Targeted disruption of decorin leads to abnormal collagen fibril morphology and skin fragility

Decorin is a member of the expanding group of widely distributed small leucine-rich proteoglycans that are expected to play important functions in tissue assembly. We report that mice harboring a targeted disruption of the decorin gene are viable but have fragile skin with markedly reduced tensile strength. Ultrastructural analysis revealed abnormal collagen morphology in skin and tendon, with coarser and irregular fiber outlines. Quantitative scanning transmission EM of individual collagen fibrils showed abrupt increases and decreases in mass along their axes. thereby accounting for the irregular outlines and size variability observed in cross-sections. The data indicate uncontrolled lateral fusion of collagen fibrils in the decorindeficient mice and provide an explanation for the reduced tensile strength of the skin. These findings demonstrate a fundamental role for decorin in regulating collagen fiber formation in vivo.

Smoking prevalence among women in the European community 1950-1990

The paper reviews trends in tobacco use among women in the European Community (EC) between 1950 and 1990. The data suggest that EC countries occupy different points on what appears to be a common prevalence curve. Southern EC countries are represented in the early phases of this curve, marked out by sharply rising prevalence. In northern EC countries, female smoking prevalence appears to have peaked. Across the EC, the commodification of tobacco use, and the production and promotion of manufactured cigarettes in particular, underlies this prevalence curve. Young women in higher socio-economic groups have led the way into cigarette smoking in both northern and southern Europe, with smoking prevalence declining first among women who are privileged in terms of their education, occupation and income. Because the decline in prevalence has yet to be repeated among women in more disadvantaged circumstances, cigarette smoking among women in the EC is likely to become a habit increasingly linked to low socio-economic status.

Women's smoking and family health

Women's smoking behaviour, and the smoking behaviour of mothers in particular, is becoming an important focus of research in the area of health and inequality. Smoking among women is linked to social disadvantage, with the highest rates among white women in working class households. Evidence is accumulating of the effects of women's smoking on their health and on the health of their children. Women's smoking behaviour is also implicated in the process of childhood socialisation into smoking, with mother's smoking attitudes and practices identified as powerful influences on children's smoking behaviour. Despite the emphasis on maternal smoking in epidemiological studies, little attention has been paid in psychological and social research to the experience of smoking in the context of poverty and motherhood. Drawing on a study of 57 women caring for pre-school children in low-income families, the article explores some of the complex links between women's poverty, caring and smoking. The study suggests that, for a significant minority of mothers, poverty and caring combine with low levels of physical and emotional energy, with sleep problems and with feelings of social isolation. In this context, smoking appeared to provide a way of coping with caring-in-poverty: a way of coping alone with the demands of full-time caring and with the struggle of making ends meet.

The influence of wheat bran and sugar-beet pulp on the digestibility of dietary components in a cereal-based pig diet

The influence of added wheat bran or dried sugar-beet pulp on the apparent digestion of dietary components was examined in pigs fitted with duodenal and terminal ileal cannulas. The pigs were fed a basal cereal-based diet alone or substituted at a level of 33% by wheat bran or beet pulp. Neither fibrous component influenced the digestibility of starch, but inclusion of beet pulp decreased dry matter content and digestibility of ash, protein and fat in the ileum and fecal digestibility of fat. Between 11 and 37% of the nonstarch polysaccharides were degraded anterior to the ileum, and the percentage of beet pulp diet nonstarch polysaccharides that was soluble increased from 11% in the feed to 35% at the ileum. Xylose and glucose were the least degraded nonstarch polysaccharide residues in all three diets, and the non-starch polysaccharide residues varied in susceptibility to breakdown within and between diets, depending on the composition of the fiber. Almost 50% of the beet pulp, but less than 20% of the wheat bran, was degraded in the large intestine. The inclusion of wheat bran and beet pulp increased fecal output by 127 and 56%, respectively.

