. Here we show the efficacy of a new infrastructure enabling unmanned sampling of surface water from ships of opportunity in providing reliable and cost-effective routine monitoring of CECs along a Europe-Arctic transect. The distribution and long-range transport of several pharmaceuticals and personal care products, artificial food additives, and stimulants were assessed. Validation of operations through strict procedural and analytical quality criteria is presented. A framework to estimate a compound-specific spatial range (SR) index of marine long-range transport based on monitoring results and information on source spatial distribution, is introduced. Estimated SR values ranged 50-350 km depending on compound, yielding a ranking of long-range transport potential which reflected expectations based on degradation half-lives. SR values were used to calculate prior maps of detection probability that can be used to plan future routine monitoring in the region.

Autonomous Surface and Underwater Vehicles as Effective Ecosystem Monitoring and Research Platforms in the Arctic-The Glider Project

Effective ocean management requires integrated and sustainable ocean observing systems enabling us to map and understand ecosystem properties and the effects of human activities. Autonomous subsurface and surface vehicles, here collectively referred to as “gliders”, are part of such ocean observing systems providing high spatiotemporal resolution. In this paper, we present some of the results achieved through the project “Unmanned ocean vehicles, a flexible and cost-efficient offshore monitoring and data management approach—GLIDER”. In this project, three autonomous surface and underwater vehicles were deployed along the Lofoten–Vesterålen (LoVe) shelf-slope-oceanic system, in Arctic Norway. The aim of this effort was to test whether gliders equipped with novel sensors could effectively perform ecosystem surveys by recording physical, biogeochemical, and biological data simultaneously. From March to September 2018, a period of high biological activity in the area, the gliders were able to record a set of environmental parameters, including temperature, salinity, and oxygen, map the spatiotemporal distribution of zooplankton, and record cetacean vocalizations and anthropogenic noise. A subset of these parameters was effectively employed in near-real-time data assimilative ocean circulation models, improving their local predictive skills. The results presented here demonstrate that autonomous gliders can be effective long-term, remote, noninvasive ecosystem monitoring and research platforms capable of operating in high-latitude marine ecosystems. Accordingly, these platforms can record high-quality baseline environmental data in areas where extractive activities are planned and provide much-needed information for operational and management purposes.

Scoping health literacy in Latin America

Studies evaluating the influence of health literacy on patient behavior and outcomes suggest a positive relationship between health literacy and health knowledge, health behaviors, and health status. In Latin American countries, studies assessing health literacy are few, regional, and demonstrate considerable variation, with reported rates of adequate health literacy ranging from 5.0% to 73.3%. In this paper, we examine and explore the state of health literacy and efforts to promote it in Latin America. Key challenges to those efforts include socioeconomic inequality, social/geographic isolation, and cultural-, language-, and policy-related barriers, many of which disproportionately affect indigenous populations and others living in rural areas. Greater use of infographics, videos, and mobile apps may enhance health literacy and patient empowerment, especially when language barriers exist. This paper provides strategies and tools for tailored programming, examples of successful health literacy interventions, and policy recommendations to improve health literacy in Latin America, intending to spur additional discussion and action. Centrally organized collaboration across multiple sectors of society, with community involvement, will enhance health literacy and improve health and well-being across Latin America.

WHO Working Group on Health Literacy in Schools

Background

Addressing children`s and adolescents` health literacy is a bedrock for personal and societal growth, health and wellbeing over the life-course, and sustainable development in the WHO European Region and beyond. Promoting health literacy competencies should already be addressed in schools. To outline a strategy for the national education sectors, WHO Europe has launched a working group on health literacy in schools, which aims to develop a conceptual framework for decision makers within the educational and health sector to advocate for health literacy, facilitate the implementation process, and support the uptake on the national level.

Methods

Based on expert workshops and meetings, literature and document analyses and discussions, this working group has developed a concept note on health literacy addressing the education sector of the WHO member states.

Results

This work is linking health literacy in schools with the wider WHO health literacy strategy. Emphasis is placed on the critical role of the education sector and the necessary resources to implement action in schools. In addition, this report provides curriculum examples from Member States and key health literacy learning objectives. This includes an action agenda in order to implement monitoring and surveillance of health literacy in schools. The concept paper acknowledges the large variation in the level and organizational structure of the school health services among the 53 regional Member States.

Conclusions

This report highlights the reason why health literacy of children and adolescents should be addressed as early as in schools. It outlines the available evidence on children and adolescent`s health literacy and the challenges the Member States might face when they aim at addressing health literacy in the education sector and schools. The report should help policy and decision makers to implement health literacy in their countries taking into consideration the importance of adapting to local contexts.

Expert Recommendations for Health Literacy Policies addressing Children and Adolescents

Background

There is an on-going and a well observable uptake of health literacy in the national and international agenda-setting pertaining to the development of new policy strategies to address the issue of promoting health literacy in whole societies. Therefore, the aim of this research is to analyse those policies on how they address children and develop recommendations for future policies.

Methods

Policy documents on national levels, published by February 2019 were retrieved using a two-pronged strategy: (1) systematic review methods (database and online search) and (2) expert consultation. Based on a SWOT analysis of these policies, an interview guide was developed and policy experts (N = 63) from 46 countries across the world were interviewed. Based on the qualitative analysis, a Delphi Study was developed to gather expert comments and validation.

