Validation of weighed records and other methods of dietary assessment using the 24 h urine nitrogen technique and other biological markers

Results from analysis of 24 h urine collections, verified for completeness with para-amino benzoic acid, and blood samples collected over 1 year were compared with 16 d weighed records of all food consumed collected over the year, and with results from 24 h recalls, food-frequency questionnaires and estimated food records in 160 women. Using the weighed records, individuals were sorted into quintiles of the distribution of the urine N excretion:dietary N intake ratio (UN:DN). UN exceeded DN in the top quintile of this ratio; mean ratio UN:DN = 1.13. Individuals in this top quintile were heavier, had significantly greater body mass indices, were reportedly more restrained eaters, had significantly lower energy intake:basal metabolic rate ratios (EI:BMR), and had correlated ratios of UN:DN and EI:BMR (r -0.62). Those in the top quintile reported lower intakes of energy and energy-yielding nutrients, Ca, fats, cakes, breakfast cereals, milk and sugars than individuals in the other quintiles but not lower intakes of non-starch polysaccharides, vitamin C, vegetables, potatoes or meat. Correlations between dietary intake from weighed records and 24 h urine K were 0.74 and 0.82, and between dietary vitamin C and beta-carotene and plasma vitamin C and beta-carotene 0.86 and 0.48. Correlations between dietary N intake from weighed records and 24 h urine excretion were high (0.78-0.87). Those between N from estimated food records and urine N were r 0.60-0.70. Correlations between urine N and 24 h recalls and food-frequency questionnaires were in the order of 0.01 to 0.5. Despite problems of underreporting in overweight individuals in 20% of this sample, weighed records remained the most accurate method of dietary assessment, and only an estimated 7 d diary was able to approach this accuracy.

Vitamin B12 and folate deficiency in later life

OBJECTIVES

to examine the prevalence of vitamin B12 deficiency and folate deficiency in later life in representative samples of the elderly population in the United Kingdom.

DESIGN

a population-based cross-sectional analysis of 3,511 people aged 65 years or older from three studies was used to estimate the age-specific prevalence of vitamin B12 deficiency and of folate deficiency. Vitamin B12 deficiency is conventionally diagnosed if serum vitamin B12 < 150 pmol/l ('low vitamin B12'). We defined 'metabolically significant vitamin B12 deficiency' as vitamin B12 < 200 pmol/l and blood total homocysteine >20 micro mol/l. Folate deficiency, which usually refers to serum folate <5 nmol/l, was defined as 'metabolically significant' if serum folate was <7 nmol/l and homocysteine >20 micro mol/l.

RESULTS

the prevalence of vitamin B12 deficiency, whether defined as low vitamin B12 or metabolically significant vitamin B12 deficiency increased with age in all three studies, from about 1 in 20 among people aged 65-74 years to 1 in 10 or even greater among people aged 75 years or greater. The prevalence of folate deficiency also increased with age, and was similar to that for vitamin B12 deficiencies, but only about 10% of people with low vitamin B12 levels also had low folate levels.

CONCLUSION

the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.

European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health

RATIONALE

This statement is an updated version of one released by the same authors in February 2003. The statement was produced to follow up the Royal College of Physicians (RCP) Tobacco Advisory Group report "Protecting smokers, saving lives: the case for a tobacco and nicotine regulatory authority", which argued for an evidence based regulatory approach to smokeless tobacco and harm reduction and posed a series of questions that regulators must address in relation to smokeless tobacco. The purpose of this statement is to provide arguments of fact and principle to follow the RCP's report and to outline the public health case for changing existing European Union (EU) regulation in this area. A review of regulation in relation to harm reduction and regulation of tobacco products other than cigarettes is required in Article 11 of EU directive 2001/37/EC, and this is a contribution towards forming a consensus in the European public health community about what policy the EU should adopt in the light of this review, or following ongoing legal action that may potentially strike out the existing regulation altogether.

