Association between early care and education centres policies and practices and children's healthy behaviours

OBJECTIVE

To examine the impact of nutritional and physical activity (PA) policies and practices at early care and education centres on behavioural changes among children ages 2-5.

METHODS

The study population included 586 children from 25 education centres throughout the state of Georgia. Policies and practices were measured using the Georgia Nutrition and PA Assessment at the start of school year in Fall 2017. Survey data were collected at the beginning of school year September/October 2017 and at the end of school year April/May 2018 to measure changes in children's nutritional and PA behaviour over the school year. We used generalised estimating equations to estimate odds ratios and 95% confidence intervals.

RESULTS

Children at centres with a high nutrition assessment score had higher odds of increasing vegetable consumption (OR = 2.1; 95% CI: 1.1, 4.0) while the odds of increasing fruit (OR = 1.4; 95% CI: 0.8, 2.4) and water (OR = 1.2; 95% CI: 0.5, 2.7) consumption increased non-significantly. The odds of improving PA were similar between children at centres with a high versus a low PA assessment score.

CONCLUSION

The results, though insignificant, indicate that policies and practices could influence children's health behaviours. Further research is warranted to examine whether improvements in policies and practices could explain changes in children's health behaviours, the impact of educator's knowledge on children's health behaviours and the implementation of and adherence to policy and practice improvement plans.

Schools and Wastewater Surveillance: Practical Implications for an Emerging Technology to Impact Child Health

Since the start of the COVID-19 pandemic, wastewater surveillance has emerged as a public health tool that supplements traditional surveillance methods used to detect the prevalence of the SARS-CoV-2 virus in communities. In May 2020, the Houston Health Department (HHD) partnered with a coalition of municipal and academic partners to develop a wastewater monitoring and reporting system for the city of Houston, Texas. The HHD subsequently launched a program to conduct targeted wastewater sampling at 52 school sites located in a large, urban school district in Houston. Data generated by this program are shared with school district officials and nurses from participating schools. Although initial feedback from these stakeholders indicated that they considered the wastewater data valuable, the emergency nature of the pandemic prevented a systematic evaluation of the program. To address this gap in knowledge, the HHD and Rice University conducted a study to determine how wastewater data are used to make decisions about COVID-19 prevention and mitigation practices in schools. Our findings indicate that maximizing the utility of wastewater data in the school context will require the development of communication strategies and education efforts tailored to the needs of specific audiences and improving collaboration between local health departments, school districts, and school nurses.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

BACKGROUND

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

METHODS

WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.

FINDINGS

Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.

INTERPRETATION

In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.

FUNDING

European Society of Intensive Care Medicine, European Respiratory Society.

Medical students' experience of studying while working part-time and the effects of COVID-19

AIMS

The costs of being a medical student are large and increasing, and many students need to work part-time to meet financial pressures. This study explores the impact that part-time extracurricular paid work during the academic year has on medical student wellbeing, their interactions with the curriculum, and the effect of COVID-19 on work in 2020.

METHODS

An online survey in 2020 gathered demographic, quantitative and qualitative information from medical students and their work experiences. Descriptive statistics analysed quantitative data; qualitative data were analysed using qualitative content analysis.

RESULTS

Of the 36% (n=530) of students who responded, 255 (49%) reported undertaking paid part-time work, with 59 (24%) reporting they would not be able to remain studying if they did not work. When interacting with the medical programme, 43% of students reported their work conflicted with scheduled medical school commitments, and 70% reported conflicts between work and individual study. COVID-19 disrupted 57% of paid work during the year. Impacts on students' wellbeing were both positive and negative. Positive aspects included developing new skills, self-confidence and resilience. Working also provided an escape from the study demands of the medical programme. Negative aspects were predominantly about the increased stress working had on students, specifically on the impact of paid work on their own health.

CONCLUSIONS

Almost half of medical students work part-time while studying. Understanding the perceived implications that part-time work has on student education and wellbeing could help medical schools provide appropriate advice and pastoral support for their students.

COVID-19 Silver Linings - Experience of Spousal Caregivers of Persons with Dementia Engaged in Support Program

Caring for a person with dementia (PWD) has been consistently associated with negative effects on health, including increases in caregiver depression, anxiety, and burden. Emerging studies have shown that the COVID-19 pandemic has increased these factors due to reported increases in caregiver workload and cognitive and behavioral symptoms of the PWD. We interviewed 10 spousal caregivers of PWD from the NYU Langone Alzheimer’s Disease and Related Dementias Family Support Program in Summer 2020 during the COVID-19 pandemic in order to gain feedback about their experiences during the pandemic and the transition from in-person to videoconferencing that could be used to improve services and support. Caregivers discussed the challenges faced during the pandemic but also the unique opportunities the situation presented. We report here on those positive aspects of COVID-19 from the perspective of the caregivers we interviewed. Methods: Interviews of caregivers residing with their spouses in the New York City area were conducted via videoconferencing, transcribed, deidentified, and analyzed using framework analysis methods. Results: We found that caregivers reported some positive reaction to videoconferencing that included increased support group cohesion, increased convenience, feeling less obligated to participate in events, and new opportunities for social contact. Participants also discussed positive inter-couple relationship changes such as increased quality time spent together. Our findings resonate with a body of literature focused on understanding the positive aspects of caregiving. Understanding the full presentation of the caregiver experience, including both positive and negative aspects, is important for developing interventions and resources for this unique group.

