Systematic Review of the Impact of Nutrition and Physical Activity on Cardiovascular Disease Risk Among Firefighters

Objectives

The objective of this systematic review was to summarize the literature on non-occupational cardiovascular disease (CVD) risk factors experienced by firefighters, specifically those related to nutrition, physical fitness, and physical activity.

Methods

Two electronic databases (PubMed and Scopus) were used for this review. Search terms included those related to CVD, nutrition, physical fitness, and physical activity among firefighters. The PRISMA checklist was followed to ensure a rigorous review. The Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research was also used for critical appraisal of the included studies. The review process was performed by one researcher and is in the process for a second independent researcher to reduce bias.

Results

Twenty-six (n = 26) articles were included in the final qualitative synthesis (4 nutrition, 4 nutrition and physical fitness/activity, and 18 physical fitness/activity). The outcomes were that firefighters do not engage in regular physical activity, tend to have substandard fitness levels and poor dietary habits, and work in a poor food environment. These factors have been shown to relate with higher prevalence of CVD and its indicators. These studies also suggest that firefighters want information, programs, and resources related to improving nutrition and physical activity to reduce CVD.

Conclusions

Among firefighters, numerous studies exist regarding increased CVD risk related to inadequate physical fitness and activity levels, however, few studies address the role of a healthy diet in the development of CVD risk. This review is beneficial for public health practitioners, researchers, and fire service leaders, as it provides insight into the need to further investigate how diet affects CVD risk among the firefighting population.

Funding Sources

None.

Impact of Child Nutrition Programs Offered in Schools on Daily Nutrition and Dietary Quality

Objectives

The average Healthy Eating Index-2015 (HEI) score for children 2–17 years of age is 53.9 out of 100. HEI scores for dietary quality directly and positively impact children's health, academic performance, and their futures. Because school Child Nutrition Programs (CNPs) impact a large proportion of US children, it is important to evaluate these programs to determine the nutrition they are providing to children, as well as their impact on dietary quality. Thus, the purpose of this study is to determine the overall nutrition provided by the four CNPs that can be implemented consistently and collectively each school day [School Breakfast Program (SBP), National School Lunch Program (NSLP), Fresh Fruit and Vegetable Program (FFVP), and the Afterschool Snack Program (ASSP)] and to determine the dietary quality score achieved collectively by serving each of these four CNPs.

Methods

This cross-sectional content analysis included four-week sample cycle menus for each of CNPs offered to elementary-aged children. Sample menus for breakfast (SBP) and lunch (NSLP) were actual cycle menus from the Cooking for Kids program. Sample menus for FFVP and ASSP were created by two researchers, who are CNP experts. Nutrient content was determined using nutrient analysis software. Dietary quality scores were determined using the HEI-2015.

Results

The proportion of daily nutrient needs met by the combined menus ranged from 0.15% to 403.7%, with an average proportion of 124.0%. The menus exceeded child daily nutrient needs for 18 of the 30 nutrients and met at least 50% of needs for 8 nutrients. The combined menus had an average 29.4-point (54.5%) higher HEI score compared to the average HEI score of the 2–17 year-old US child's diet (p = 0.002). Significant differences in HEI scores between the combined menus and the diet of the average US child included whole grains, dairy, added sugar, and total score favoring higher dietary quality in the combined menus (p < 0.05).

Conclusions

The results of the current study support why school districts should implement all four CNPs (SBP, NSLP, FFVP, ASSP) within their schools if possible, especially in low-income areas where children may not be provided with adequate nutrition outside of school, to provide children with the highest dietary quality meal patterns and to greatly contribute to children's daily nutrient needs.

Funding Sources

None.

Qualitative Assessment of Fire Station Food Environment Using Photovoice

Objectives

Cardiovascular events are the leading cause of death for on-duty firefighters. Studies evaluating modifiable risk factors to mitigate this outcome are nascent. Limited qualitative data suggest fire station food environments are “toxic” and demand attention. Further defining objective evaluations of the food environment and associated perceptions among firefighters are essential for development of interventions. The objective of this study was to define the fire station food environment using a novel approach.

Methods

This cross-sectional study employed Photovoice to document food environment healthfulness of four fire stations within a rural Midwest career fire department. Photos of the fire station food environment were taken in the ‘voice’ of firefighters and researchers. Details surrounding timing, fire station, shift, food location, and voice were captured for each photo. Photos were then coded deductively based on criteria selected a priori, including presence of Healthy Eating Index 2015 (HEI) components for dietary quality (DQ) and behavioral economics techniques (BET) supporting foods in photos. NVivo qualitative analysis software was used for analysis. Descriptive statistics summarized frequency of codes and photo details. Chi-square was used to compare frequency of codes across photo details.

Results

Analysis included 40 images. Based on preliminary results, there were 273 total coded references. Moderation HEI components and BET promoting them were the most frequent codes: low DQ food is normal (10.3% of coded references), added sugar (9.9%), low DQ food is convenient (9.2%), low DQ foods are attractive (8.8%), saturated fat (8.4%), and sodium (8.4%). Adequacy HEI components and BET promoting them were less frequently coded: total fruit (1.5%), whole fruit (1.5%), whole grains (1.8%), and dark greens and legumes (2.2%).

Conclusions

Results confirm existing data that fire station food environments support low DQ food choices. The most common coded references were low DQ food is normal, attractive, and convenient, as well as presence of added sugar, saturated fat, and sodium. The least common coded references included presence of fruits, whole grains, and dark greens and legumes and their promotion. This indicates an unhealthy, obesogenic food environment.

Funding Sources

OSU Vice President for Research Jumpstart Accelerator Grant.

Analysis of a State Police Academy Menu Cycle for Dietary Quality and Performance Nutrition Adequacy

Objectives

Current literature suggests law enforcement officers have high rates of obesity. With diet as a leading risk factor, early career nutrition interventions could be beneficial in establishing long-term healthy eating habits. Thus, the purpose of this study was to determine the diet quality (DQ) and performance nutrition adequacy of a state police academy's dining facility menu.

Methods

This cross-sectional content analysis included six weeks (three daily meals, Monday–Friday) of a state police academy's dining facility menu. Nutrient content was determined by meeting with the dining facility manager, portioning menus, gathering food specifications from purchase orders, and then performing nutrient analysis. DQ was assessed using the Healthy Eating Index-2015 (HEI). Independent t-test and Cohen's d determined differences between menu nutrient content and performance nutrient needs.