Results

The search has identified 26 policies in 19 countries including case-laws and enacted statues, governmental strategies, polices driven by national key experts, and educational policies. The content of these informed the interview guide. The initial analysis of the interviews led to several recommendations pertaining to schools and the education sector, including principals, teachers and whole-school approaches, characteristics of different settings, such as policy, education and administration, economic perspectives, and the need for research and evidence in order to inform future strategies.

Conclusions

The results will be compiled into a recommendation report and a policy brief. In addition, those will be translated into other languages to share with the countries of the experts who participated in this project. While almost all policies address children somehow, several limitations make it difficult to evaluate the quality of the different policies. To secure and sustain more effective, child-focused policies, current knowledge gaps regarding research on children`s health literacy should be addressed.

Psychometric properties of the Danish version of the European Health Literacy Survey Questionnaire

Background

Understanding and utilizing health information has become increasingly demanding whereby people's health literacy becomes important. European Health Literacy Survey Questionnaire (HLS-EU-Q16) measures health literacy (HL). We aimed to study the psychometric properties of the Danish version in the general population and a population with coronary artery disease.

Methods

A national, cross-sectional survey of individuals from the general Danish population and patients with Myocardial Infarction (MI) was conducted. The general population sample consisted of 7,653 individuals. The MI sample of 4,440 individuals had previously been hospitalized with MI. To assess the influence of large sample sizes, we examined five randomly drawn subsamples of 500 from each population. The Rasch analysis was conducted using RUMM-2030 consisting of inspection of unidimensionality, local dependency, Differential item Functioning (DIF), and item fit.

Results

The results are preliminary and analyses still ongoing. The HLS-EU-Q16 did not fit the Rasch model, neither for the total sample, subsamples, the general population sample, nor for the MI sample.

For the MI sample, there were signs of local dependence and item 6 had the largest item misfit. DIF was observed for item 6 and 7 (age and gender). The general population sample also showed signs of local dependence, and item 1 indicated the largest item misfit. DIF was observed for item 1 (age) and item 1, 7, 8, 13 and 16 (gender).

Conclusions

The Danish version of HLS-EU-Q16 did not fit the Rasch model neither in the general population sample nor for the MI sample. Our large population-based study indicated scalability problems of the HLS-EU-Q16. The validation procedure is a step on the path to ensure the use of valid measures of HL in both populations and patient groups to support the raising awareness of HL as a necessary element to ensure equity in our health system and thereby initiating an urgent public health activity.

Key messages

We studied the construct validity of the Danish version of the European Health Literacy Survey Questionnaire HLS-EU-Q16 with a Rasch model. Our large population-based study indicate problems with the psychometric properties of the current Danish version of the HLS-EU-Q16.

WHO European Health Literacy Action Plan

Background

Grounded in the last decade's health literacy developments; the work of the European health literacy action networks on measurement and NCDs as well as the newly adopted European Health Literacy Roadmap and resolution agreed upon by their 53 Member States in 2019, the WHO European Region continues its investment in health literacy. A WHO European health literacy action plan is under development to be launched in 2021. The action plan implies concrete actions for Member States on how to develop health literate populations and societies.

Methods

Based on co-creation principles, the development of the action plan is conducted by stakeholders from a wide range of fields and disciplines. Lead by the WHO European Regional Office, the process includes an initial stakeholder meeting, iterative technical consultations with experts and the wider stakeholder community and Member State consultations. The analytical methods integrate a SWOT-analysis, future scenario thinking and long-sight action planning approaches as well as application of health literacy analytics.

Results

The results of the initial analytical steps will be presented such as the SWOT analysis, the future scenarios and associated recommendations on how to create health literate populations and societies in Europe. Additionally, the outline of the draft of the European health literacy action plan will be open for discussion and input.

Conclusions

Through an iterative process, the European health literacy action plan is co-produced by multiple actors through a series of consultations facilitating ownership and accountability. The European health literacy action plan can be an inspiration and a model for other world regions.

Developing the European Health Literacy Action Plan using a transformative future scenario planning approach

Background

The 53 Member States of the WHO European Region adopted in 2019 a health literacy roadmap and a resolution to develop an action plan to guide the work of the Member States. The development of the action plan builds on achievements regarding the EU funded European Health Literacy Survey and the WHO action networks on health literacy measurement and NCD related demonstration projects as well as the multiple national initiatives launched in the European region in the last decade.

Methods

Scenario planning is a methodology that uses the inherent human capacity for imagining futures to better understand the present regarding the development of a new strategy or action plan. In the kick-off phase of the development process of the health literacy action plan, a transformative future scenario planning approach was applied in combination with a SWOT analysis (strengths, weaknesses, opportunities, threats) of current achievements, challenges and gaps considering the development of health literate societies involving 50 experts from a wide range of sectors and disciplines. Additionally, an iterative process followed including technical consultations with experts in Europe in preparation for a governmental consultation.

Results

The SWOT analysis, long-sight planning and generation of complementary concrete actions served as basis for the development of the action plan highlighting its relevance, sustainability and accountability. Additionally, the health literacy plan was developed in a process of co-creation with the wider health literacy community as well as stakeholders with multiple backgrounds in research, policy, education and practice.