Spousal dementia caregivers' use of technology during the COVID‐19 global pandemic: Lessons learned from the NYU family support program

Background

Daily routines have been drastically impacted by COVID‐19, including healthcare appointments, home services, and many recreational opportunities. Spousal dementia caregivers (CGs) are particularly vulnerable during COVID‐19, as many rely on family members, daycare, in‐home assistance, and other respite opportunities. We conducted qualitative interviews in May/June 2020 to understand the impact of COVID‐19 on dementia CGs and how they experienced the switch of all the NYU ADRD Family Support Program (FSP) services to telehealth.

Method

A total of 10 spousal CGs participated in videoconference interviews about their COVID‐19 experiences and the FSP’s transition to the telehealth format. Semi‐structured interviews were conducted by one of two interviewers who were external to the FSP to encourage freedom of discussion. All sessions were recorded and transcribed. De‐identified transcripts were coded by two independent coders using NVivo, with discrepancies resolved by a third researcher.

Result

CGs ranged in age from 54 to 86; 7 were female, 8 were non‐Hispanic White, and 2 were Black. All were New York City residents living with the person with dementia; 2 households had additional adult family members. Qualitative analysis revealed several major themes related to COVID‐19 experiences: fears surrounding COVID‐19 and staying healthy; changes in daily routines; the impact of reduced respite and support services; adaptation to technology that enabled increased contact with family/friends. Feedback about the telehealth adaptation of the FSP included observations about new group dynamics and decreased barriers to involvement due to the ability to participate from home, reducing the need for transportation and other logistics related to traveling.

Conclusion

Despite significant challenges due to COVID‐19, CGs reported benefit and support from the FSP in the new telehealth format. One participant described the FSP as “indispensable” and expressed how much members relied on each other during COVID‐19. In addition, we learned that the telehealth FSP not only served as a source of support during the crisis but that there were perceived advantages to this format, including reductions in barriers to in‐person services (finding transportation, travel time, getting respite care for the person with dementia). We recommend continuing the option of telehealth services for dementia CGs after the COVID‐19 crisis.

Longitudinal study: understanding the lived experience of couples across the trajectory of dementia

Background

The longitudinal study, “Couples Lived Experiences,” focuses on whether and how relationship characteristics of older couples change with the cognitive decline of one member of the couple, and how these changes affect each individual’s emotional and physical health outcomes. Until now, most psychosocial research in dementia has focused either on the person with dementia (PWD) or the caregiver separately. The previous literature examining relationship characteristics and their role in outcomes for the caregiver and PWD is scant and suffers from methodological issues that limit the understanding of which relationship characteristics most influence outcomes for caregivers and care-receivers and what other factors may mitigate or exacerbate their effects.

Methods

We will enroll 300 dyads and collect information via online interviews of each member of the couple, every 6 months for 3 years. Relationship characteristics will be measured with a set of short, well-validated, and reliable self-report measures, plus the newly developed “Partnership Approach Questionnaire.” Outcomes include global quality of life, subjective physical health, mental health (depression and anxiety), and status change (transitions in levels of care; i.e., placement in a nursing home). Longitudinal data will be used to investigate how relationship characteristics are affected by cognitive, functional, and behavioral changes, and the impact of these changes on health outcomes. Qualitative data will also be collected to enrich the interpretation of results of quantitative analyses.

Discussion

Psychosocial interventions have demonstrated effectiveness in promoting the wellbeing of PWD and their caregivers. The knowledge gained from this study can lead to the development or enhancement of targeted interventions for older couples that consider the impact of cognitive and functional decline on the relationship between members of a couple and thereby improve their wellbeing.

Trial registration

This study has been registered with ClinicalTrials.gov. ClinicalTrials.gov Identifier is: NCT04863495.

Analyzing Who, When, and Where: Data for Better Targeting of Resources for School-Based Asthma Interventions

BACKGROUND

Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance-treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions.

METHODS

Incidence rates of 1826 ambulance-treated asthma attacks for children aged 5-18 years were calculated for school zones for elementary, middle, and high schools in the Houston (Texas) Independent School District (HISD). Zones with rates in the upper quartile were identified as the highest rate zones and were compared with other school zones in the district by demographics, location, and timing of attacks.