Results

The mean (±SD) total HEI score for the six-week menu was 54 ± 9.55 out of 100. Subcomponent scores of total protein (4.97 out of 5) and whole fruits (4.77 out of 5) indicate adequacy. Total fruit (3.19 out of 5), whole grains (6.10 out of 10), total vegetable (3.77 out of 5), and dark greens and legumes (3.51 out of 5) scores could be improved. Seafood and plant proteins (0.33 out of 5), fatty acid ratio (1.31 out of 5), and dairy (1.59 out of 10) scores were low. The menu met recommended intake for 13 of 19 subcomponents investigated. Subcomponents that did not meet adequacy were calories (% mean difference, needs – menu = 36.7%), carbohydrates (% mean difference = 52.3%), vitamins D (% mean difference = 82.5%) and E (% mean difference = 66.7%), magnesium (% mean difference = 44.1%), and potassium (% mean difference = 41.8%).

Conclusions

The academy menu is adequate in most performance-related nutrients, but also leaves room for improvement in DQ and shortfall nutrients. By focusing on increasing low HEI subcategory scores, overall DQ of the menu will increase and could potentially simultaneously make up for inadequate nutrients. To optimize current and future performance and health, police academies should consider evaluating their menus and ensuring adequacy and high DQ.

Funding Sources

None.

Mindfulness Surrounding Eating Among Current Firefighters, Law Enforcement Officers, and Military Personnel and Its Relationship to Weight Status

Objectives

Obesity among first responders and military personnel is a major concern for personal health and occupational performance, with 40% of law enforcement (LE) officers obese, 70–75% of firefighters overweight/obese, and about 25% of the military personnel overweight/obese. There is also high occurrence of anxiety, depression, substance abuse, emotional strain, sleep disturbances, and suicide among these groups. A point of connection is mindfulness surrounding eating, as it is related to obesity, such that as mindfulness during eating decreases, body mass index (BMI) increases from excess calorie intake. The purpose of this study was to determine level of mindfulness surrounding eating among current firefighters, LE officers, and military personnel and how it relates to weight status.

Methods

This cross-sectional study employed an online survey shared via social media and email, including demographics, physical activity level, diet type and perceived healthfulness, BMI, and 20-item mindful eating questionnaire (MEQ). Descriptive statistics assessed level of mindfulness of the tactical groups. Correlation coefficients were calculated to determine relationships between MEQ scores and demographics, physical activity level, diet type and perceived healthfulness, and BMI.

Results

Preliminary data from 120 surveys (85% fire, 2.5% LE, 12.5% military) indicate MEQ scores for all tactical groups ranged from 2.50–4.47 out of 5. Average MEQ score (± standard deviation) for all tactical groups was 3.13 ± 0.46, with a score of 3 indicating mostly neutral/lack mindfulness surrounding eating. MEQ scores were similar across tactical occupations (fire = 3.12 ± 0.47, LE = 3.33 ± 0.80, military = 3.17 ± 0.70).

Conclusions

 Considering negative consequences of obesity among these groups for themselves, one another, and those they serve, investigating mindfulness surrounding eating indicates ambivalence and need for further research, including intervention, in this area.

Funding Sources

Oklahoma State University Freshman Research Scholars program.

Results of the ROTC and Nutrition/Kinesiology (RANK) Needs Assessment

Objectives

Military officers report obtaining nutrition information most often from popular media and least often from doctors or dietitians. The majority of officers state the military places too little emphasis on nutrition and there needs to be greater focus on changing Soldiers’ nutrition. They suggest increasing opportunities for nutrition education for military personnel. Collaborations between university departments and ROTC programs present as an ideal opportunity. Thus, the purpose of the RANK needs assessment was to determine interest, perceived importance, desired components, and foreseen challenges to a nutrition and physical training education program for university ROTC programs by cadets (students) and cadre (instructors).

Methods

Two focus groups were conducted in November 2020 with cadets (n = 5) and cadre (n = 5) in OSU ROTC programs. Questions covered demographics, level of interest, perceived importance, class logistics, interest in additional services, and career impact. Thematic analysis was performed using video recordings and detailed notes.

Results

Out of 5 (highest interest), cadets scored interest as 4.8 and importance as 4.2. Cadre scored interest and importance as 5. Cadets and cadre were consistent in responses regarding class logistics. They recommended classes be offered in person, livestreamed, and recorded to maximize reach and include PowerPoint slides, but remain interactive. They reported no need for incentives. A health challenge aspect was desirable. Class length and frequency was suggested at one hour every week of the semester. Cadets foresaw several major benefits, while cadre provided a long list of benefits for cadets’ future careers.

Conclusions

University departments collaborating with their respective ROTC programs to provide nutrition/physical training classes is of high interest and importance to cadets and cadre with countless significant benefits to the careers of these future military leaders.

Funding Sources

Oklahoma State University Wentz Research Scholarship.

Determinants of Postprandial Triglycerides Across the Spectrum of Aging

Objectives

Elevated postprandial triglycerides (TG) are a risk factor for cardiovascular disease, and older adults exhibit greater postprandial lipemia (PPL) compared to younger adults. However, determinants of PPL, especially in older populations, remain poorly defined. This cross-sectional study examined the influence of body composition, lifestyle behaviors, and metabolic risk factors for PPL across the aging spectrum.

Methods

We recruited individuals evenly distributed between the ages of 50–89 years (50% male; 50% female). Participants completed diet and physical activity questionnaires and wore an accelerometer for 5 days. Body composition was measured via bioelectrical impedance. Following an overnight fast, participants also completed an abbreviated fat tolerance test: a blood draw was performed before and 4 hours after consumption of a high-fat meal (9 kcal/kg; 73% fat) to determine fasting and peak postprandial metabolic responses.