Response of circulating tumor cells to systemic therapy in patients with metastatic breast cancer: comparison of quantitative polymerase chain reaction and immunocytochemical techniques

PURPOSE

We previously developed a quantitative system for the detection of cytokeratin 19 (CK-19) transcripts using reverse transcriptase polymerase chain reaction (PCR) to detect breast carcinoma cells in blood and bone marrow. The aim of this study was to determine the value of this system in monitoring patients with metastatic disease and to compare it with an established immunocytochemical method.

PATIENTS AND METHODS

Patients with progressive, locally advanced, and metastatic breast cancer (all stage IV) who were due to start systemic treatment were recruited. Blood samples were analyzed for CK-19 transcripts using quantitative PCR (QPCR) and immunocytochemistry (ICC) throughout their course of treatment.

RESULTS

One hundred forty-five blood samples were obtained from 22 patients over 13 months. Seventy-two (49.6%) of these samples were positive by QPCR, and 56 (42%) of 133 were positive by ICC. Of the 133 specimens analyzed by both techniques, 95 (71.4%) had the same results for each, and of the 71 samples that were positive, 40 (56%) were positive by both methods. The relationship between the number of cells detected and the QPCR values was statistically significant (P <.0001). Of the 25 courses of assessable treatment, 17 (68%) of 25 treatment outcomes (either response or disease progression) were reflected by QPCR measurements, and 12 (57%) of 21 were reflected by ICC. During the course of the study, five patients showed a response, and of these, ICC was in agreement in four cases (80%) and QPCR in three cases (60%). Eighteen courses of treatment resulted in progression of the disease; however, only 15 of these were assessable by ICC. ICC was in agreement in eight (53%) of 15 of these cases, and QPCR in 15 (83%) of 18 cases.

CONCLUSION

Circulating carcinoma cells are frequently found in patients with metastatic breast cancer. In the majority of patients, cancer cell numbers as evaluated by QPCR or ICC reflected the outcome of systemic treatment.

Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilities

BACKGROUND

Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of 'typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position.

METHODS

This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID.

RESULTS

Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy.

CONCLUSIONS

A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage.

A study of the pathogenesis of Helicobacter pylori negative chronic duodenal ulceration

In the past five years 12 patients have been identified presenting with chronic duodenal ulcer (DU) disease and with no evidence of current or recent Helicobacter pylori (H pylori) infection. Four of them were taking regular non-steroidal anti inflammatory agents, one was subsequently found to have Crohn's disease of the duodenum, and one to have the Zollinger-Ellison syndrome. The remaining six patients with idiopathic DU disease were remarkable for their absence of the A1 blood antigen gene. Detailed studies of gastric function were performed in these six patients and compared with H pylori positive patients with DU and with healthy volunteers. The median integrated gastrin response in the patients with idiopathic DU (2810 (range 750-8750) ng/l min) was similar to that of the H pylori positive patients with DU (3355 (550-8725)) and higher than that of the H pylori negative healthy volunteers (560 (225-1125)). The median peak acid output in the patients with idiopathic DU (37 mmol/h, range 17-52) was similar to that of the H pylori positive patients with DU (40 (15-57)) and higher than that of the non-ulcer controls (22 (16-29)). The median percentage of a liquid meal retained in the stomach at 60 minutes was less in the patients with idiopathic DU (23 (15-33)) than in H pylori negative healthy volunteers (34 (30-53) p < 0.01). The median percentage of a solid meal retained at 60 minutes was less in the patients with idiopathic DU (54 (9-83)) than in either H pylori negative healthy volunteers (87 (49-95) p<0.01) or H pylori positive patients with DU (79 (51-100) p<0.01). In conclusion, three abnormalities of gastric function are prevalent in patients with H pylori negative idiopathic DU disease - hypergastrinaemia, increased acid secretion, and the one feature distinguishing them from H pylori positive patients with DU - rapid gastric emptying of both liquids and solids. Each of these abnormalities will increase the exposure of the duodenal mucosa to acid and thus explain its ulceration. The absence of the blood group A1 antigen gene is consistent with a genetic basis for the disturbed gastric function linked to the ABO blood group antigen genes.