PUBLIC HEALTH CASE

We believe that the partial ban applied to some forms of smokeless tobacco in the EU should be replaced by regulation of the toxicity of all smokeless tobacco. We hold this view for public health reasons: smokeless tobacco is substantially less harmful than smoking and evidence from Sweden suggests it is used as a substitute for smoking and for smoking cessation. To the extent there is a "gateway" it appears not to lead to smoking, but away from it and is an important reason why Sweden has the lowest rates of tobacco related disease in Europe. We think it is wrong to deny other Europeans this option for risk reduction and that the current ban violates rights of smokers to control their own risks. For smokers that are addicted to nicotine and cannot or will not stop, it is important that they can take advantage of much less hazardous forms of nicotine and tobacco-the alternative being to "quit or die". and many die. While nicotine replacement therapies (NRT) may have a role in harm reduction, tobacco based harm reduction options may reach more smokers and in a different, market based, way. Chewing tobacco is not banned or regulated in the EU but is often highly toxic, and our proposal could remove more products from the market than it permitted.

REGULATORY OPTIONS

We believe that the EU policy on smokeless tobacco should adapt to new scientific knowledge and that the European Commission should bring forward proposals to amend or replace Article 8 of directive 2001/37/EC with a new regulatory framework. Canada has developed testing regimens for tobacco constituents and these could be readily adapted to the European situation. A review of EU policy in this area is required no later than December 2004, and we believe the Commission should expedite the part of its review that deals with harm reduction and regulation of tobacco products other than cigarettes so as to reconsider its policy on smokeless tobacco. We held this view before Swedish Match brought its legal proceedings to challenge EU legislation and we will continue to hold these views if its action fails.

'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes

BACKGROUND

The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging.

OBJECTIVES

To determine: (i) prevalence of PenA records; (ii) patient characteristics associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care.

METHODS

We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing, mortality, MRSA infection/colonization and Clostridioides difficile infection.

RESULTS

PenA prevalence was 5.9% (IQR = 3.8%-8.2%). PenA records were more common in older people, females and those with a comorbidity, and were affected by GP practice. Antibiotic prescribing varied significantly: penicillins were prescribed less frequently in those with a PenA record [relative risk (RR)  = 0.15], and macrolides (RR = 4.03), tetracyclines (RR = 1.91) nitrofurantoin (RR = 1.09), trimethoprim (RR = 1.04), cephalosporins (RR = 2.05), quinolones (RR = 2.10), clindamycin (RR = 5.47) and total number of prescriptions were increased in patients with a PenA record. Risk of re-prescription of a new antibiotic class within 28 days (RR = 1.32), MRSA infection/colonization (RR = 1.90) and death during the year subsequent to 1 April 2013 (RR = 1.08) increased in those with PenA records.

CONCLUSIONS

PenA records are common in the general population and associated with increased/altered antibiotic prescribing and worse health outcomes. We estimate that incorrect PenA records affect 2.7 million people in England. Establishing true PenA status (e.g. oral challenge testing) would allow more people to be prescribed first-line antibiotics, potentially improving health outcomes.

Late asthmatic reactions provoked by intradermal injection of T-cell peptide epitopes are not associated with bronchial mucosal infiltration of eosinophils or T(H)2-type cells or with elevated concentrations of histamine or eicosanoids in bronchoalveolar fluid

BACKGROUND

Isolated late asthmatic reactions can be provoked by intradermal challenge of allergen-derived T-cell peptide epitopes.

OBJECTIVE

The purpose of this study was to determine whether the isolated LAR is associated with the local accumulation of inflammatory cells, the expression of T(H)2 cytokines, and the production of pharmacologic mediators.

METHODS

A randomized, placebo-controlled, crossover study design was used. The investigation involved bronchial and skin biopsies and bronchoalveolar lavage (BAL) fluids from 8 cat-allergic subjects who developed significant late asthmatic reactions 6 hours after intradermal injection of Fel d 1 chain 1-derived peptides (FC1Ps).