RESULTS

The ambulance-treated asthma rate was respectively 5, 3, and 2 times greater in the highest rate school zones compared with all other school zones for those school levels. Ambulance-treated asthma attacks in the high-rate school zones occurred most at midday and in the evening and high-rate zones were often geographically contiguous. Schools in the high-rate zones had a higher percent of socioeconomically disadvantaged students and were more often without a school nurse.

CONCLUSION

Spatial and temporal analysis of ambulance data can be valuable tools for schools to focus policy and program interventions for the students in need of improved asthma management.

The effect of milk on the attenuation of exercise-induced muscle damage in males and females

PURPOSE

The consumption of 500 ml milk following muscle damaging exercise can attenuate decreases in muscle functional capacity and increases in markers of muscle damage and soreness in males. There has been no similar research in female participants. Therefore, the aim of this study was to investigate the effects of milk consumption on exercise-induced muscle damage (EIMD) in males and females.

METHODS

Thirty-two team sport players (male n = 16; female n = 16) were randomly, but equally divided into four groups: male milk, male carbohydrate, female milk, and female carbohydrate. Immediately following muscle damaging exercise, participants consumed either 500 ml of milk or 500 ml of an energy-matched carbohydrate solution. Skeletal troponin I (sTnI), creatine kinase (CK), peak torque, counter movement jump height, 20 m sprint performance and passive and active soreness were recorded prior to and 24, 48 and 72 h post-EIMD.

RESULTS

For females, milk had a likely/very likely beneficial effect on attenuating losses in peak torque at 60°/s from baseline to 24, 48 and 72 h, and a likely beneficial effect in minimising decrements in sprint performance and soreness over 72 h. Milk was unlikely to have a negative effect on serum markers of damage from baseline to 48 and 72 h. For males, milk had an unclear effect on muscle function variables. Milk had a most likely/likely beneficial effect on limiting muscle soreness from baseline to 72 h, and a possible beneficial effect on attenuating increases in CK. The effect on sTnI was unlikely to be negative from baseline-72 h. Overall gender comparisons provided many unclear outcomes. However, female participants demonstrated smaller increases in sprint time, passive soreness, active soreness (non-dominant leg) and sTnI values.

CONCLUSION

Consumption of 500 ml of milk post-EIMD can limit decrements in muscle function in females, and limit increases in soreness and serum markers of muscle damage in females and males.

Supplementary biotin decreases tibial bone weight, density and strength in riboflavin-deficient starter diets for turkey poults

1. Growth and skeletal responses to different dietary concentrations of riboflavin and biotin were compared in turkey poults from hatch to 21 d of age. The birds were fed on a turkey starter diet with different concentrations of supplementary riboflavin (0, 20 and 40 mg/kg) and biotin (0, 0.3 and 0.6 mg/kg) in a factorial design. 2. Poults fed on diets with no supplementary riboflavin had poor gait scores, decreased times to sit and higher rates of culling compared to poults fed on the control diet (20 mg riboflavin and 0.3 mg biotin/kg [corrected] diet). Histologically, riboflavin deficiency was associated with a peripheral neuropathy similar to that described previously in chicks and, unexpectedly, in growth plate abnormalities. 3. Tibiae of poults fed on the control diet were larger, more dense, stronger and stiffer than the diets with no supplementary riboflavin. 4. Increasing supplementary biotin in poults fed on diets with no supplementary riboflavin was associated with a decrease in tibia weight, density, strength and stiffness. 5. The results demonstrated that riboflavin deficiency in fast-growing turkey poults was associated with growth retardation, growth plate disturbance and peripheral nerve dysfunction leading to an inability to walk.

Serotonin syndrome associated with clozapine withdrawal

IMPORTANCE

We describe a case of serotonin syndrome secondary to clozapine withdrawal and concomitant use of citalopram hydrobromide, a phenomenon that has been rarely reported.

OBSERVATIONS

This is a case report of a 47-year-old woman admitted to an academic medical center intensive care unit with coma, hypersalivation, hyperreflexia, and stimulus-induced clonus. The patient received a diagnosis of serotonin syndrome attributed to abrupt clozapine withdrawal with concomitant use of citalopram. She improved only minimally with supportive treatment (intravenous fluids, benzodiazapines, and withdrawal of selective serotonin-reuptake inhibitor) and received cyproheptadine hydrochloride on her third day of symptoms. Four hours after she received the loading dose of cyproheptadine, she was alert and oriented and at her baseline mental status, although some clonus remained.

CONCLUSIONS AND RELEVANCE

Serotonin syndrome can result from the abrupt withdrawal of a 5-hydroxytryptamine receptor 2A antagonist from a treatment regimen that also includes a medication that increases serotonin availability.