Conclusions

The European health literacy action plan is multi-sectoral, people-centred and targeted governmental actions with the aim of developing health literate societies and populations. It can serve as a model for other world regions to adapt.

Comprehensive health literacy in general populations – An international comparison

Background

The HLS-EU study in 2011 demonstrated for 8 EU Member States that there exists limited comprehensive health literacy for considerable proportions of the general population, that there is a social gradient for health literacy and that limited health literacy has problematic consequences for healthy lifestyles, self-reported health and utilization of professional health services. It was also shown that distributions and associations of health literacy differ considerable between countries. WHO-Europe started the Acton Network on Measuring Population and Organizational Health Literacy (M-POHL) to measure health literacy regularly with the Health Literacy Survey 2019 (HLS19).

Methods

Based on the design and instrument of the HLS-EU study (to allow comparisons for countries participating in both surveys) a core questionnaire was developed for measuring comprehensive health literacy and its relevant correlates. Optional packages were created to measure, among others, digital health literacy and its most relevant correlates. Data were collected from probability samples of at least 1.000 respondents per country for the general population 18+ by personal interviews, telephone interviews or internet surveys in at least 15 member states of the WHO-Europe region.

Results

Distributions for indices, scales and levels of comprehensive health literacy will be presented as well as correlations and regressions for associations of health literacy with social determinants and with consequences for selected life style indicators, indicators for self-reported health and use of professional health care services.

Conclusions

Preliminary results show that the general trends of the HLS-EU study concerning health literacy hold true for HLS19 and that there are considerable differences between participating countries. Health literacy is relevant for health policy in all countries, but to understand the differences between countries a more detailed analysis is necessary.

A National Position Paper: Health Literacy from a Structural Perspective-A path to equity in health?

Background

Health literacy (HL) as an enabler of health equity and health promotion. HL is closely linked to other social determinants of health such as age, sex, education, social status and ethnicity. HL responsiveness is the degree to which systems or organizations make it easier for people to navigate, understand, and use information and services. HL can be enhanced through individual support, by targeting the responsiveness of the health professional workforce, or by taking a structural or organizational HL perspective.

Methods

In Denmark, the HL Network, which is part of Danish Society for Public Health, developed a position paper for approaching HL from a structural level. In 2018-2019 a rapid literature review was conducted followed by three different methodologies: (i) stakeholder meetings, (ii) expert interviews (policy, practice, research) and (iii) thematic meeting focusing on different dimension of the initial recommendation for the position paper, which was published at the National Conference for Public Health.

Results

In the position paper eight recommendations were developed to improve HL in Denmark from a structural perspective. The recommendations overall aim to prevent low HL and its consequences by targeting health services at the organizational level. The recommendations are: Integrate HL into Danish health policies and strategiesDevelop HL throughout the life courseInclude HL in health education curriculaIntegrate HL at organizational levelsIntegrate HL into partnership and co-creation processesMeasure and monitor HL using local and national dataDevelop, test and evaluate HL interventionsConsider HL in all forms of health communication

Conclusions

The recommendations can support the integration of a health literate thinking into current national health strategies, including the ongoing efforts to achieve the 17 UN Global SDGs, and thereby contribute to the equitable distribution of health in the Danish population.

Voice break in boys-temporal relations with other pubertal milestones and likely causal effects of BMI

STUDY QUESTION

How is timing of voice break related to other male pubertal milestones as well as to BMI?

SUMMARY ANSWER

We provide a comprehensive temporal analysis of male pubertal milestones, including reproductive hormone dynamics, confirm voice break as a late milestone of male puberty and report a likely causal relationship between higher BMI and earlier age at voice break in men.

WHAT IS KNOWN ALREADY

Voice break represents a late pubertal milestone and recalled age at voice break is frequently used in epidemiological studies as a measure of puberty. In contrast, clinical studies use mainly testicular enlargement and/or genital tanner stage as the marker of pubertal onset. However, neither correlation of pubertal milestones nor reproductive hormone dynamics have been assessed in detail previously. Further, although BMI and puberty timing are known to be closely linked, cause and effect between these traits are not known.

STUDY DESIGN, SIZE, DURATION

The study included a population-based mixed cross-sectional and longitudinal cohort (2006–2014, COPENHAGEN Puberty Study) of 730 healthy Danish boys. Data for 55 871 male research participants from the 23andMe study were obtained, including genome-wide single nucleotide polymorphism data and age at voice break.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We performed a detailed evaluation of pubertal milestones and reproductive hormone levels (study population 1). A Mendelian randomization (MR) approach was used to determine the likely causal link between BMI and timing of voice break (study population 2).