RESULTS

Immunostaining of bronchial biopsy specimens showed no changes in the numbers of eosinophils, neutrophils, basophils, mast cells, CD3(+), CD4(+) or CD8(+) T cells, CD25(+) cells or macrophages, or cells mRNA(+) for IL-4, IL-5, or IL-13 when the FC1P day was compared with the diluent control day. There were also no significant differences in eosinophil numbers, either in BAL fluids or in peripheral blood after FC1P challenge. Furthermore, there were no significant alterations in the concentrations of histamine, histamine-releasing factors, or eicosanoids (LTC(4)/D(4)/E(4), PGD(2), PGE(2), TXB(2), PGF(2alpha)) in BAL fluids. FC1Ps induced a significant (P <.05) elevation in CD8(+) cells in the skin and an unexpected decrease in IL-5 in BAL fluids (P =.043).

CONCLUSION

Part of the asthma process might involve T cell-dependent airway narrowing with no requirement for IgE, mast cells, or infiltrating inflammatory cells.

The future of tobacco product regulation and labelling in Europe: implications for the forthcoming European Union directive

The European Commission has announced that it is considering legislation concerning further restrictions on cigarette tar and nicotine yields, as well as new provisions to regulate additives and the labelling of tobacco products. This report considers these issues and their relation to public health. In particular, we argue that further reductions in tar and nicotine yields as measured by the International Standards Organisation/Federal Trade Commission (ISO/FTC) method will be largely cosmetic and certainly misleading to consumers. If a new directive uses the ISO/FTC methodology as a basis for regulation, it risks lending further official support to the concept of "low tar" cigarettes, which may be used by smokers as an alternative to smoking cessation. Although new regulations based on the ISO/FTC methodology may appear to offer health gains, these will be illusory and there may even be negative health consequences, as has been the case with these tests up to the present. We therefore make the following recommendations for the way forward.

Essential fatty acids in plasma phospholipids in schizophrenics

Blood samples were taken from schizophrenics and control patients in three different centers. The phospholipids were extracted from plasma and their fatty acid composition analyzed. Similar and consistent differences between schizophrenics and controls were observed at all three centers. The n-6 essential fatty acid levels were significantly reduced, whereas n-3 essential fatty acids were elevated.

Relationship of Campylobacter isolated from poultry and from darkling beetles in New Zealand

Campylobacter, a foodborne pathogen closely associated with poultry, is considered to be an important agent of human gastroenteritis in New Zealand. The pathways involved in the contamination of poultry flocks remain unclear; however, many vectors, such as insects, rodents, and wild birds, have been implicated. Infestation of poultry houses by insects, particularly darkling beetles (Alphitobius diaperinus), is difficult to control. Furthermore, darkling beetles are known vectors for a variety of pathogens that include Salmonella, infectious bursal disease virus, Aspergillus, Escherichia coli, and Marek's disease virus. In this investigation, the relationship between darkling beetles and Campylobacter contamination of poultry flocks was investigated. A New Zealand breeder flock and four of its progeny broiler flocks were included in the study. Samples of beetles and of intestinal excreta of the birds were cultured for the presence of Campylobacter spp. A subset of the recovered isolates was subsequently genotyped using flaA short variable region (SVR) DNA sequence analysis. A large number of Campylobacter subtypes were isolated, indicating that Campylobacter colonization of poultry is likely to arise from a number of different reservoirs. However, a set of genetically distinct isolates were found to be common to the broiler flocks and to the beetles. This research provides data that indicates that Alphitobius diaperinus may serve as a source of Campylobacter contamination of poultry. A more thorough understanding of the relationship between beetle infestation and the Campylobacter status of poultry flocks should enable progress in further development of biosecurity control measures.