Results

56 participants (age groups: 50s, n = 15; 60s, n = 15; 70s, n = 15; 80s,  n = 11) completed the study. Fasting TG did not differ across age groups (50s: 99.7 ± 50.1 mg/dL; 60s: 114.3 ± 71.1 mg/dL; 70s: 102.9 ± 45.0 mg/dL; 80s: 86.9 ± 39.5 mg/dL; P = 0.63). There was also no difference in 4-hour TG across age groups (50s: 162.9 ± 76.9 mg/dL; 60s: 181.9 ± 99.9 mg/dL; 70s: 130.8 ± 82.0 mg/dL; 80s: 130.8 ± 60.6 mg/dL; P = 0.40). Across age groups, variables significantly correlated (p's &lt; 0.05) with 4-hour TG included BMI (r = 0.29), visceral adiposity (r = 0.31), ALT (r = 0.37), fasting glucose (r = 0.27), 4-hour glucose (r = 0.34) and alcohol intake (r = 0.33). In a backward elimination regression (R2 = 0.31), the most predictive variables of 4-hour TG were 4-hour glucose (β = 0.31; P = 0.01), ALT (β = 0.33; P = 0.007), and alcohol intake (β = 0.25; P = 0.04).

Conclusions

In older adults aged 50–89, we identified ALT, postprandial glucose, and alcohol intake as key determinants of postprandial TG. Future studies should aim to explore the relationship between liver health, insulin resistance, alcohol intake, and PPL across the aging spectrum.

Funding Sources

Donna Cadwalader Research and Development Grant, College of Education and Human Sciences and Oklahoma State University Foundation.

Relationship Between Body Mass Index and Health and Occupational Performance Among Law Enforcement Officers, Firefighters, and Military Personnel: A Systematic Review

Objectives

The prevalence of overweight and obesity among tactical populations is estimated at 70–75%, which may negatively impact health and performance. Since the relationship between BMI and health and performance is not well studied in tactical populations, the purpose of this study was to systematically review available literature on the relationship between BMI and health and performance among law enforcement officers (LEO), firefighters, and military personnel.

Methods

Literature searches were conducted in PubMed and SCOPUS using combinations of search terms: body mass index, health*, cardiovascular disease, heart disease, heart attack, myocardial infarction, heart failure, stroke, hypertension, cancer, diabetes, performance, physical fitness test*, physical training, fitness test*, injur*, law enforcement, police, trooper, firefighter, military, soldier, airmen, and sailor. Included studies used BMI as an adiposity assessment; involved cardiovascular disease (CVD), cancer, diabetes (T2DM), performance testing, and injuries among US LEOs, firefighters, or military personnel; and involved peer-reviewed primary research between 2000–2020. Review studies; studies on other tactical populations, retirees, and trainees; and studies using BMI as a covariate were excluded. Included articles were critically appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

Results

Twenty-seven articles were included. Overall quality was neutral. Nine studies found BMI was positively associated with CVD risk factors. Studies involving BMI and cancer were lacking. One study found BMI was positively associated with T2DM risk. Five studies on occupational/physical performance and twelve studies on injury found a higher BMI was often indicative of decreased performance and increased risk of injury in general, but protective against stress fractures.

Conclusions

Higher BMI was often associated with negative health and performance outcomes among tactical populations, especially when beyond the overweight classification. Public health practitioners should focus efforts on improving nutrition and physical activity to promote a healthy BMI among these individuals.

Funding Sources

None.

An investigation of putative exposure of staff to novel psychoactive substances in a prison

Issue

In a prison in Scotland, an increasing number of incidents occurred where staff became unwell secondary to potential exposure to novel psychoactive substances (NPS) smoked by prisoners. There were high levels of concern for the safety of individual staff, and for establishment staffing. NPS use is a significant problem in custodial settings, and impacts individuals and establishments.

Methods

HMP and HPT led an incident response: HMP focused on prevention and direct management of incidents; HPT focused on exposure circumstances, clinical presentation and toxicological testing of symptomatic staff. A protocol was agreed between all agencies involved. Over 8 months, all incidents’ initial assessment and any subsequent clinical and toxicological results were collated and analysed by HPT.

Results

There were 19 incidents involving 16 staff members. Cases presented in clusters, in one instance 13 people presented over 5 days. Five presented in early 2018.

Individuals reported a wide range of non-specific physical and psychological effects; some cases experienced severe impairment of day-to-day function. The most common effects were headache and fatigue but some reported sleep disturbance and confusion lasting up to 72 hrs. There were no significant clinical observations at hospital, and the 3 tests for toxicology were negative.

Lessons

The individuals affected by these incidents experienced physical and psychological distress, and impairment of daily functioning which impacted on the safe function of the establishment. It is unlikely staff presentations were due to toxicological effects from substances used by prisoners. It is possible their symptoms were psychosomatic. This could be further investigated, and consideration given to supportive intervention for staff affected by exposure to NPS. The investigation demonstrated excellent collaborative work between the prison, health services, and forensic laboratories in a novel investigation into NPS exposure in prisons.

Key messages

NPS use, and subsequent exposure to staff, is a growing issue in custodial settings. A combination of supportive interventions for staff, including reduction and mitigation of risk of exposure to NPS, plus control of substances use in prisons can help.

Biparental/androgenetic mosaicism in a male with features of overgrowth and placental mesenchymal dysplasia

Biparental/androgenetic mosaicism is a rarely diagnosed condition in humans. It is typically ascertained prenatally on the basis of placental mesenchymal dysplasia. Fetal outcome can range from demise due to intrauterine growth retardation to term delivery. Most of the published cases of liveborns represent females that are either completely normal or have features of Beckwith-Wiedemann syndrome. Only two healthy liveborn males with mosaicism detected in the placenta have been described to date. Here, we report another liveborn male with hepatic mesenchymal hamartoma, soft tissue overgrowth on his right fifth toe, hemangiomas over his chest, right buttock and foot, anemia, thrombocytopenia and congenital hypothyroidism with biparental/androgenetic mosaicism detected in the toe mass in addition to the placenta. This new case adds to the existing literature of individuals with biparental/androgenetic mosaicism and expands the range of clinical presentations that may be seen in male patients with this condition. This study also illustrates the important use of single-nucleotide polymorphism microarray in conjunction with short-tandem repeat analysis on affected tissue to provide a diagnosis for patients with features of overgrowth and prior, non-diagnostic, genetic analyses of their peripheral blood.