Agreement between paper and pen visual analogue scales and a wristwatch-based electronic appetite rating system (PRO-Diary©), for continuous monitoring of free-living subjective appetite sensations in 7-10 year old children

Electronic capture of free-living subjective appetite data can provide a more reliable alternative to traditional pen and paper visual analogue scales (P&P VAS), whilst reducing researcher workload. Consequently, the aim of this study was to explore the agreement between P&P VAS and a wristwatch-based electronic appetite rating system known as the PRO-Diary© technique, for monitoring free-living appetite sensations in 7-10 year old children. On one occasion, using a within-subject design, the 12 children (n=6 boys; n=6 girls) recorded their subjective appetite (hunger, prospective food consumption, and fullness), at two time points before lunch (11:30 and 12:00) and every 60 min thereafter until 21:00. The agreement between the P&P VAS and PRO-Diary© technique was explored using 95% limits of agreement and 95% confidence intervals (95% CI) calculated using the Bland and Altman (1986) technique. For hunger, prospective food consumption and fullness, the 95% limits of agreement were -1±25 mm (95% CI: lower limit -8mm; upper limit +6mm), 0±21 mm (95% CI: lower limit -6mm; upper limit +6mm) and -6±24 mm (95% CI: lower limit -14 mm; upper limit +1mm), respectively. Given the advantages associated with electronic data capture (inexpensive; integrated alarm; data easily downloaded), we conclude that the PRO-Diary© technique is an equivalent method to employ when continuously monitoring free-living appetite sensations in 7-10 year old children, but should not be used interchangeably with P&P VAS.

The role of cherries in exercise and health

Recently, cherries and cherry products have received growing attention within the literature with regard to their application in both exercise and clinical paradigms. Reported to be high in anti-inflammatory and anti-oxidative capacity, cherries and their constituents are proposed to provide a similar but natural alternative akin to over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics. Within exercise paradigms, concern has been raised with regard to the use of products, which inhibit such inflammatory or oxidative actions, because of the possibility of the blunting of physiological training adaptations. Despite this, numerous scenarios exist both within exercise and clinical populations where a goal of optimal recovery time is more important than physiological adaptation. This review critically evaluates and discusses the use of cherries as a supplementation strategy to enhance recovery of muscle function, inhibit exercise-induced inflammation, oxidative stress, and pain primarily; furthermore, the potential application of cherries to clinical populations is discussed.

Association of nuclear localization of a long interspersed nuclear element-1 protein in breast tumors with poor prognostic outcomes

Within healthy human somatic cells, retrotransposition by long interspersed nuclear element-1 (also known as LINE-1 or L1) is thought to be held in check by a variety of mechanisms, including DNA methylation and RNAi. The expression of L1-ORF1 protein, which is rarely found in normal tissue, was assayed using antibodies with a variety of clinical cancer specimens and cancer cell lines. L1-ORF1p expression was detected in nearly all breast tumors that the authors examined, and the protein was also present in a high percentage of ileal carcinoids, bladder, and pancreatic neuroendocrine tumors, as well as in a smaller percentage of prostate and colorectal tumors. Tumors generally demonstrated cytoplasmic L1-ORF1p; however, in several breast cancers, L1-ORF1p was nuclear. Patients with breast tumors displaying nuclear L1-ORF1p had a greater incidence of both local recurrence and distal metastases and also showed poorer overall survival when compared with patients with tumors displaying cytoplasmic L1-ORF1p. These data suggest that expression of L1-ORF1p is widespread in many cancers and that redistribution from cytoplasm to nucleus could be a poor prognostic indicator during breast cancer. High expression and nuclear localization of L1-ORF1p may result in a higher rate of L1 retrotransposition, which could increase genomic instability.

Sedative load of medications prescribed for older people with dementia in care homes

BACKGROUND

The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential) care homes.

METHODS

Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL) study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model.

RESULTS

At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively). More than 10% of residents had a high sedative load score (≥ 3) at baseline (12.2%), and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9%) regularly used one or more psychotropic medication(s). Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs), were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives.

CONCLUSIONS

Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were lower than previously reported in studies conducted in long-term care wards which have on-site clinical support. Nevertheless, strategies to optimise drug therapy for care home residents with dementia which rely on clinicians external to the care home for support and medication review are required.

Agreement between two methods of dietary data collection in female adolescent netball players

The accuracy of a combined dietary data collection method (self-reported, weighed food diary and 24-h recall technique) in 13 female, adolescent netball players (14-16 years) was explored. The girls were observed for a 12 h period (08:00-20:00), during which food and drink items were available ad libitum throughout the day and for the period between 20:00 and 08:00 the following morning. All items were covertly weighed before and after consumption to calculate observed energy intake. To calculate participant reported energy intake, food and drink items were weighed and recorded in a food diary by the participants, which was then supplemented with information from the 24-h recall the following morning. Agreement between observed and participant reported energy intake was calculated using the Bland and Altman technique. The mean difference between observed and participant reported energy intake was 0.46 MJ d(-1) (change in mean of 4.2%) indicating a slight bias towards over-reporting using the combined dietary data collection method. There was good agreement at the group level with the confidence interval for bias ranging from 0.00 to 0.92 MJ d(-1). The combined dietary data collection method is an effective technique to employ in 14-16-year old, female adolescent netball players when quantifying energy intake.