Poor hospital infection control practice in venepuncture and use of tourniquets

Previous studies have indicated that tourniquets may act as reservoirs of pathogenic organisms and could therefore pose a risk to patients through cross-infection. In this study, 200 tourniquets were sampled from health professionals working in a large teaching hospital. A parallel survey of control of infection was also undertaken. Staphylococcus aureus was isolated from 10 (5%) of the tourniquets sampled. Methicillin-resistant S. aureus was not isolated. Seventy-five (37.5%) of the tourniquets sampled had visible blood stains; house officers (72.7%) and laboratory phlebotomists (69.2%) had the highest proportion of blood-stained tourniquets. Tourniquets were owned on average for 1.86 years, with most respondents only obtaining a new tourniquet when the old tourniquet was lost. Three percent of respondents used a separate tourniquet for patients with known infective risk factors, e.g. HIV, MRSA. Twenty-seven percent of respondents did not wear gloves for venepuncture or did so only occasionally. Only 42% washed their hands both before and after venepuncture. Our survey reveals poor infection control practice, but a relatively low frequency of S. aureus contamination of tourniquets.

Intramucosal carcinoma of the gastric antrum complicating Menetrier's disease

A 48-year-old man presented with haematemesis and was found to have Menetrier's disease. Three and a half years later early gastric cancer was detected at routine follow-up endoscopy. This is the first report of the development of early gastric cancer during follow-up in a case of Menetrier's disease. It is probable that patients with Menetrier's disease are at increased risk of gastric cancer, and should have regular endoscopic follow-up with gastric biopsy.

Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome

AIM

To describe incidence, aetiology and outcome data for Scotland since the inception of the Scottish Liver Transplant Unit (SLTU) in 1992.

BACKGROUND

Acute liver failure (ALF) is a rare but frequently fatal condition. Few studies have adequate patient numbers to draw convincing conclusions over demographic features, aetiology and outcome.

DESIGN

Statistical analysis of prospectively collected data on aetiology, demographic, clinical and outcome of all admissions, including those with ALF, to the SLTU.

METHODS

Incidence data presented for admissions and ALF. Descriptive frequencies for aetiology, clinical, demographic and outcome data presented; including split analysis for paracetamol and non-paracetamol aetiologies. Univariate and multivariate analysis of admission factors predictive of outcome is described.

RESULTS

Nine hundred and forty-nine patients were admitted to the SLTU between 1992 and 2009. Five hundred and twenty-four patients had ALF. The annual incidence of ALF in the Scottish population is 0.62 per 100,000 and paracetamol overdose (POD) was the largest causative factor; responsible for 0.43 cases of ALF per 100,000 population per year. The odds ratio (OR) of transplantation or death was 0.47 in the POD group compared to other aetiologies; yet of not being a transplant candidate having met the Kings College Hospital poor prognostic criteria OR was 4.9. Of admissions listed for transplant 76.0% were transplanted. Of those listed and not transplanted mortality was approaching 100% and 76.1% of those transplanted survived to discharge.

CONCLUSION

This large, prospective, single centre study with a defined geographical area and well-recorded population provides accurate data regarding ALF between 1992 and 2009.

Plasma essential fatty acids in pure and mixed race American Indians on and off a diet exceptionally rich in salmon

Eskimos on a traditional diet have unusually low prevalences of cardiovascular disease and cancer. One possible reason is the high intake of eicosapentaenoic acid (EPA) which is thought to account for the high EPA and low arachidonic acid (AA) levels in Eskimo plasma. People who also consume a traditional diet exceptionally rich in EPA are the Indians of the west coast of Vancouver Island. There are about 12,000 of these people and their traditional diet has been affected much less than that of the Eskimos. When on their traditional diet the Vancouver Island Indians, like the Eskimos, have high EPA and low AA levels in plasma. When eating European food, EPA levels are in the European range, but AA levels are still exceptionally low, a finding also reported from Eskimos living in Denmark. In a small mixed race group, AA levels were intermediate between those in pure Indians and in Europeans. The high EPA levels in Eskimos and West Coast Indians are related to diet. The low AA levels, in contrast, are probably genetically determined. Unusual disease patterns in these populations cannot be entirely attributed to diet.