The microfluidics of the eccrine sweat gland, including biomarker partitioning, transport, and biosensing implications

Non-invasive and accurate access of biomarkers remains a holy grail of the biomedical community. Human eccrine sweat is a surprisingly biomarker-rich fluid which is gaining increasing attention. This is especially true in applications of continuous bio-monitoring where other biofluids prove more challenging, if not impossible. However, much confusion on the topic exists as the microfluidics of the eccrine sweat gland has never been comprehensively presented and models of biomarker partitioning into sweat are either underdeveloped and/or highly scattered across literature. Reported here are microfluidic models for eccrine sweat generation and flow which are coupled with review of blood-to-sweat biomarker partition pathways, therefore providing insights such as how biomarker concentration changes with sweat flow rate. Additionally, it is shown that both flow rate and biomarker diffusion determine the effective sampling rate of biomarkers at the skin surface (chronological resolution). The discussion covers a broad class of biomarkers including ions (Na(+), Cl(-), K(+), NH4 (+)), small molecules (ethanol, cortisol, urea, and lactate), and even peptides or small proteins (neuropeptides and cytokines). The models are not meant to be exhaustive for all biomarkers, yet collectively serve as a foundational guide for further development of sweat-based diagnostics and for those beginning exploration of new biomarker opportunities in sweat.

Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation

BACKGROUND

Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.

METHOD

Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points--at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.

RESULTS

Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.

CONCLUSIONS

Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

Therapeutic and prophylactic ethanol lock therapy in patients with bleeding disorders

Obtaining a reliable venous access is a limiting factor for early initiation of clotting factor prophylaxis and immune tolerance induction. To circumvent this issue, central venous access devices (CVADs) are increasingly being used. Catheter-related infections (CRIs) remain the primary complication of insertion of CVAD. Thus, newer strategies for treatment and prevention of CRI are needed. Ethanol lock therapy (ELT) has been used to treat and prevent CRI in non-bleeding disorder patients. The aim of this study was to assess the efficacy of ELT in treating and preventing CRI in bleeding disorder patients. The medical charts of patients with bleeding disorders who underwent ELT for antimicrobial resistant CRIs were reviewed and data were analysed. ELT was effective in catheter salvage in 87% of patients with antimicrobial resistant CRI by a wide variety of pathogens. Prophylactic therapy with ethanol lock was associated with catheter dysfunction especially in mediports. ELT should be considered prior to removal of catheters in bleeding disorder patients with resistant CRIs. Further studies are needed for using prophylactic ethanol lock in prevention of CRIs in bleeding disorder patients.

Facing the challenge of mental ill health in the workplace

Purpose

This paper aims to outline the extent and cost of work‐related mental ill health and the challenges it causes in the workplace. It focuses on what employers can do to facilitate an early return to work for those absent from work. It argues for a proactive approach to the management of mental ill health in the workplace and highlights the important role of the line manager. Good practice from Europe is reported.

Design/methodology/approach

This paper reviews evidence from the HSE, EU_OSHA and IOSH.

Findings

Rather than only dealing reactively with cases of mental ill health in the workplace, it is more effective for an employer to adopt a proactive approach, recognising that employees are a valuable asset, assessing psychosocial risks and promoting health and wellbeing. This involves not only protecting their employees from work‐related health and safety risks, but also helping employees with minor conditions to stay at work, for example, by negotiating flexible hours. Employees also need opportunities to look after their own health and wellbeing at work. Finally, it is important to create a culture where working with a mental health condition is accepted by other employees as normal.

Originality/value

The paper highlights the importance of a proactive management approach to managing mental ill health.

O17. The development of 'time release' nail enamels

In our recent studies on the effects of plasticizers on nail enamel films, we developed a high interest in a phenomenon that we named as 'internal flow'[1]. During the film forming process there is an area that develops beneath the film surface where the film components remain dynamic and mobile. The time frame during which the film maintains this status is directly related to the balance of the resins, plasticizers, polymers and solvents utilized. We found that the longer this 'internal flow' persists, the better the nail enamel wears. At Tevco, we have been able to control the rate at which the solvents and plasticizers flash off the substrate during the film forming process by regulating the interactions and the levels of film constituents. This 'time release' action is the foundation of our study. This study shows that the alkyl adipates are an integral component in controlling the film's internal flow through time release. As plasticizers, these materials, when in proper balance with other components, can create a film surface that is crack-and scuff-resistant. Finally, the substrate in this study is the human nail. The film we developed has to adhere and provide consistent performance over a wide range of temperatures, oil content and the surface abrasion of human nails. We have found that by utilizing adhesion promoters in conjunction with our optimized internal flow time release formula, our film meets all required criteria and generally outperforms conventional quick dry films. In conclusion, we have been able to optimize the film characteristics of conventional quick dry nail enamels. By controlling the internal flow of the film, we can enhance the performance criteria generally expected by consumers in nail enamels.

Phase II study of short course CHOP-rituximab (R) followed by ibritumomab tiuxetan (IT) as first-line treatment for follicular lymphoma (FL)

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Background: Therapy with CHOP-R and radioimmunotherapy (RIT) is a promising treatment for untreated FL. Press reports complete responses (CR) of 69% in FL patients (pts.) with 6 cycles of CHOP followed by I-131 tositumomab. We report efficacy and safety using 3 cycles of CHOP-R followed by IT and extended R. Methods: Eligibility criteria include symptomatic or grade 3 untreated FL. 60 pts. have been accrued and 47 evaluated. The treatment consists of two phases: CHOP-R for 3 cycles followed by IT. One week after IT, pts receive R weekly × 4. Bone marrow (BM) biopsies and fusion PET-CT scans are obtained at baseline, after CHOP-R, and 12 weeks post RIT. The primary endpoint is CR rate. CR requires a neg. PET scan and conventional Working Group criteria. Results: Toxicity data are available for 47 pts of median age 56 (range, 39–78), 44 of whom completed both phases of therapy and are evaluated for response. Characteristics and CR rates after IT are shown: 3 pts. did not receive RIT (1 second malignancy, 1 non-compliance, 1 septic death). Of the 44, CR after CHOP-R is 41%. After IT, CR improved to 89%. Of the 5 pts who did not achieve CR, 3 had neg. PET scans (2 with PR, 1 with SD by CT), and 2 had residual disease by PET with PR by CT. At a mean follow-up of 16 months (range, 6–33 months), there are 4 relapses: 3 who achieved CR by PET-CT, 1 with PR by PET-CT. Toxicity was predominantly myelosuppression. There was 1 episode of febrile neutropenia after RIT. Conclusions: 3 cycles of CHOP-R followed by IT and R achieve a high CR in previously-untreated pts. with FL. Addition of RIT increased CR from 41% to 89%. Data will be presented on the affect of bulky disease, positive BM, grade 2 or 3 histology, and high FLIPI score on CR. Further follow-up is necessary to evaluate response duration and determine whether there is a correlation with early or late CR.