Culture, consent, costs and care homes: enabling older people with dementia to participate in research

OBJECTIVES

To describe factors that support and inhibit recruitment and participation of people with dementia living in care homes.

METHOD

This article focuses on the methods used to recruit people with dementia to a longitudinal study that employed a mixed-method design to track events and care that older people with dementia experienced over two years in six care homes. A staged approach to recruitment was adopted involving separate meetings with staff, residents and relatives. Individual consent was secured with residents with dementia who could consent in the moment and for those without capacity, through mail and follow-up telephone contact with consultees. Data were collected on the frequency of meetings, issues raised by staff, consultees and people with dementia as well as the overall time taken to complete recruitment.

RESULTS

Over five months, 133 older people with dementia were recruited (62% of sampling frame). The recruitment process was supported or hindered by the number of individuals and organisations that needed to be consulted, the care home culture, staff's understanding of how people with dementia can be involved in research, and how they interpreted their role as mediators, protectors and gatekeepers.

CONCLUSIONS

Care homes are isolated communities of care. To achieve the research objectives, researchers in the initial stages need to consider the philosophical underpinnings of individual care homes, and the politics of hierarchy both within the care home and between it, and health professionals. There is a need to develop credible infrastructures of support that enable people with dementia to participate in research.

Energy intake and appetite following netball exercise over 5 days in trained 13-15 year old girls

Free-living energy intake and subjective appetite were monitored in a group of eleven 13-15-year old trained adolescent netball players. During preliminary visits, a FLEX heart rate calibration and resting metabolic test were conducted. Heart rate data were collected during a netball exercise session and sedentary period and during the waking hours of all study days, to enable exercise-induced and 24-h energy expenditure to be quantified. The girls completed two 5-day treatment weeks, interspersed with a 2-week 'wash out' period. A 47-min bout of netball exercise or an equivalent sedentary period was carried out on day 3 of each treatment week. Energy intake was measured over each 5-day period using a combined self-reported, weighed, food diary and 24-h recall interview technique. Subjective appetite (hunger, prospective food consumption, fullness) and mood were rated by subjects immediately before and after meals each day, and before and after the netball exercise and the sedentary period. Forty eight hour energy intake was significantly higher following the netball exercise compared to the sedentary period. The girls felt significantly more hungry immediately following the netball exercise compared to immediately before. In conclusion, a single intermittent exercise bout alters subsequent appetite and energy intake in trained 13-15-year old girls.

Pandemic influenza planning: addressing the needs of children

Children represent one quarter of the US population. Because of its enormous size and special needs, it is critically important to address this population group in pandemic influenza planning. Here we describe the ways in which children are vulnerable in a pandemic, provide an overview of existing plans, summarize the resources available, and, given our experience with influenza A(H1N1), outline the evolving lessons we have learned with respect to planning for a severe influenza pandemic. We focus on a number of issues affecting children-vaccinations, medication availability, hospital capacity, and mental health concerns-and emphasize strategies that will protect children from exposure to the influenza virus, including infection control practices and activities in schools and child care programs.

Oxidative stress and matrix metalloproteinase-9 in acute ischemic stroke: the Biomarker Evaluation for Antioxidant Therapies in Stroke (BEAT-Stroke) study

BACKGROUND AND PURPOSE

Experimental stroke studies indicate that oxidative stress is a major contributing factor to ischemic cerebral injury. Oxidative stress is also implicated in activation of matrix metalloproteinases (MMPs) and blood-brain barrier injury after ischemia-reperfusion. Plasma biomarkers of oxidative stress may have utility as early indicators of efficacy in Phase 2 trials of antioxidant therapies in human stroke. To date, a valid biomarker has been unavailable. We measured F2-isoprostanes (F2IPs), free-radical induced products of neuronal arachadonic acid peroxidation, in acute ischemic stroke. We aimed to determine the change in plasma F2IP levels over time and relationship with plasma MMP-9 in tPA-treated and tPA-untreated stroke patients.