Gender and class as dimensions of smoking behaviour in Britain: insights from a survey of mothers

The decline in cigarette smoking in Britain over the last four decades has been associated with a profound change in its social distribution. Gender differences have narrowed to the point where smoking has all but lost its male identity. Class differences have widened, with cigarette smoking emerging as a habit sustained within working class communities. The paper reports on a study which sheds light on how being a woman and being working class connects with smoking behaviour. Focusing on women with young children, the study points to clear associations between smoking status and the social and material circumstances of mothers' lives. Specifically, it highlights how cigarette smoking is linked to additional caring responsibilities and restricted access to material resources.

Structures of active and latent PAI-1: a possible stabilizing role for chloride ions

Serpins exhibit a range of physiological roles and can contribute to certain disease states dependent on their various conformations. Understanding the mechanisms of the large-scale conformational reorganizations of serpins may lead to a better understanding of their roles in various cardiovascular diseases. We have studied the serpin, plasminogen activator inhibitor 1 (PAI-1), in both the active and the latent state and found that anionic halide ions may play a role in the active-to-latent structural transition. Crystallographic analysis of a stable mutant form of active PAI-1 identified an anion-binding site between the central beta-sheet and a small surface domain. A chloride ion was modeled in this site, and its identity was confirmed by soaking crystals in a bromide-containing solution and calculating a crystallographic difference map. The anion thus located forms a 4-fold ligated linchpin that tethers the surface domain to the central beta-sheet into which the reactive center loop must insert during the active-to-latent transition. Timecourse experiments measuring active PAI-1 stability in the presence of various halide ions showed a clear trend for stabilization of the active form with F(-) > Cl(-) > Br(-) >> I(-). We propose that the "stickiness" of this pin (i.e., the electronegativity of the anion) contributes to the energetics of the active-to-latent transition in the PAI-1 serpin.

Childhood disadvantage and health inequalities: a framework for policy based on lifecourse research

Tackling health inequalities is moving up the policy agenda of richer societies like the UK, with governments looking for evidence to guide policy review and development. Observational studies of how childhood disadvantage compromises health in adulthood are an important part of the evidence base, but are largely inaccessible to the policy community. We develop a framework which captures the findings of these studies. Our framework highlights how disadvantage in childhood adversely affects both socio-economic circumstances and health in adulthood through a set of interlocking processes. Key among these are children's developmental health (their physical, cognitive and emotional development) and health behaviours, together with the associated educational and social trajectories. In breaking down the link between childhood disadvantage and adult health into its constituent elements, the framework provides a basis for understanding where and how policies can make a difference. The paper argues that the process of policy review and development needs to include both new programmes and the mainstream policies in which they are embedded.

Can readmissions to a geriatric medical unit be prevented?

During the year ending April 2, 1982, 153 patients readmitted to a geriatric medical unit within twelve months of their previous discharge from any hospital in the district accounted for 24.8% of the 617 patients admitted. Readmission of the 153 patients was due to unavoidable clinical deterioration (32%), inadequate medical management (21%), non-compliance of patient (20.2%), social problems (18.3%), or inadequate rehabilitation (8.5%). Readmission could have been prevented in 73 (47.7%) patients. These figures emphasise the importance of greater medical interest in the problems of the aged and support the need for a higher consultant/bed ratio in geriatric medical units to allow more effective management of patients aged 75 years and over.

Social determinants and lifestyles: integrating environmental and public health perspectives

OBJECTIVE

Industrialization and urbanization have been associated with an epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the stable Holocene epoch in which human societies have prospered. The lifestyles of high-income countries are major drivers of these twin processes. Our objective is to highlight the common causes of chronic disease and environmental change and, thereby, contribute to shared perspectives across public health and the environment.

STUDY DESIGN

Integrative reviews focused on social determinants and lifestyles as two 'bridging' concepts between the fields of public health and environmental sustainability.