Transient riboflavin depletion in preterm infants

Biochemical riboflavin status was measured in 68 preterm infants who were receiving either human milk or a preterm infant formula (containing riboflavin, 1.8 mg/l) during the first few weeks of life. The relation between riboflavin status, type of diet, and time of introduction of a multivitamin supplement containing riboflavin was analysed and the duration of phototherapy was recorded. Those who received the multivitamin supplement on or before day 7 of life seldom became deficient and no significant difference between diets was seen in this group. Of those who received the supplement after day 7, human milk fed infants commonly developed abnormal riboflavin status (18 out of 23 infants) compared with a small and significantly lower incidence in the formula fed group. Dietary effects on riboflavin status seemed to outweigh in importance those of phototherapy. It is concluded that the riboflavin content of human milk, which may be lowered by photodegradation, is not sufficient to ensure normal biochemical status in preterm infants. The larger amounts provided by a multivitamin supplement or by a preterm infant formula may, however, prevent biochemical deficiency. The desirability (and safety) of routine riboflavin supplementation of preterm infants is discussed.

An epidemic of optic neuropathy and painful sensory neuropathy in Cuba: clinical aspects

An epidemic of bilateral optic neuropathy and painful sensory neuropathy occurred in Cuba in 1991-1993. Over 45,000 individuals were stated to have been affected. We report a clinical study on 25 patients seen in Cuba in 1993-1994. Affected patients showed either bilateral optic neuropathy with caecocentral scotomata or a distal predominantly sensory neuropathy sometimes associated with deafness, or a combination of both optic and peripheral sensory neuropathy. The nature of the epidemic is discussed. The clinical features in patients with confirmed neurological deficits were consistent with a diagnosis of Strachan's syndrome, probably related to nutritional deficiency. Other patients with similar symptoms showed no evidence either of optic or peripheral neuropathy and were considered to represent disease mimicry on a psychoneurotic basis.

The pharmacokinetics of 5-fluorouracil administered by arterial infusion in advanced colorectal hepatic metastases

The pharmacokinetics of 5-fluorouracil (5FU) following its administration via the hepatic artery in conjunction with biodegradable albumin microspheres and angiotensin II have been studied. Peripheral venous concentrations of 5FU are lower and plasma clearance values higher following intrahepatic arterial administration compared with a similar dose administered by intravenous infusion over both 2 h and 24 h. For the 2 h drug infusions, plasma 5FU concentrations following co-treatment with angiotensin II and microspheres via the hepatic artery were intermediate between those of arterial and venous infusions of 5FU alone. There was a trend towards the peak plasma drug concentrations and the area under the plasma concentration-time curve (AUC) being significantly lower following co-treatment with angiotensin II and microspheres compared with intra-arterial and intravenous infusions of 5FU over 24 h. Co-administration of 5FU, angiotensin II and microspheres via the hepatic artery may reduce drug exposure in the systemic compartment and therefore may increase the therapeutic ratio of 5FU administration via the hepatic artery.

Fatty acids in plasma phospholipids and cholesterol esters from identical twins concordant and discordant for schizophrenia

The fatty acid compositions of plasma phospholipids and cholesterol esters were measured in 18 pairs of twins discordant for schizophrenia and 20 pairs concordant for schizophrenia. In the twins discordant for schizophrenia the only significant abnormalities were elevations of adrenic (22:4n-6) and docosapentaenoic (22:5n-6) acids in the schizophrenic twins. These fatty acids have also recently been reported to be elevated in brains from schizophrenics. The twins concordant for schizophrenia showed many differences from the normal discordant twins. 22:4n-6 and 22:5n-6 were even more abnormal than in the schizophrenic discordant twins. In addition, linoleic acid was significantly reduced, an abnormality which has been found consistently in other schizophrenic populations. These observations are consistent with the concept that unsaturated fat metabolism may be abnormal in schizophrenia.