METHODS

We performed a case-control study of consecutive ischemic stroke patients (25 tPA-treated and 27 tPA-untreated) presenting within 8 hours of stroke onset. Controls were individuals without prior stroke from a primary care clinic network serving the source population from which cases were derived. Infarct volume was determined on acute diffusion-weighted MRI (DWI) performed within 48 hours using a semi-automated computerized segmentation algorithm. Phlebotomy was performed at <8 hours, 24 hours, 2 to 5 days, and 4 to 6 weeks. F2IPs were measured by gas chromatography/mass spectrometry and MMP-9 by ELISA. Prestroke antioxidant dietary intake was measured by the 24-hour recall method.

RESULTS

In 52 cases and 27 controls, early (median 6 hours postonset) F2IPs were elevated in stroke cases compared with controls (medians 0. 041 versus 0.0295 pg/mL, P=0.012). No difference in F2IPSs was present at later time points. Early plasma F2IPs correlated with MMP-9 in all patients (P=0.01) and the tPA-treated subgroup (P=0.02). No correlation was found with NIHSS, DWI infarct volume, 90-day Rankin score, or C-reactive protein (P>0.05 for all).

CONCLUSIONS

In early human stroke we found evidence of increased oxidative stress and a relationship with MMP-9 expression, supporting findings from experimental studies.

Influence of the glycaemic index of an evening meal on substrate oxidation following breakfast and during exercise the next day in healthy women

OBJECTIVE

To investigate whether the 'overnight second-meal effect' results in altered substrate oxidation during the postprandial period following breakfast and subsequent sub-maximal exercise in women.

SUBJECTS/METHODS

Seven recreationally active women were recruited for the study. In each trial, participants were provided with their evening meal on day 1, which was composed of either high glycaemic index (HGI) or low glycaemic index (LGI) carbohydrates (CHO). On day 2, participants were provided with a standard HGI breakfast and then performed a 60 min run at 65% \[V.]O(2 max) 3 h later.

RESULTS

The incremental area under the curve (IAUC) for plasma glucose concentrations during the postprandial period following breakfast was greater in the HGI trial compared to the LGI trial (P<0.01). Similarly, the IAUC for serum insulin concentrations was greater in the HGI trial than the LGI trial (P<0.05). No differences in plasma free-fatty acids (FFA) or plasma glycerol concentrations were found between trials during the postprandial period. During subsequent exercise, there were no significant differences in substrate metabolism.

CONCLUSION

The glycaemic index of an evening meal does not alter substrate oxidation at rest following breakfast or during subsequent submaximal exercise in women. This study provides further evidence for the overnight second-meal effect on glycaemic responses following a LGI mixed evening meal.

Effects of the glycemic index of breakfast on metabolic responses to brisk walking in females

OBJECTIVE

The aim of this study was to examine the metabolic responses during 1 h of brisk walking, 3 h after ingesting high glycemic index (HGI) and moderate glycemic index (MGI) breakfasts.

DESIGN AND SUBJECTS

Six females completed three treadmill walking trials (approximately 50% VO2 max), separated by at least 1 month. Three hours before walking, they ingested either water or a HGI or MGI breakfast. The MGI breakfast consisted of a mixture of an HGI breakfast cereal and low GI carbohydrate (CHO) foods. The GI values of the HGI and MGI meals were 77 and 51, respectively.

SETTING

The study took place in the School of Sport and Exercise Sciences at Loughborough University, Loughborough, UK.

RESULTS

In the HGI and MGI trials, plasma glucose and serum insulin concentrations peaked 15 min into the postprandial period. At the onset of exercise, plasma insulin concentrations were twofold higher in the HGI (31.5+/-7.7 microl U l(-1)) than in the MGI trial (15.2+/-1.9 microl U l(-1)) (P<0.05). However, there were no differences in substrate utilization between the two CHO trials.

CONCLUSION

These results suggest that although the addition of LGI CHO foods to an HGI breakfast cereal reduces the overall GI of the meal, the metabolic response to exercise is similar to that following a breakfast comprised entirely of HGI foods.

Derivation of a scrapie-free sheep flock from the progeny of a flock affected by scrapie

The Cheviot flock at the Institute for Animal Health's Neuropathogenesis Unit (npu) has endemic scrapie, which affects primarily vrq/vrq sheep and at high frequency. A new flock with a full range of PrP genotypes, including the highly susceptible vrq/vrq, has been produced on a separate site, from animals in the npu breeding flock, and it remains scrapie-free after eight years. In contrast, in a parallel flock at the npu farm, scrapie has reappeared after five years, although the animals were kept in separate accommodation from the scrapie-affected sheep. During this time the npu breeding flock continued to have scrapie cases. Although it is known that highly susceptible sheep can remain free of infection in a clean environment, this is the first report of the infection being removed successfully from the bloodlines of scrapie-affected sheep. The results confirm that scrapie is not a genetic disease dependent only on the PrP gene sequence, but requires both genetic susceptibility and an infectious agent.