METHODS

We drew on established frameworks to consider the position of the natural environment within social determinants of health (SDH) frameworks and the position of social determinants within environmental frameworks. We drew on evidence on lifestyle factors central to both public health and environmental change (mobility- and diet-related factors). We investigated how public health's focus on individual behaviour can be enriched by environmental perspectives that give attention to household consumption practices.

RESULTS

While SDH frameworks can incorporate the biophysical environment, their causal structure positions it as a determinant and one largely separate from the social factors that shape it. Environmental frameworks are more likely to represent the environment and its ecosystems as socially determined. A few frameworks also include human health as an outcome, providing the basis for a combined public health/environmental sustainability framework. Environmental analyses of household impacts broaden public health's concern with individual risk behaviours, pointing to the more damaging lifestyles of high-income households.

CONCLUSION

The conditions for health are being undermined by rapid environmental change. There is scope for frameworks reaching across public health and environmental sustainability and a shared evidence base that captures the health- and environmentally damaging impacts of high-consumption lifestyles.

Effect of pelleting and beta-glucanase supplementation on the ileal and fecal digestibility of a barley-based diet in the pig

The influences of pelleting and beta-glucanase supplementation on the digestibility of dietary components in a barley-based diet were investigated in pigs fitted with cannulas in the terminal ileum. The diet contained 49.0% starch, 18.9% crude protein and 14.8% dietary fiber, with arabinoxylans (4.9%), mixed-linked beta-glucans (3.4%) and cellulose (3.3%) as the main fiber components. Pelleting increased mixed-linked beta-glucan solubility from 45 to 62%. Neither treatment influenced the ileal or fecal apparent digestibilities of dry matter (64 and 80%, respectively), energy (62 and 79%), crude protein (53 and 75%), crude fat (26 and 27%) or dietary fiber (58 and 72%). However, pelleting increased (P less than .01) the pre-ileal apparent digestibility of starch from 91.5 to 95.3% and decreased (P less than .03) that of ash from -10 to -23%, while increasing (P less than .005) the fecal apparent digestibility of starch from 98.6 to 99.7%. The solubility of mixed-linked beta-glucans in ileal digesta was lower (P less than .001) in pelleted (26%) than in unpelleted (58%) diets. beta-glucanase supplementation also increased (P less than .05) the ileal apparent digestibility of starch, from 92.6 to 94.3%, and of mixed-linked beta-glucans, from 95.7 to 97.1%. Significant between-pig differences in the apparent digestibility of dietary components were observed. In conclusion, treatments that disrupt the endosperm cell walls in barley can increase the proportion of the diet digested prior to the large intestine.

Cigarette consumption and socio-economic circumstances in adolescence as predictors of adult smoking

AIM

To investigate effects of cigarette consumption level and socio-economic circumstances during adolescence on adult smoking.

METHODS

1958 British birth cohort (all births 3-9 March 1958). Logistic regression used to predict (i) smoking at 41 years and (ii) persistent smoking (at 23, 33 and 41 years) from cigarette consumption and socio-economic circumstances at 16 years, indicated by social class and educational qualifications.

RESULTS

Of 6537 subjects with full smoking history, 30% smoked at 16 years, 23% smoked at 41 years and 19% smoked at 23, 33 and 41 years (persistent smokers). Heavier smokers at 16, 23 and 33 years were more likely to smoke at 41 years than lighter smokers. The odds ratio (OR) of smoking at 41 years was 2.5 for men and 3.0 for women who smoked >/=60 cigarettes/week at age 16, relative to <20 cigarettes/week. Subjects from manual social backgrounds and those with no qualifications had elevated risks of being a smoker at 41 years or a persistent smoker. These effects were robust to adjustment for adolescent consumption level (e.g. adjusted OR for no qualifications was 3.8). However, adolescent consumption level modified the effect of educational achievements. Among lighter adolescent smokers, those gaining higher qualifications had lower prevalence of smoking at 41 years (16%) than men with no qualifications (83%); among heavier adolescent smokers, prevalence was more similar for subjects with higher (56%) and no qualifications (69%).