MAIN RESULTS AND THE ROLE OF CHANCE

Voice break occurred at mean age 13.6 (95% CI: 13.5–13.8) years. At voice break, mean (95% CI) testosterone levels, LH levels and bi-testicular volume were 10.9 (10.0–11.7) nmol/L, 2.4 (2.2–2.5) IU/L and 24 (23–25) mL, respectively. Voice break correlated moderately strongly with timing of male pubertal milestones, including testicular enlargement, gonadarche, pubarche, sweat odor, axillary hair growth and testosterone above limit of detection (r² range: 0.43–0.61). Timing of all milestones was negatively associated with age-specific BMI (all P ≤ 0.001). MR analyses inferred likely causal effects of higher BMI on earlier voice break in males (−0.35 years/approximate SD, P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

Participation rate of the population-based cohort was 25%. Further, boys that were followed longitudinally were examined approximately every 6 months limiting the time resolution of pubertal milestones. Using adult BMI as exposure instead of prepubertal BMI in the MR analysis and the known inaccuracies of the testosterone immunoassay at low testosterone levels may be further limitations.

WIDER IMPLICATIONS OF THE FINDINGS

We provide valuable normative data on the temporal relation of male pubertal milestones. Further, the likely causal relationship between BMI and puberty timing highlights the importance of preventing obesity in childhood.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by Danish Agency for Science, Technology and Innovation (09-067 180); Danish Ministry of the Environment, CeHoS (MST-621-00 065); Capital Region of Denmark (R129-A3966); Ministry of Higher Education and Science (DFF-1331-00 113); Innovation Fund Denmark (InnovationsFonden, 14-2013-4); The International Center for Research and Research Training in Endocrine Disrupting Effects of Male Reproduction and Child Health. B.H., F.R.D., J.R.B.P. and K.K.O. are supported by the Medical Research Council (MC_UU_12015/2). The 23andMe study is supported by the National Human Genome Research Institute of the National Institutes of Health (R44HG006981). Members of the 23andMe Research Team are employees of 23andMe, Inc. and hold stock or stock options in 23andMe.

TRIAL REGISTRATION NUMBER

NCT01411527

Gentoo penguins (Pygoscelis papua) react to underwater sounds

Marine mammals and diving birds face several physiological challenges under water, affecting their thermoregulation and locomotion as well as their sensory systems. Therefore, marine mammals have modified ears for improved underwater hearing. Underwater hearing in birds has been studied in a few species, but for the record-holding divers, such as penguins, there are no detailed data. We played underwater noise bursts to gentoo penguins (Pygoscelis papua) in a large tank at received sound pressure levels between 100 and 120 dB re 1 µPa RMS. The penguins showed a graded reaction to the noise bursts, ranging from no reactions at 100 dB to strong reactions in more than 60% of the playbacks at 120 dB re 1 µPa. The responses were always directed away from the sound source. The fact that penguins can detect and react to underwater stimuli may indicate that they make use of sound stimuli for orientation and prey detection during dives. Further, it suggests that penguins may be sensitive to anthropogenic noise, like many species of marine mammals.

Cancer literacy applied in national cancer control plans – from policy to strategic guidelines in the EU

Background

The study concerned a systematic analysis of National Cancer Control Plans (NCCPs) regarding cancer literacy. A national cancer control programme (NCCP) is a public health strategy designed to reduce cancer cases and improve quality of life of cancer patients. Cancer literacy is critically important for cancer patients who must make a complex set of diagnostic and treatment-based decisions at times of physical and emotional distress. Yet, it is unclear to what extent cancer literacy is reflected in cancer strategies such as the NCCPs.

Methods

The aim was to identify NCCPs from the EU to explore if health literacy or cancer literacy was included as a strategic priority. The NCCPs were retrieved in August to November 2018 from online portals as well as through key informants specialised in public health and health literacy.

Results

The data collection yielded 45 NCCPs of which 31 originated from the EU Member States. The document analysis revealed that six out of 45 NCCPs specifically included the term health literacy. The countries concern Austria, Belgium, Germany, Portugal, New Zealand and Maryland, the U.S. In addition, only one NCCP entailed the term ‘cancer literacý, namely the plan from Maryland focusing on ‘oral cancer literacý, specifically.

Discussion

Although, it is politically recognized that improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and population health the study of NCCPs revealed that ‘health literacy’ in general and ‘cancer literacý in particular, have not yet been commonly implemented as part of NCCPs. The countries who have actively mentioned health literacy, were all countries where health literacy is on the political health agenda in various ways.

Health literacy policy-making regarding children and adolescents

Background

There is an on-going and a well observable uptake of health literacy in the national and international agenda setting pertaining the development of new policy strategies to address the issue of promoting health literacy in whole societies. Even though children have been declared to be a priority target, no research is available that has analysed if and how children are addressed by these policy approaches. Therefore, the aim of this research is to analyse those policies on how they address children.

Methods

Policy documents on national levels that have been published by February 2019 were retrieved by using a two-pronged strategy comprising of (1) systematic review methods (database and online search) and (2) expert consultation.

Results

The search has identified 26 policies for 19 countries including case-laws and enacted statues, governmental strategies, polices driven by national key experts, and educational policies. No policies on children’s health literacy were found for South America and Africa. The policies differ in many ways, such as their embedding into general health policy making, policy and implementation processes, rationality and networks, and influence of governance. Children are either addressed by (1) specific programmes, (2) school health approaches, (3) their parents, (4) healthcare action, or (5) using a combination of those areas. However, there is almost no evaluation data available nor are these policies underpinned by health literacy evidence generated within the children`s population. Most policies are designed for adult populations rather than children.