Frequencies ofPrPgene haplotypes in British sheep flocks and the implications for breeding programmes

AIMS

To analyse the frequencies of prion (PrP) gene haplotypes in UK sheep flocks and evaluate their relevance to transmissible spongiform encephalopathies (TSEs) and TSE resistance breeding programmes in sheep.

METHODS AND RESULTS

Genomic DNA isolated from sheep blood was PCR amplified for the coding region of the PrP gene and then sequenced. This study has analysed the sequence of PrP between codons 110 and 245 in 6287 ARQ haplotypes revealing a total of eight variant sequences, which represent a higher than expected 41% of all ARQ haplotypes. The additional PrP gene dimorphisms were M112T, L141F, M137T, H143R, H151C, P168L, Q175E and P241S.

CONCLUSION

The results do not suggest a correlation between the occurrence of a specific ARQ haplotype and the scrapie disease status of a flock. The ARQ haplotype variability appears to be different in the UK sheep flocks compared with sheep flocks from outside the UK.

SIGNIFICANCE AND IMPACT OF THE STUDY

Additional PrP dimorphisms may impact on the methodologies used for standard PrP genotyping in sheep breeding programmes. Some of these polymorphisms were found with significant frequencies in the UK sheep flocks and should therefore be considered in breeding programmes.

Risk of scrapie in British sheep of different prion protein genotype

There is a well-established association between sheep prion protein (PrP) genotype and the risk of death from scrapie. Certain genotypes are clearly associated with susceptibility to the disease and others to resistance. However, there have been no attempts to quantify the disease risk for all 15 PrP genotypes. Here, datasets of the PrP genotypes of nearly 14 000 British sheep and of more than 1500 confirmed scrapie cases were combined to yield an estimate of scrapie risk (reported cases per annum per million sheep of the genotype, or RCAM) for British sheep. The greatest scrapie risk by far, ranging from 225 to 545 RCAM, was for the VRQ-encoding genotypes ARQ/VRQ, ARH/VRQ and VRQ/VRQ. The next greatest risk (37 RCAM) was for the ARQ/ARQ genotype. The ARR/ARR genotype was the only numerically significant genotype for which no scrapie cases have been reported. The AHQ allele conferred resistance and the risk of scrapie in AHQ/VRQ sheep was very low (0·7 RCAM), although there was a higher and moderate risk for the AHQ homozygote (5 RCAM). The ARH allele appeared to confer susceptibility when encoded with VRQ, but possible resistance when encoded with other alleles. Scrapie risk varied with age: for VRQ/VRQ and ARH/VRQ the risk peaked at 2 years of age; that for ARQ/VRQ peaked at 3 years. There was some evidence that, following the lower risk at 4 and 5 years, a second rise occurred from about 6 years. Comparison with other published data indicated that the scrapie risk of certain PrP genotypes may differ between Great Britain and other countries.

A novel cAMP-stimulated pathway in protein phosphatase 2A activation

Elevated cAMP in NRK-52E and L6 cells causes a marked reduction in the phosphorylation of numerous phosphoproteins, as detected initially with phosphoserine-specific antibodies. Here, we show that elevation of cAMP in NRK cells by forskolin/3-isobutyl-1-methylxanthine (IBMX) treatment decreased phosphorylation of substrates for different protein kinases, pointing to a common protein phosphatase as a target for cAMP-dependent regulation. Forskolin/IBMX treatment completely dephosphorylated a selective protein phosphatase 2A (PP2A) substrate, elongation factor-2 (EF-2), at its Ca(2+) calmodulin-dependent kinase site, and decreased phosphorylation of substrates for cyclin-dependent kinases, including retinoblastoma (Rb) protein. As reported before, forskolin/IBMX also decreased phosphorylation of a protein kinase C substrate, the Na,K-ATPase. The cAMP-stimulated dephosphorylation was blocked by the protein phosphatases 1 (PP1) and PP2A inhibitor okadaic acid at concentrations selective for PP2A but was not blocked by tautomycin at concentrations selective for PP1. The data implicate PP2A as a cAMP-activated phosphatase. Contrary to expectation, we found evidence that cAMP-dependent activation of PP2A did not depend on protein kinase A (PKA). Pretreatment of cells with the PKA inhibitor H89 abolished PKA activity measured in cell extracts and significantly decreased cAMP-activated phosphorylation of a known PKA substrate, ARPP-19, in cells, but failed to block the cAMP-stimulated dephosphorylation of EF-2, Rb, and other proteins. This novel pathway of PP2A activation, acting on the time scale of minutes, represents yet another example of a cAMP-mediated, PKA-independent signaling mechanism. Because PP2A is active toward a variety of endogenous substrates, cAMP-stimulated dephosphorylation may have complicated the interpretation of many prior studies.