[Table: see text] [Table: see text]

Imaging results after CHOP-rituximab followed by 90Y ibritumomab tiuxetan and rituximab (R) in patients with previously-untreated follicular lymphoma (FL)

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Background: There has been some question regarding the predictive value of 111In scans in FL. We report imaging results with fusion PET-CT scans and 111In scans in a single-institution, non-randomized, phase II trial in patients with FL treated with CHOP-R followed by 90Y ibritumomab tiuxetan (Zevalin (Z)) and R. Methods: Eligible patients have CD20 positive FL, Grade 1–3 or transformed, Stage II-IV, no prior treatment with monoclonal antibody or chemotherapy, and symptomatic disease (if grade 1–2). CHOP-R is given every 21 days for 3 cycles. Four weeks after the last dose of CHOP-R, patients receive the Zevalin regimen, which includes 111In imaging and 90Y therapy. One week after Z, patients receive R 375 mg/m2 IV weekly for 4 doses. Bone marrow examination and fusion PET-CT scans are performed at baseline, after CHOP-R, and 12 weeks after Z. The primary endpoint is CR, and responses are reported using the International Working Group (IWG) criteria with the additional requirement of a negative PET scan for CR/CRu. Results: Thirty-six FL patients have been accrued, and 16 patients have completed therapy and follow-up studies. One patient did not have a positive PET scan at baseline. Following therapy, the proportion with a negative PET scan improved from 8 of 15 (53.3%) after CHOP-R to 15 of 15 (100%) after Z. Using IWG criteria in combination with PET scan results, the CR rate increased from 4 of 15 (26.7%) after CHOP-R to 12 of 15 (80%) after Z. Five of 6 patients (83%) with tumor uptake by 111In scan and 7 of 9 (78%) with a 111In scan negative for tumor achieved a CR. Conclusions: There was no significant difference in CR between those patients with 111In tumor uptake versus patients with a negative 111In scan. Functional imaging with PET-CT may be a more sensitive method than CT alone in determining residual disease in FL. This trial continues to accrue patients, and more time is needed to determine the duration of response and time to next therapy.

No significant financial relationships to disclose.

An exploratory randomised controlled trial of a support programme for carers of patients with a psychosis

BACKGROUND

Despite an acknowledgement of the impact of serious mental disorders on informal caregivers, we still know little about how to best help them. The aim of the study was to evaluate the effectiveness of a two-phased carers' intervention comprising family sessions followed by relatives' groups. This intervention was designed to be of 'intermediate' intensity, that is,one lying between brief educational programmes and long-term family psychoeducational treatments.

METHODS

An exploratory randomised controlled trial was conducted comparing the experimental support programme with 'standard' care. All carers of patients with a psychotic disorder from a defined population were approached. Outcome measures were based on a 'stress-appraisal-coping' model of caregiving.

RESULTS

Despite concerted attempts to engage carers, only 42% participated in the study. The carers' programme did not offer any significant advantage on any of the outcome measures: psychological morbidity, negative appraisal, coping or social support. The severity of caregiving difficulties decreased over the study period for the group as a whole.

CONCLUSIONS

There is still uncertainty about the most effective interventions for carers. Meeting 'needs' may not improve caregiver distress.

Evaluating a model of caregiving for people with psychosis

BACKGROUND

The caregiving experience has been conceptualised as distress or satisfaction attributed to various factors in the carer's external and internal world.

AIMS

The aim of this study was to test how such factors relate to one another in the framework of a 'stress-coping' model using data from a group of carers of people with psychosis.

METHOD

Standard univariate analyses and graphical modelling techniques were applied to baseline and follow-up interview data available from a clinical trial of a support package offered to 77 carers in contact with a community psychiatric service.

RESULTS

Results at baseline were consistent with a stress-coping model. Carer distress was most strongly associated with coping. In turn, coping was associated with two sets of factors - one related to appraisal and caregiving difficulty, the other to social support. Using a small sample of longitudinal data (n = 38), most individual measures were predictable from baseline. However, there was again a strong association between carer distress and current coping. Support from confidants assumed an important relationship to effective coping. The level of effective coping increased over time while caregiving difficulty decreased, but carer appraisal and distress did not change.

CONCLUSIONS

The findings provide some support for an interactive, stress-coping model of caregiving in psychosis. Effective coping in caregivers may improve with support from confidants. Carer distress may not change while caregiving continues.

Surveillance mammography after treatment of primary breast cancer: a systematic review

As the prevalence of diagnosed breast cancer increases, it is important to define how best to provide long-term follow-up. Whereas many aspects of follow-up remain controversial, guidelines recommend surveillance mammograms as the only investigation to be performed routinely. We conducted a systematic review of the literature to elucidate the effect of routine surveillance mammograms on detecting ipsilateral recurrence (IR) and contralateral breast cancers (CBC). The systematic review yielded 15 articles. All were observational studies and ranked as level II-2 or III evidence. There were no randomized controlled trials identified. Most of the ten studies on detection of IR did not report on outcomes after detection. When reported, most studies found that the method of detection of IR did not influence overall survival or disease-free survival. Two of the nine studies on detection of CBC found that the CBC was detected at an earlier stage than the initial breast cancer, but did not report on long-term outcomes. This systematic review highlights the need for further research to help better define the optimum surveillance mammography regimen.

The experience of caregiving for severe mental illness: a comparison between anorexia nervosa and psychosis

BACKGROUND

The aim of this study was to examine the experience of care giving for people with anorexia nervosa and to compare it with the experiences of those people who care for a person with a psychotic illness.

METHOD

Carers (parents, siblings and husbands) of people with eating disorders who had experienced an episode of inpatient care for anorexia nervosa (n=71) were given the General Health Questionnaire and the Experience of Caregiving Inventory. A sample of carers (N=68) of people with a psychotic illness from the community were used as a comparison group. A subgroup of the carers (n=20) of people with anorexia nervosa were asked to write about their experiences.