Regulation of nicotine replacement therapies (NRT): a critique of current practice

Nicotine replacement therapy (NRT) describes a group of products delivering nicotine that are licensed for the relief of withdrawal as an aid to smoking cessation. This paper examines areas where public health considerations suggest changes should be made to the current indications and characteristics for NRT products. It is argued that the current regulatory framework restricts access to NRT without adequately considering that the likely consequence is continued dependent use of a far more harmful and widely available version of the same drug: tobacco. The paper argues that minors, pregnant smokers and smokers with cardiovascular disease (CVD) be allowed to use NRT. NRT use for smoking reduction, to support temporary abstinence, for long-term use should also be enabled and NRT products should be made as widely available as cigarettes. This paper also recommends that regulators encourage the development of less harmful forms of nicotine delivery devices to compete with cigarettes. Although this paper is written largely with reference to the UK medicines regulatory framework, these issues also apply to many other countries.

British urological surgery practice: 1. Prostate cancer

OBJECTIVE

To investigate the treatment of prostate cancer in the United Kingdom.

METHODS

A postal survey was conducted of consultant urologists and general surgeons with an interest in urology to assess the current patterns of management of patients with prostate cancer in the UK and to determine patterns of clinical practice.

RESULTS

Two-hundred and seventy-four replies were analysed. Radical radiotherapy (50%) and radical prostatectomy (29%) were the most favoured treatment options for patients < 70 years old with poorly differentiated T1 disease; for those aged > 70 years, active treatment was favoured by 183 (67%) consultants with radical radiotherapy (37%) and hormonal intervention (29%) the most frequent choices. In well-differentiated T1 disease, active treatment was favoured by 226 (83%) of consultants for patients < 70 years, with radical prostatectomy (44%) the most frequent choice. For patients > 70 years, observational management was preferred by 190 (69%) of consultants. In poorly differentiated T1 prostate cancer, active treatment was favoured by 252 (91%) for patients < 70, with radiotherapy (50%) the most frequent choice and for patients > 70 years, active treatment was favoured by 67% with radical radiotherapy the most common preference being chosen, by 102 (37%). For asymptomatic locally advanced disease, 55% of consultants favoured active treatment, whilst 63% favoured the active treatment of asymptomatic metastatic disease. For patients with symptomatic metastatic disease, GnRH agonist therapy was the treatment of choice of 66% of urologists and was given as monotherapy by 44% or as part of maximal androgen blockade by 22%. In clinical practice, 82% of urologists have close links with oncology, available through joint clinics or on-site referral. However, < 5% of urologists refer patients to an oncologist before the development of hormone refractory disease. At relapse, only 53% of urologists referred their patients to oncologists or palliative-care clinicians. A wide variety of hormonal treatments was offered at relapse; only 24% of urologists treated their patients by antiandrogen withdrawal or introduction, which is currently the most effective second-line hormonal treatment for recurrent prostate cancer.

CONCLUSION

There is a wide variation in the clinical management of prostate cancer and we recommend the establishment of standards of practice.

First Report of Laurel Wilt Disease Caused by Raffaelea lauricola on Sassafras in Florida and South Carolina