Interaction of protein kinase C and cAMP-dependent pathways in the phosphorylation of the Na,K-ATPase

To test the hypothesis that there is cross-talk between the protein kinase C (PKC) and protein kinase A (PKA) pathways in the regulation of the Na,K-ATPase, we measured its phosphorylation in mammalian cell cultures. Phosphorylation of the PKC site, Ser-18, appeared to be due to the activation of the alpha isoform of the kinase. In NRK-52E and L6 cells, this phosphorylation was reduced by prior activation of a cAMP-dependent signaling pathway with forskolin. In principle this would be consistent with direct interaction between the two phosphorylation sites, but further investigation suggested a more indirect mechanism. First, phosphorylation of Ser-938, the PKA site, could not be detected despite the presence of active PKA. Second, there was a major reduction in the phosphorylation of unrelated phosphoproteins as a consequence of elevation of cAMP, suggesting generalized reduction of kinase activity or activation of phosphatase activity. In NRK-52E and L6, phosphorylation of the Na, K-ATPase at Ser-18 paralleled this global change. In C6 cells, in contrast, there was no cAMP effect on Na,K-ATPase phosphorylation at Ser-18 and no global cAMP effect on other phosphoproteins. The cross-talk is evidently mediated by events occurring at the cellular level.

Internal energies of analyte ions generated from different matrix-assisted laser desorption/ionization matrices

A transfer of energy into the internal modes of the matrix and analyte is expected to occur during matrix-assisted laser desorption/ioniziation (MALDI) processes. Both the physical and thermochemical properties of the MALDI matrix used can influence the ion internal energy and analyte ion fragmentation. Here we report the effect of several MALDI matrices on the relative internal energy of the 2'-deoxyadenylyl-(3',5')-2'-deoxyguanosine (AG) anion. Relative internal energies were probed by low-energy collision-induced dissociation in a Fourier transform ion cyclotron resonance mass spectrometer. Sublimation temperatures of the matrices under study were also determined and found to lie between 409 and 455 K. Analyte ion internal and initial kinetic energies did not correlate with matrix sublimation temperatures. In contrast, a strong correlation between the relative internal energy of the analyte anions and the gas-phase basicity of the matrix anions was found. These results suggest that gas-phase proton transfer reactions play an important role in MALDI analyte ion formation and influence their internal energy and fragmentation behavior. Copyright 2000 John Wiley & Sons, Ltd.

Methadone maintenance and hepatitis C virus infection among injecting drug users

Harm reduction strategies for the prevention of transmission of human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs) have been widely implemented in Australia and are seen to have been effective in preventing the spread of HIV. A major strategy has been increasing the availability of and accessibility to methadone maintenance therapy (MMT) programmes. We have reviewed the experience of a major MMT general practice with hepatitis C virus (HCV) infection from 1991 to 1995. Of 1741 individuals tested for HCV antibodies at least once 66.7% were positive. Of 73 IDUs who were initially seronegative and were retested at least once, 19 were subsequently seropositive. Seroconverters to HCV were younger than non-seroconverters, and were more likely to have evidence of previous hepatitis B infection. The overall HCV incidence rate was 22 cases per 100 person-years, and this did not differ between those on MMT programs (continuous or interrupted) between HCV tests and those not on MMT. These findings suggest that the role of MMT in the control of the spread of HCV infection among IDUs needs further assessment, and that control of the current epidemic of HCV infection among IDUs in Australia will be very difficult.

Impact of improved laboratory compliance on notification of genital Chlamydia trachomatis infection in Victoria

BACKGROUND AND OBJECTIVES

Although regulations in Victoria require notification of chlamydia infection by both clinician and laboratory, review found many reports that were notified only by one source (i.e., were unmatched).

GOALS

To identify problems with the notification system and to improve the quality of surveillance for this disease.

STUDY DESIGN

All notified cases of chlamydia diagnosed in January or February 1995 were followed up by contacting diagnosing doctors. Identified noncompliant laboratories were asked to provide a list of all diagnoses for the period and institute ongoing reporting. Notification data were reviewed for timeliness and completeness.

RESULTS

Clinicians never notified without laboratory confirmation. Soliciting laboratory reports increased total notifications by 30%, and there was a highly significant improvement in reporting by both clinicians and laboratories. Reasons for failure to notify by clinicians included an assumption by some clinicians that laboratories would notify and ignorance that notification was required.

CONCLUSIONS

Notified cases generally are now accompanied by a laboratory report, and although nonnotification by clinicians continues, notification has improved. Further improvements in clinician notification may depend on doctors knowing that public health action results from reporting. An alternative to requiring doctors' time to be spent in duplicate notification would be to strengthen laboratory reporting and then check that adequate treatment and partner notification has occurred through contact with the diagnosing doctor.

Surveillance for sexually transmissible diseases in Victoria, 1983 to 1992

Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Neisseria gonorrhoeae and cultures for Chlamydia trachomatis processed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and underdiagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.