RESULTS

The clinical samples had a similar duration of illness, but the patients with anorexia nervosa were significantly younger and a larger proportion were living at home. The general health scores were significantly higher in the carers of anorexia nervosa and they experienced higher levels of difficulties in most areas of caregiving. A variety of variables from the Caregiving Inventory contributed to the level of psychological distress, accounting for 36% of the variance. The themes of guilt and shame were additional dimensions that were addressed in the letters.

CONCLUSIONS

Carers of people with anorexia nervosa are challenged by the difficulties their role produces.

The Experience of Caregiving Inventory: further evidence

BACKGROUND

The aim of this study was to reexamine the construct validity of the Experience of Caregiving Inventory (ECI) using new, independent data from a population of patients and their carers. This involved re-testing the ECI within the stress-coping model, but adding new variables which included independently rated (rather than carer-rated) assessments of the patient's symptoms and disabilities, a rating of social support (this time for the patient rather than the carer) and a measure of a range of service inputs.

METHOD

Data were available on 69 patients and their carers from the PRiSM Psychosis Study. Two regression analyses were performed; the first to establish the extent to which the ECI predicted GHQ scores and the second to examine predictors of the ECI selected from the wider dataset on the basis of their likely relationship to carer appraisal. The second regression analysis was performed in two stages, allowing the effect of service factors to be assessed after controlling for the impact of patient personal characteristics such as illness-related or environmental factors.

RESULTS

ECI scores accounted for 27% of the variance of GHQ scores. Over one-third of the ECI negative appraisal can be explained by a combination of patient disability (the Social Behaviour Score Total), extent of patients' social network (Social Network Schedule: Number of Friends) and involvement of a Community Psychiatric Nurse (CPN). At the same level of patient morbidity and informal social network, CPN contact reduced ECI scores.

CONCLUSION

As hypothesised, ECI scores correlated significantly with the other measures in the directions predicted by the stress-coping model; that is, negative caregiving as measured by the ECI predicted carer morbidity, while it in turn was predicted by a combination of stressor variables (patient symptoms and disability) acting to increase it, and mediating variables (social support, service inputs) acting to reduce it. Implications for services are discussed.

Glucose-6-phosphate dehydrogenase (G6PD) variants in Malaysian Chinese

We screened 38 G6PD-deficient male Chinese neonates for known G6PD mutations using established PCR-based techniques. We found 50.0% (19 of 38) were mutation 1376G>T, 34.2% (13 of 38) were mutation 1388G>A, 5.2% (2 of 38 ) were mutation 95A>G and 2.2% (1 of 38) was mutation 1024C>T. In 7% (3 of 38) of the cases the mutations remained uncharacterised. Sixty three percent (24 of 38) of the G6PD deficient neonates had neonatal jaundice with 28.9 % (11 of 38) developing moderate to severe hyperbilirubinemia. The group of neonates with 1388 mutation showed the highest incidence of moderate to severe hyperbilirubinemia requiring phototherapy and/or exchange transfusion respectively. Majority (70%) of the G6PD deficient neonates showed severe enzyme deficiency. However, there was no meaningful association between the level of enzyme activity and the severity of neonatal jaundice. In summary, four mutations account for more than 90% of the G6PD deficiency cases among the Chinese in Malaysia and the pattern of distribution of the molecular variants is similar to those found among the Chinese in Taiwan and southern mainland China. Our findings also suggest the possible association of nt 1388 mutation with severe neonatal jaundice.

A novel four-drug ablative regimen with hemopoietic stem cell rescue for patients with breast cancer: a phase II study

High-dose chemotherapy and autologous hemopoietic stem cell transplantation (HSCT) may provide durable progression-free survival in some patients with stage IV breast cancer (S4Brca). We have studied a new four-drug intensive preparative regimen with HSCT in a group of 158 women with S4Brca to define the risk and potential benefit of this regimen in this patient population. From May 1988 through May 1997, 158 women with S4Brca at a single center were treated with cisplatin, etoposide, thiotepa, and cyclophosphamide (PETCy) plus autologous HSCT Eligible patients were also treated with posttransplant involved-field radiation therapy. Patients with estrogen-receptor positive tumors not previously treated with tamoxifen also received this therapy for 5 years following transplantation. All patients experienced significant toxicity requiring blood-product support and parenteral nutrition. Eighteen patients (11%) died of regimen-related toxic events. With a median follow-up of 540 days for surviving patients, a retrospective Kaplan-Meier analysis projects an overall survival of 38+/-8.5% (95% CI) at 890 days with a maximum follow-up of 8.8 years. For 52 patients in sensitive relapse, the median event-free survival time is 767 days, with 46.2+/-15.3% (95% CI) predicted to be alive at 884 days with a maximal follow-up of almost 9 years. Nearly one-half of patients in this study with S4Brca in sensitive relapse have experienced durable remissions following PETCy ablation and HSCT. Although toxicity is significant, the PETCy regimen produces a favorable balance between efficacy (event-free survival) and treatment failure (relapse + regimen-related toxic death) compared with published results. These data suggest that within the high-dose range for preparative therapy, a steep dose-response may exist for breast cancer. Trials comparing the dose intensity of preparative regimens are warranted.

Different prevalences of Renibacterium salmoninarum detected by ELISA in Alaskan chinook salmon Oncorhynchus tshawytscha spawned from freshwater and seawater

Soluble antigen of Renibacterium salmoninarum (Rs) was detected by a polyclonal enzyme-linked immunosorbent assay (ELISA) at significantly higher prevalences in adult chinook salmon Oncorhynchus tshawytscha that matured in freshwater than in the same cohort of fish spawned after maturation in seawater. The cumulative results were consistent during 4 yr of comparison at the Little Port Walter Hatchery on Baranof Island, Alaska, USA. Possible causes for this difference are discussed. Maturation of chinook salmon broodstock in seawater has become a practical strategy at this hatchery to reduce the prevalence of Rs-positive parent fish and the numbers of culled eggs.