Conclusions

Health literacy has developed into an important health policy-making target. While almost all policies address children somehow, several limitations make it difficult to evaluate the quality of the different policies. To secure and sustain more effective, child-focused policies, current knowledge gaps regarding research on children`s health literacy should be addressed.

Work stress, migration background and risk of long-term sickness absence in Denmark

Background

Work stress may increase risk of long-term sickness absence, but little is known if this association differs by migration background. In this study, we examined the prospective association between effort-reward imbalance at work and risk of long-term sickness absence in individuals with and without migration background in the Danish workforce.

Methods

We included 59,468 respondents from a nationwide survey on work and health, 3,226 with a migration background (immigrants or first generation descendants of immigrants) and 56,242 without a migration background. Effort-reward imbalance was assessed by self-report. Migration background and long-term sickness absence (spells ≥6 weeks) were assessed by national register data. Using Cox regression, we estimated the association between effort-reward imbalance and onset of long-term sickness absence during 12 months follow-up separately for participants with and without a migration background, adjusted for age, sex, education and previous long-term sickness absence.

Results

The effort-reward imbalance score at baseline was similar for respondents with and without a migration background. The hazard ratio for long-term sickness absence during follow-up per 1 standard deviation increment in effort-reward imbalance at baseline was 1.26 (95% CI: 1.16-1.37) and 1.16 (95% CI: 1.13-1.20) for respondents with and without a migration background, respectively.

Conclusions

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. Although the estimate was higher in workers with a migration background, confidence intervals overlapped indicating that associations were similar in both groups. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence should not be prioritized by migration background but should be offered to the whole workforce.

Key messages

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence activities should be offered to the whole workforce.

The advective origin of an under-ice spring bloom in the Arctic Ocean using multiple observational platforms

Under-ice blooms of phytoplankton in the Chukchi Sea have been observed, with strong implications for our understanding of the production regimes in the Arctic Ocean. Using a combination of satellite remote sensing of phytoplankton biomass, in situ observations under sea ice from an autonomous underwater vehicle (AUV), and in vivo photophysiology, we examined the composition, magnitude and origin of a bloom detected beneath the sea ice Northwest of Svalbard (Southern Yermak Plateau) in May 2010. In situ concentration of up to 20 mg chlorophyll a [Chl a] m⁻³, were dominated by the northern planktonic spring species of diatoms, Thalassiosira nordenskioeldii, T. antarctica var. borealis, Chaetoceros socialisspecies complex and Fragilariopsis oceanica. These species were also found south of the marginal ice zone (MIZ). Cells in the water column under the sea ice were typically high-light acclimated, with a mean light saturation index (E_k) of 138 μmol photons m⁻² s⁻¹ and a ratio between photoprotective carotenoids (PPC) and Chl a (w:w) of 0.2. Remotely sensed data of [Chl a] showed a 32,000 km² bloom developing south of the MIZ. In effect, our data suggest that the observed under-ice bloom was in fact a bloom developed in open waters south of the ice edge, and that a combination of northward-flowing water masses and southward drifting sea ice effectively positioned the bloom under the sea ice. This have implications for our general understanding of under-ice blooms, suggesting that their origin and connection with open water may be different in different regions of the Arctic.

Cryopreservation of ovarian tissue for fertility preservation in a large cohort of young girls: focus on pubertal development

STUDY QUESTION

Is there an association between the need for medical puberty induction and the diagnosis or treatment received in girls who have undergone cryopreservation of ovarian tissue for fertility preservation?

SUMMARY ANSWER

There was a clear association between the intensity of treatment received and requirement for medical puberty induction but no association with the diagnosis.

WHAT IS KNOWN ALREADY

Although it cannot be predicted which girls will become infertile or develop premature ovarian insufficiency (POI) following intensive chemotherapy or irradiation, patients who are at high risk of POI should be offered ovarian tissue cryopreservation (OTC). This includes girls who are planned to receive either high doses of alkylating agents, conditioning regimen before stem cell transplantation (SCT), total body irradiation (TBI) or high radiation doses to the craniospinal, abdominal or pelvic area.

STUDY DESIGN, SIZE, DURATION

This is a retrospective cohort study. In total, 176 Danish girls under 18 years of age have had OTC performed over a period of 15 years. An overview of the girls' diagnoses and mean age at OTC as well as the number of deceased is presented. Of the 176 girls, 38 had died and 46 girls were still younger than 12 years so their pubertal development cannot be evaluated yet. For the 60 girls who had OTC performed after 12 years of age, the incidence of POI was evaluated and in the group of 32 girls who were younger than 12 years at OTC, the association between the diagnosis and received treatment and the requirement for medical puberty induction was examined.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The need for medical puberty induction was assessed in 32 girls who were prepubertal at the time of OTC.