CONCLUSIONS

Socio-economic background appears to influence adult smoking behaviour separately from adolescent cigarette consumption which is a recognized measure of nicotine dependence. There was some evidence that effects of early nicotine dependence are modified by educational achievements.

Tip-mediated fusion involving unipolar collagen fibrils accounts for rapid fibril elongation, the occurrence of fibrillar branched networks in skin and the paucity of collagen fibril ends in vertebrates

Collagen fibrils are the principal source of mechanical strength of connective tissues such as tendon, skin, cornea, cartilage and bone. The ability of these tissues to withstand tensile forces is directly attributable to the length and diameter of the fibrils, and to interactions between individual fibrils. Although electron microscopy studies have provided information on fibril diameters, little is known about the length of fibrils in tissue and how fibrils interact with each other. The question of fibril length has been difficult to address because fibril ends are rarely observed in cross-sections of tissue. The paucity of fibril ends, or tips, has led to controversy about how long individual fibrils might be and how the fibrils grow in length and diameter. This review describes recent discoveries that are relevant to these questions. We now know that vertebrate collagen fibrils are synthesised as short (1-3 microm) early fibrils that fuse end-to-end in young tissues to generate very long fibrils. The diameter of the final fibril is determined by the diameter of the collagen early fibrils. During a late stage of tissue assembly fibril tips fuse to fibril shafts to generate branched networks. Of direct relevance to fibril fusion is the fact that collagen fibrils can be unipolar or bipolar, depending on the orientation of collagen molecules in the fibril. Fusion relies on: (1) specific molecular interactions at the carboxyl terminal ends of unipolar collagen fibrils; and (2) the insulator function of small proteoglycans to shield the surfaces of fibrils from inappropriate fusion reactions. The fusion of tips to shafts to produce branched networks of collagen fibrils is an elegant mechanism to increase the mechanical strength of tissues and provides an explanation for the paucity of fibril tips in older tissue.

Characteristics associated with smoking cessation during pregnancy among working class women

Although smoking prevalence among pregnant women is highest among those of lower socio-economic status, the factors associated with cessation in this high risk group are poorly documented. This paper reports on data from a survey of working class women in Nottingham and Coventry, who were interviewed 6 months after having delivered a baby. It compares the characteristics of the 32 women who quit smoking during their pregnancy and were still ex-smokers at the 6 month post-natal point, with 472 women who had continued to smoke during their pregnancy or had returned to smoking in the post-partum period. A logistic regression analysis revealed three variables that were independently associated with long term cessation-having previously quit for more than 1 week, having a non-smoking partner, and believing that the children of smokers are more likely to get infections. Among the most disadvantaged, an understanding of how close social ties and economic circumstances influence smoking behaviour is crucial, if we are to develop more effective smoking cessation intervention strategies for working class women.

The social context of parenting 3-year-old children with developmental delay in the UK

BACKGROUND

Children with intellectual or developmental disability have significantly poorer health and mental health than their non-disabled peers and are at high risk of social exclusion. The aim of the present paper is to provide information on the circumstances in which 3-year-old children at risk of intellectual or developmental disability are growing up in the UK.

METHODS

Secondary analysis of data on 12 689 families in English-speaking monolingual households from the first two waves of the UK's Millennium Cohort Study. A total of 440 children (3% of the weighted sample) were identified as being developmentally delayed.

RESULTS

When compared with other children, children with developmental delays were more disadvantaged on every indicator of social and economic disadvantage examined. Two out of three children with developmental delays had been exposed to repeated disadvantage as measured by income poverty, material hardship, social housing and receipt of means-tested benefits. The effect of repeated disadvantage on the risk of developmental delay remained after account was taken of parental education and occupational status.

CONCLUSIONS

Young children with delayed development in the UK are likely to be exposed to repeated socio-economic disadvantage. Implications for policy and understanding the nature of the link between poverty and child disability are discussed.