The use of antiepileptic medication in a population-based cohort of adults with learning disability and epilepsy

The purpose of the current study was to assess the trend of antiepileptic drug use in a sample of 143 adults with learning disability and epilepsy in one health district. Information on the dose and serum level of antiepileptic drugs received by the subjects, their demographic data and the epilepsy-related data were gathered from the medical case-notes, examination of subjects and interview with the carers. Sixty (42% of the cohort) subjects received polytherapy of antiepileptic medication. The use of polytherapy was significantly associated with being female, longer duration of epilepsy, multiple-seizure type, and active epilepsy (i.e. seizure during the previous 12-month period). Of the cohort, 52% receivd sodium valproate, 38.5% received carbamazepine, 29% phenytoin, 11% lamotrigine and 11% primidone. The majority of subjects received antiepileptic drugs within the BNF-recommended range; however, 38% of the subjects receiving carbamazepine had a lower dose than that recommended in the BNF. The serum levels of most antiepileptic drugs were within the local laboratory reference range, except that in 39% of cases the phenytoin level was below the local reference range. No statistically significant difference was observed in the use of different antiepileptic drugs and the rate of mental disorder in the cohort, although the subjects receiving lamotrigine and primidone showed more behavioural problems. Similarly, no significant association was observed between the seizure types and the use of different antiepileptic medications.

Psychiatric illness and behavioural problems in adults with learning disability and epilepsy

We retrospectively collected data on the rate and type of psychiatric illness and behavioural problems on 143 adults with learning disability and epilepsy. 55% behavioural problems. 19% verbal aggression and temper tantrums, and 13% injurious behaviour. The overall rates of behavioural problems and different types of behaviours found in the current study cohort are similar to what was found before in learning disabled adults in general, as well as in epileptic and non-epileptic learning disabled adults. Psychiatric diagnosis was made in 12.6% combined diagnosis of schizophrenia, delusional disorder and schizo-affective disorder was most common (5%) diagnosis of depressive episode (3%) bipolar affective disorder.

Selective inhibition of factor Xa in the prothrombinase complex by the carboxyl-terminal domain of antistasin

Studies of antistasin, a potent factor Xa inhibitor with anticoagulant properties, were performed wherein the properties of the full-length antistasin polypeptide (ATS-119) were compared with the properties of forms of antistasin truncated at residue 116 (ATS-116) and residue 112 (ATS-112). ATS-119 was 40-fold more potent than ATS-112 in prolonging the activated partial thromboplastin time (APTT), whereas ATS-119 inhibited factor Xa 2.2-fold less avidly and about 5-fold more slowly than did ATS-112. The decreased reactivity of ATS-119 suggests that the carboxyl-terminal domain of ATS-119 stabilizes an ATS conformation with a reduced reactivity toward factor Xa. The observation that calcium ion increases the reactivity of ATS-119 but not that of ATS-112 suggests that calcium ion may disrupt interactions involving the carboxyl terminus of ATS-119. Interestingly, ATS-119 inhibited factor Xa in the prothrombinase complex 2-6-fold more potently and 2-3-fold faster than ATS-112. These differences in affinity and reactivity might well account for the greater effectiveness of ATS-119 in prolonging the APTT and suggest that the carboxyl-terminal domain of ATS-119 disrupts interactions involving phospholipid, factor Va, and prothrombin in the prothrombinase complex. The peptide RPKRKLIPRLS, corresponding to the carboxyl domain of ATS-119 prolonged the APTT and inhibited prothrombinase-catalyzed processing of prothrombin, but it failed to inhibit the catalytic activity of isolated factor Xa. Thus, this novel inhibitor appears to exert its inhibitory effects at a site removed from the active site of factor Xa.

Reviewing the reviews: the example of chronic fatigue syndrome

OBJECTIVE

To test the hypothesis that the selection of literature in review articles is unsystematic and is influenced by the authors' discipline and country of residence.

DATA SOURCES

Reviews in English published between 1980 and March 1996 in MEDLINE, EMBASE (BIDS), PSYCHLIT, and Current Contents were searched.

STUDY SELECTION

Reviews of chronic fatigue syndrome (CFS) were selected. Articles explicitly concerned with a specialty aspect of CFS and unattributed, unreferenced, or insufficiently referenced articles were discarded.

DATA EXTRACTION

Record of data sources in each review was noted as was the departmental specialty of the first author and his or her country of residence. The references cited in each index paper were tabulated by assigning them to 6 specialty categories, by article title, and by assigning them to 8 categories, by country of journal publication.

DATA SYNTHESIS

Of 89 reviews, 3 (3.4%) reported on literature search and described search method. Authors from laboratory-based disciplines preferentially cited laboratory references, while psychiatry-based disciplines preferentially cited psychiatric literature (P = .01). A total of 71.6% of references cited by US authors were from US journals, while 54.9% of references cited by United Kingdom authors were published in United Kingdom journals (P = .001).

CONCLUSION

Citation of the literature is influenced by review authors' discipline and nationality.

Effects of antidepressant treatment on corticotropin-induced cortisol responses in patients with melancholic depression

To date, there appears to be no consensus of opinion as to whether the adrenal glands are hyperresponsive during depression and, if so, whether this a state-dependent phenomenon. We aimed to determine the effects of antidepressant treatment on ACTH-induced cortisol responses in patients with melancholic depression. Seven female patients with DSM-III-R major depressive disorder, non-psychotic, melancholic subtype, were evaluated using the following rating scales: the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale and the Newcastle Endogenicity Scale. All subjects were then given an intravenous bolus dose (250 micrograms) of tetracosactrin, a potent stimulus of adrenocortical hormone secretion. Plasma levels of cortisol were measured at times 0, + 30, + 60, + 90, + 120 and + 180 min. Patients were then randomised to receive either 50 mg of sertraline or 20 mg of paroxetine (both of which are selective serotonin re-uptake inhibitors) and were re-tested while medication-free. Treatment resulted in a significant decrease in delta (the difference between the baseline values and the maximum increase post-ACTH administration) cortisol values of 1633.3 +/- 378.5 nmol/l vs. 595.1 +/- 207.7 nmol/l. Successful pharmacological treatment of major depressive disorder appears to be associated with a reduction in ACTH-induced cortisol release in drug-free patients.

Effect of chronic low-level exposure to jet fuel on postural balance of US Air Force personnel

This study used the postural stability technique to investigate the neurological effects of cumulative low-level exposure to raw JP-8 jet fuel vapor on aircraft maintenance personnel. All subjects performed two sets of four 30-second postural sway tests. The results of mean cumulative exposure levels (in parts per million +/- standard error of mean) were the following: naphthas, 1308 +/- 292; benzene, 21.2 +/- 5.7; toluene, 23.8 +/- 6.1; and m-,o-, p-xylene, 22.7 +/- 5.4. Covariate adjusted regression analysis of the exposed group data showed a statistically significant association (P < 0.05) between the solvents (benzene, toluene, and xylene) and increased postural sway response. For all solvent exposures, the "eyes closed, on foam" test provided the strongest association between sway length and JP-8 benzene (r2 range, 0.45 to 0.52), implying subtle influence on vestibular/proprioception functionalities.