MAIN RESULTS AND THE ROLE OF CHANCE

Indications for OTC were allogeneic SCT for leukaemia, myelodysplastic syndrome or benign haematological disorders, autologous SCT for lymphoma or sarcoma, and irradiation to the pelvis or to the spinal axis. The mean age at OTC of the 176 girls were 11.3 years. The two most prevalent diagnoses of the 176 girls were malignant tumours and malignant haematological diseases. Among the 32 prepubertal girls, 12 received high dose chemotherapy and either TBI prior to SCT or irradiation to the pelvis, abdomen or the spinal axis, 13 received high dose alkylating agents but no irradiation prior to SCT, six received alkylating agents as part of conventional chemotherapy and one patient had a genetic metabolic disorder and did not receive gonadotoxic treatment. Among these 32 girls, 23 did not undergo puberty spontaneously and thus received medical puberty induction. Among the nine girls, who went through spontaneous puberty, four had received high dose alkylating agents and five had received conventional chemotherapy.

LIMITATIONS REASONS FOR CAUTION

All information was retrieved retrospectively from patient records, and thus some information was not available.

WIDER IMPLICATIONS OF THE FINDINGS

OTC should be recommended to all young girls, who present a high risk of developing ovarian insufficiency and/or infertility following high dose chemotherapy and/or irradiation.

STUDY FUNDING/COMPETING INTERESTS

The Childhood Cancer Foundation (2012-2016) and the EU interregional project ReproHigh are thanked for having funded this study. They had no role in the study design, collection and analysis of the data or writing of the report. The authors have no conflict of interest to disclose.

Effects of photodemethylation on the methylmercury budget of boreal Norwegian lakes

Methylmercury (MeHg) concentrations in freshwater fish from southeastern Norway continue to increase, highlighting the need for a comprehensive understanding of MeHg sources, cycling, and degradation in the aquatic environment. The authors assessed the importance of photodemethylation in the MeHg budget of 4 Norwegian lakes. Photodemethylation rates were determined using incubation experiments with MeHg-spiked natural lake water. The authors determined full-spectrum exposure rates at all study sites and waveband-specific rates (photosynthetically active radiation, ultraviolet-A radiation, and ultraviolet-B radiation) at 1 clear-water (Sognsvann) and 1 humic (Langtjern) site. No significant differences in photodemethylation rates between the sites were found, and the authors' observed rates agreed with available literature for lake and wetland waters. The authors paired experimentally derived photodemethylation rates with lake-specific incident irradiation, light attenuation, and MeHg concentrations to estimate MeHg loss through photodemethylation for the study sites. For Langtjern, losses through photodemethylation equalled 27% of total annual inputs, highlighting the importance of photodemethylation in the MeHg budget. Furthermore, the authors assessed how changes in terrestrial dissolved organic carbon (DOC) exported to freshwaters and climate-driven reductions in ice cover duration may affect MeHg losses through photodemethylation. Results suggest that future increases in DOC may lead to higher aqueous MeHg concentrations in boreal lakes due to increased DOC-associated MeHg inputs paired with significant decreases in the loss of MeHg through photodemethylation due to increased light attenuation.

Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project

Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels.

Urinary phthalates from 168 girls and boys measured twice a year during a 5-year period: associations with adrenal androgen levels and puberty

BACKGROUND

Little is known about the possible deleterious effects of phthalate exposure on endogenous sex steroid levels in children.

OBJECTIVE

Our objective was to investigate whether urinary phthalate metabolite levels are associated with circulating adrenal androgen levels and age at puberty.

METHODS

This was a longitudinal study of 168 healthy children (84 girls) examined every 6 months for 5 years. Serum levels of dehydroepiandrostenedione sulfate (DHEAS), Δ4-androstenedione, testosterone, and urinary morning excretion of 14 phthalate metabolites, corresponding to 7 different phthalate diesters were determined. A variation in urinary excretion of phthalates was evident in each child, which made a mean of repetitive samples more representative for long-term excretion than a single determination.

RESULTS

We found that girls with excretion of monobutyl phthalate isomers (MBP) and di(2-ethylhexyl) phthalate metabolites above the geometric group mean (795 and 730 ng/kg, respectively) had lower levels of DHEAS and Δ4-androstenedione, although statistically significant only at 13 years of age. In boys, we found that excretion of monobenzyl phthalate above the geometric group mean (346 ng/kg) was associated with lower levels of DHEAS at 11 years of age but higher levels of testosterone at 13 years of age. The same trend was observed for MBP excretion, albeit not statistically significant. A lower age at pubarche was observed in boys with excretion of MBP above the geometric group mean (11.0 vs 12.3 years, P = 0.005).

CONCLUSION

Our data indicate that exposure to dibutyl phthalate isomers (DBP) (in girls) and butylbenzyl phthalate (in boys) are negatively associated with adrenal androgen levels and in boys positively associated with testosterone level at 13 years of age. High exposure to DBP was associated with earlier age at pubarche in boys. In girls, no associations between phthalate exposure and age at pubertal milestones were observed.

Changes in anti-Müllerian hormone (AMH) throughout the life span: a population-based study of 1027 healthy males from birth (cord blood) to the age of 69 years

CONTEXT

Anti-Müllerian hormone (AMH), which is secreted by immature Sertoli cells, triggers the involution of the fetal Müllerian ducts. AMH is a testis-specific marker used for diagnosis in infants with ambiguous genitalia or bilateral cryptorchidism.

AIM

The aim of the study was to describe the ontogeny of AMH secretion through life in healthy males.

SETTING

This was a population-based study of healthy volunteers.