Laurel wilt disease, caused by Raffaelea lauricola (T.C. Harr., Fraedrich & Aghayeva sp. nov.), which is a fungal symbiont of the nonnative redbay ambrosia beetle (Xyleborus glabratus Eichhoff), has caused widespread mortality of native redbay (Persea borbonia (L.) Spreng) in Georgia, South Carolina, and Florida since 2002. The disease has been noted on other species in the Lauraceae including sassafras in Georgia (1), and more recently, on avocado and camphor in Florida (4). Since 2005, wilted shoots, branch dieback, and tree death have been observed in sassafras trees (Sassafras albidum (L.)) in Liberty, McIntosh, Chatham, Effingham, Bulloch, Evans, and Screven counties in Georgia; Bamberg, Beaufort, Charleston, Colleton, Hampton, and Orangeburg counties in South Carolina; and Putnam County in Florida. Symptomatic sassafras trees ranged from 1 to 12 m high and 2.5 to 25 cm in diameter at breast height. In contrast to red bay trees that retain wilted foliage, symptomatic sassafras defoliate rapidly as trees wilt and die. Multiple symptomatic ramets originating from a common root system have been observed. Removal of bark from stem and root sections from wilted trees revealed black-to-brownish staining in the sapwood, characteristic of laurel wilt. Wood chips from symptomatic areas of branches and roots were surface sterilized and plated on cycloheximide-streptomycin malt agar as previously described (1) and R. lauricola was routinely isolated. Small subunit (18S) sequences from rDNA were amplified by PCR and sequenced using primers NS1 and NS4 (3) for isolates from sassafras from Florida and South Carolina. BLASTn searches revealed homology to Raffaelea sp. C2203 (GenBank Accession No. EU123076, 100% similarity) described by Fraedrich et al. (1) from redbay and later named R. lauricola (2). The small subunit rDNA sequences for these isolates have been deposited into GenBank ( http://www.ncbi.nlm.nih.gov/Genbank/index.html ) and assigned Accession Nos. EU980448 (Florida) and GQ329704 (South Carolina). Koch's postulates have been completed with R. lauricola on this host previously (1). Laurel wilt on sassafras often was geographically isolated from other symptomatic hosts in Georgia and South Carolina and appears to occur on this host independently of proximity to redbay. Further studies to determine the epidemiology of laurel wilt on sassafras, potential resistance, and impact on sassafras life history and distribution are needed. Given the clonal nature of sassafras, the disease would appear to have the potential to move through roots of trees once established in a stand. References: (1) S. W Fraedrich et al. Plant Dis. 92:215, 2008. (2) T. C. Harrington et al. Mycotaxon 104:399, 2008. (3) M. A. Innis et al. PCR Protocols, A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990. (4) J. A. Smith et al. Plant Dis. 93:198, 2009.

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

OBJECTIVES

To describe the selection and modification of an appropriate diet score to assess diet quality in early old age.

DESIGN AND SETTING

Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy.

SUBJECTS

In total, 1475 traced, surviving cohort members aged 60 years and over.

RESULTS

Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items.

CONCLUSIONS

The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

The analysis of 5-fluorouracil in human plasma by gas chromatography-negative ion chemical ionization mass spectrometry (GC-NICIMS) with stable isotope dilution

5-Fluorouracil (5-FU) was extracted from plasma and converted to its di-N-ditrifluoromethylbenzyl (DTFMBz) derivative by treatment with DTFMBzBr. Under negative ion chemical ionization (NICI) conditions the derivative yielded a mass spectrum in which most of the ion current was carried by the M(-)-DTFMBz ion (m/z 355). Selected ion monitoring enabled detection of this derivative in amounts less than 1 pg, and the practical limit of detection for 5-FU extracted from plasma was ca 400 pg ml-1. 5-FU was quantified by adding a fixed amount of [15N2]5-FU to samples of plasma before extraction, and comparing the ratio of the ions of m/z 355 and 357 against a calibration curve constructed over the concentration range under investigation. The method was used to measure the variation in the concentration of 5-FU with time during continuous infusion of the drug via three, different protocols in patients with hepatic tumour.

Sputum cytology: a limited role

AIMS

To determine the cost and sensitivity of sputum cytology in routine use and to determine when sputum cytology is most appropriate.

METHODS

A retrospective study, based on all sputum cytology requests received in five histopathology/cytopathology laboratories in Yorkshire from 1 January to 31 December 1993. Cytology findings were correlated with histological diagnosis or clinical outcome, and related to the speciality of the referring clinician.

RESULTS

Laboratory practice and performance was similar in all five centres. The average laboratory cost of sputum cytology was 26.93. The mean absolute sensitivity was 36% and the specificity was 99.6%. The majority of specimens was submitted by general physicians or geriatricians. The largest proportion of positive specimens were submitted by chest physicians.

CONCLUSIONS

Often sputum cytology is used inappropriately as a screening investigation on, or soon after, admission. In addition, it is used inappropriately before bronchoscopy. Sputum cytology should be limited to individuals in whom a histological diagnosis is desired, but in whom bronchoscopy is inappropriate or unsuccessful.