The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review

The prognosis of chronic fatigue syndrome and chronic fatigue has been studied in numerous small case series. We performed a systematic review of all studies to determine the proportion of individuals with the conditions who recovered at follow-up, the risk of developing alternative physical diagnoses, and the risk factors for poor prognosis. A literature search of all published studies which included a follow-up of patients with chronic fatigue syndrome or chronic fatigue were performed. Of 26 studies identified, four studied fatigue in children, and found that 54-94% of children recovered over the periods of follow-up. Another five studies operationally defined chronic fatigue syndrome in adults and found that < 10% of subjects return to pre-morbid levels of functioning, and the majority remain significantly impaired. The remaining studies used less stringent criteria to define their cohorts. Among patients in primary care with fatigue lasting < 6 months, at least 40% of patients improved. As the definition becomes more stringent the prognosis appears to worsen. Consistently reported risk factors for poor prognosis are older age, more chronic illness, having a comorbid psychiatric disorder and holding a belief that the illness is due to physical causes.

Hemiballismus and normal pressure hydrocephalus as long-term sequelae following a hemispherectomy for intractable epilepsy in a man with a learning disability

We report here a case of a 48-year-old gentleman with mild/moderate learning disability who developed late complications of hemispherectomy 28 years following the operation. The original operation was performed to treat intractable epilepsy (both generalized tonic/clonic and complex partial seizures) in an 8-year-old boy. After a 28 year seizure-free period, the patient developed cognitive decline, seizures, hemiballismus and a subacute confusional state, possibly related to normal pressure hydrocephalus. A ventriculo-peritoneal shunt operation, along with treatment with high doses of sulpiride, brought improvement in both mental state and hemiballismus.

Lead poisoning in telephone cable strippers: a new setting for an old problem

Lead poisoning among workers processing lead sheathed telephone cable was identified at five worksites. High blood lead levels (BLLs) were identified during the medical evaluation of symptomatic workers following employer mandated air monitoring and through employer mandated blood lead levels. Once high BLLs were identified, governmental agencies became involved at every site, either as a result of worker complaints to OSHA or as a registry reporting mechanism. Workplace evaluation revealed significant overexposure to lead, particularly among workers mechanically stripping the lead sheaths. After intervention by a government agency, four of the workplaces chose to stop lead cable processing. Because the ongoing replacement of lead sheathed telephone cable with fiber optics may be continuing in many areas of the country, there is concern that the clusters we have identified represents a widespread and little recognized setting for lead overexposure. Recommendations for preventing overexposure to lead in this setting are given.

Diabetes mellitus affects prostaglandin E2 levels in mouse embryos during neurulation

The arachidonic acid cascade leading to prostaglandins has been implicated in diabetic embryopathy. Both arachidonic acid and prostaglandin E2 reverse the teratogenic effects of high glucose concentrations on neural tube development in mouse embryos in culture. Arachidonic acid supplementation also protects against diabetes-induced neural tube defects in vivo. In the present study, prostaglandin E2 was measured directly in embryos from normal and diabetic mice. In normal mice a clear developmental pattern was seen. Prostaglandin E2 levels were high during early formation of the cranial neural folds (day 8), declined during convergence and fusion of the cranial neural folds to form the neural tube (day 9), and were low after neurulation was complete (days 10 and 11). In addition, evidence in this study indicates that embryos have cyclooxygenase activity capable of generating prostaglandin E2 during a brief developmental period preceding neural tube closure. In embryos from mice made diabetic (> 13.9 mmol/l glucose) with streptozotocin, prostaglandin E2 levels were significantly lower than normal during early development of the cranial neural folds (day 8), but similar to normal after the cranial neural tube had closed (late day 9 and day 10). The findings suggest that diabetes mellitus, as ascertained by high blood glucose, promotes cranial neural tube malformations by causing a functional deficiency of prostaglandin E2 during early neurulation. Whether the altered PGE2 pattern in the embryo indicates a diabetic effect on the arachidonic acid-prostaglandin cascade in cells of the embryo or in cells of extraembryonic or maternal tissues is uncertain.

Nucleotide 1376 G-->T mutation in G6PD-deficient Chinese in Malaysia

G6PD deficiency is the most common human enzymopathy and affects 200 million people worldwide. To date more than 400 biochemical variants and at least 60 different point mutations in the G6PD locus have been discovered. In Malaysia the overall incidence of G6PD deficiency among males is 3.1%, being more prevalent among the Chinese and Malays and less common among the Indians. As part of our initial effort to characterise G6PD deficiency in the Malaysian population, we investigated 18 G6PD deficient Chinese male neonates for the G6PD mutation G-->T at nt 1376, a common mutation seen among the Chinese in Taiwan and mainland China. The mutation was detected by a PCR-based technique using primers that artificially create a site for restriction enzyme Xho I. We found 61% (11 out of 18) of the Chinese G6PD deficient male neonates positive for this mutation. Study of enzyme electrophoretic mobility in 7 of the cases positive for this mutation revealed three different patterns of mobility. 107% (5 out of 7), 103% (1 out of 7) and 100% (1 out of 7). This study shows that mutation G-->T at nt 1376 is a common allele causing G6PD deficiency in Malaysians of Chinese origin. The finding of different patterns of electrophoretic mobility among the 7 cases positive for 1376 G-->T mutation supports the notion that diverse biochemical variants may share the same mutation.

Integrated health and education input in the development of educational resources about asthma for schools

The development of educational packages on health-related topics has become common in school curricula. This paper describes an integrated health and education input in the development of an educational package about asthma for Year 8 high school students. Ownership and educational relevance of the package (ensuring its appropriateness for inclusion within the Personal Development/Health/Physical Education curriculum) was achieved by collaboration between teachers with an understanding of the principles of curriculum design and health professionals with content knowledge about asthma. The model used for the production of the package about asthma could be extended to other health topics.