PARTICIPANTS

PARTICIPANTS included 1027 healthy males from birth (cord blood) to 69 yr. A subgroup was followed up longitudinally through the infantile minipuberty [(in cord blood, and at 3 and 12 months), n=55] and another group through puberty [(biannual measurements), n=83].

MAIN OUTCOME MEASURES

Serum AMH was determined by a sensitive immunoassay. Serum testosterone, LH, and FSH were measured, and pubertal staging was performed in boys aged 6 to 20 yr (n=616).

RESULTS

Serum AMH was above the detection limit in all samples with a marked variation according to age and pubertal status. The median AMH level in cord blood was 148 pmol/liter and increased significantly to the highest observed levels at 3 months (P<0.0001). AMH declined at 12 months (P<0.0001) and remained at a relatively stable level throughout childhood until puberty, when AMH declined progressively with adults exhibiting 3-4% of infant levels.

CONCLUSION

Based on this extensive data set, we found detectable AMH serum levels at all ages, with the highest measured levels during infancy. At the time of puberty, AMH concentrations declined and remained relatively stable throughout adulthood. The potential physiological role of AMH and clinical applicability of AMH measurements remain to be determined.

Hypothesis: exposure to endocrine-disrupting chemicals may interfere with timing of puberty

A recent decline in onset of puberty - especially among girls - has been observed, first in the US in the mid-1990s and now also in Europe. The development of breast tissue in girls occurs at a much younger age and the incidence of precocious puberty (PP) is increasing. Genetic factors and increasing prevalence of adiposity may contribute, but environmental factors are also likely to be involved. In particular, the widespread presence of endocrine-disrupting chemicals (EDCs) is suspected to contribute to the trend of earlier pubertal onset. The factors regulating the physiological onset of normal puberty are poorly understood. This hampers investigation of the possible role of environmental influences. There are many types of EDCs. One chemical may have more than one mode of action and the effects may depend on dose and duration of the exposure, as well as the developmental stage of the exposed individual. There may also be a wide range of genetic susceptibility to EDCs. Human exposure scenarios are complex and our knowledge about effects of mixtures of EDCs is limited. Importantly, the consequences of an exposure may not be apparent at the actual time of exposure, but may manifest later in life. Most known EDCs have oestrogenic and/or anti-androgenic actions and only few have androgenic or anti-oestrogenic effects. Thus, it appears plausible that they interfere with normal onset of puberty. The age at menarche has only declined by a few months whereas the age at breast development has declined by 1 year; thus, the time span from initiation of breast development to menarche has increased. This may indicate an oestrogen-like effect without concomitant central activation of the hypothalamic-pituitary axis. The effects may differ between boys and girls, as there are sex differences in age at onset of puberty, hormonal profiles and prevalence of precocius puberty.

Nitrogen dynamics and removal in a horizontal flow biofilm reactor for wastewater treatment

A horizontal flow biofilm reactor (HFBR) designed for the treatment of synthetic wastewater (SWW) was studied to examine the spatial distribution and dynamics of nitrogen transformation processes. Detailed analyses of bulk water and biomass samples, giving substrate and proportions of ammonia oxidising bacteria (AOB) and nitrite oxidising bacteria (NOB) gradients in the HFBR, were carried out using chemical analyses, sensor rate measurements and molecular techniques. Based on these results, proposals for the design of HFBR systems are presented. The HFBR comprised a stack of 60 polystyrene sheets with 10-mm deep frustums. SWW was intermittently dosed at two points, Sheets 1 and 38, in a 2 to 1 volume ratio respectively. Removals of 85.7% COD, 97.4% 5-day biochemical oxygen demand (BOD(5)) and 61.7% TN were recorded during the study. In the nitrification zones of the HFBR, which were separated by a step-feed zone, little variation in nitrification activity was found, despite decreasing in situ ammonia concentrations. The results further indicate significant simultaneous nitrification and denitrification (SND) activity in the nitrifying zones of the HFBR. Sensor measurements showed a linear increase in potential nitrification rates at temperatures between 7 and 16 degrees C, and similar rates of nitrification were measured at concentrations between 1 and 20mg NH(4)-N/l. These results can be used to optimise HFBR reactor design. The HFBR technology could provide an alternative, low maintenance, economically efficient system for carbon and nitrogen removal for low flow wastewater discharges.

A common deletion in the uridine diphosphate glucuronyltransferase (UGT) 2B17 gene is a strong determinant of androgen excretion in healthy pubertal boys

BACKGROUND

Testosterone (T) is excreted in urine as water-soluble glucuronidated and sulfated conjugates. The ability to glucuronidate T and other steroids depends on a number of different glucuronidases (UGT) of which UGT2B17 is essential. The aim of the study was to evaluate the influence of UGT2B17 genotypes on urinary excretion of androgen metabolites in pubertal boys.

STUDY DESIGN

A clinical study of 116 healthy boys aged 8-19 yr. UGT2B17 genotyping was performed using quantitative PCR. Serum FSH, LH, T, estradiol (E2), and SHBG were analyzed by immunoassays, and urinary levels of androgen metabolites were quantitated by gas chromatography/mass spectrometry in all subjects.

RESULTS

Ten of 116 subjects (9%) presented with a homozygote deletion of the UGT2B17 gene (del/del), whereas 52 and 54 boys were hetero- and homozygous carriers of the UGT2B17 gene (del/ins and ins/ins), respectively. None of the reproductive hormones were affected by UGT2B17 genotype. In all subjects, mean urinary T/epitestosterone ratio was 1.56 [1.14 (SD); 0.1-6.9 (range)] and unaffected by age or pubertal stage. Subjects with homozygous deletions of UGT2B17 had significantly lower urinary levels of T and 5alpha- and 5beta-androstanediol. Mean urinary T/epitestosterone was significantly reduced in del/del subjects [0.29 (0.30); 0.1-1.0 (range), P < 0.0001].

CONCLUSION

In pubertal boys, a common homozygous deletion in the UGT2B17 gene strongly affected urinary excretion pattern of androgen metabolites but did not influence circulating androgen levels.

Parameterization of the inherent optical properties of Murchison Bay, Lake Victoria

Lake Victoria, Africa's largest freshwater lake, suffers greatly from negative changes in biomass of species of fish and also from severe eutrophication. The continuing deterioration of Lake Victoria's ecological functions has great long-term consequences for the ecosystem benefits it provides to the countries bordering its shores. However, knowledge about temporal and spatial variations of optical properties and how they relate to lake constituents is important for a number of reasons such as remote sensing, modeling of underwater light fields, and long-term monitoring of lake waters. Based on statistical analysis of data from optical measurements taken during half a year of weekly cruises in Murchison Bay, Lake Victoria, we present a three-component model for the absorption and a two-component model for the scattering of light in the UV and the visible regions of the solar spectrum along with tests of their ranges of validity. The three-component input to the model for absorption is the chlorophyll-a (Chl-a), total suspended materials concentrations, and yellow substance absorption, while the two-component input to the model for scattering is the Chl-a concentration and total suspended materials.

Serum sex hormone-binding globulin levels in healthy children and girls with precocious puberty before and during gonadotropin-releasing hormone agonist treatment

CONTEXT

The regulation of SHBG is complex and influenced by sex steroids and insulin.

OBJECTIVE

Our objective was to describe serum levels and evaluate determinants of SHBG levels in healthy children and in girls with central precocious puberty (CPP) before and during GnRH analog (GnRHa) treatment.

DESIGN

We conducted a cross-sectional study on healthy subjects and a 2-yr longitudinal study in girls with CPP.

SETTING

The study took place at a tertiary referral center for pediatric endocrinology.

PARTICIPANTS/PATIENTS

A total of 903 healthy schoolchildren served as healthy subjects, and 25 girls with precocious/early puberty participated.

INTERVENTIONS

Girls with CPP were treated with the long-acting GnRHa triptorelin.

RESULTS

SHBG levels declined with increasing age in both sexes until adulthood. In healthy children, SHBG was significantly negatively correlated with testosterone, estradiol, dehydroepiandrosterone sulfate, and body mass index (BMI) in boys (total model R(2) = 0.71) but only with dehydroepiandrosterone sulfate and BMI in girls (total model R(2) = 0.26). Body fat percentage was significantly negatively correlated with SHBG levels (P < 0.001) in both boys (R(2) = 0.18) and girls (R(2) = 0.23). Girls with CPP had significantly lower pretreatment SHBG levels compared with age-matched controls [SHBG sd score, -1.29 (-4.48; 0.01)], which declined even further during GnRHa treatment [-2.75 (-5.9; 0.53); P < 0.001]. Even after adjustment for BMI and pubertal stage, girls with CPP had lower SHBG levels (P < 0.001) compared with healthy controls.

CONCLUSIONS

SHBG levels were strongly dependent on body composition and sex steroid levels in children with normal and precocious puberty. Studies on insulin sensitivity and SHBG in puberty are needed to better understand the interaction between body composition and gonadal maturation.

Assessment of burn depth: a prospective, blinded comparison of laser Doppler imaging and videomicroscopy

INTRODUCTION AND AIMS

There is a need, both in clinical and research settings, for an affordable, objective method of assessing burn depth. This study compares burn depth assessment by videomicroscopy with laser Doppler imaging (LDI) in patients with dermal burns. The videomicroscope is inexpensive compared to LDI, and can visualise the dermal capillary structure, therefore potentially allowing objective assessment of dermal burn injuries.

METHODS

Patients admitted <72 h post-injury were included in the trial. Blinded LDI and videomicroscopy assessments were carried out. The patients were then followed up to one of three end-points: primary healing without surgery; early surgery; delayed healing and subsequent split skin grafting. The incidence of infection was also noted.

RESULTS

Twenty-seven burn wounds were examined. In superficial partial thickness injuries, the videomicroscope reliably demonstrated an intact or nearly intact dermal vascular structure, progressing through to large amounts of capillary destruction and haemoglobin deposition in deep partial thickness injuries and complete destruction in full thickness injuries. The videomicroscope findings correlated strongly with both those of the LDI (p<0.001) and with clinical outcome (p<0.001).

DISCUSSION

The videomicroscope is capable of accurately and objectively assessing burn depth. The results correlated well with both the clinical outcome and the laser Doppler findings. In addition, videomicroscopy is significantly cheaper than LDI and avoids several of the disadvantages of LDI.