Surgical timing and complications, with body image, quality of life, sexual function and genital sensation in patients with congenital adrenal hyperplasia

INTRODUCTION

The aim of this project was to document the long-term outcomes relating to sexual function, genital sensation, body image and quality of life, in an Australian cohort of adolescent and adult women with congenital adrenal hyperplasia (CAH) who have undergone feminising genitoplasty in infancy, childhood or adolescence.

MATERIALS AND METHODS

Identification and follow-up of women with CAH aged 12-40 years who had their first feminising genitoplasty or ongoing management at a single tertiary referral center with multidisciplinary care (n = 80). Medical records were reviewed for Prader stage, and operative outcomes. The prospective component of the study included tracing indivudals aged 12-40 years (n = 69), of whom 34 were contactable. Twenty-one responded to the invitation to participate in the study, completing some or all of a series of validated standardized questionnaires and/or participation in examination of external genital with sensation testing. Results were compared to a control population of similar age distribution (n = 23).

RESULTS

The median Prader stage was 3, median age at surgery was four months, median hospital stay of three days with 80 % of surgery undertaken by one surgeon. There was one major and eight minor complications. Re-operation rates were low. There was no difference between participants and controls in terms of sexual function, quality of life, or body image outcomes including genital appearance. Participants had increased sensitivity to soft touch on genital sensation testing compared to controls. Most participants (71 %) reported that early timing of surgery was 'good', four (19 %) felt their surgery was too late, one felt their surgery was too early, and one was unsure. Most were happy with the outcome of their surgery.

DISCUSSION

Outcomes after feminising genitoplasty are mixed and influenced not only by the surgery itself, but also the ongoing management of the condition alongside each patient's own cultural and social context. At present there is no comparative data available on the sexual, mental, body image and quality of life outcomes of young females with CAH who have had their operation delayed until adulthood. Our study is limited by low participant response rate, and difficulty recruiting 1:1 control population for all participants, but nevertheless provides some insight into the outcomes of these patients for which limited data is available.

CONCLUSION

In the population studied feminising genitoplasty in infancy and childhood had overall positive outcomes. This occurred in a tertiary center with expert multidisciplinary individualised care.

Lung function, COPD and Alternative Healthy Eating Index in US adults

Background

There is a large burden of COPD in the US. The purpose of this study was to investigate the association between diet quality with lung function, spirometric restriction and spirometrically defined COPD in a nationally representative sample of US adults.

Methods

Adults (19–70 years of age) from the National Health and Nutrition Examination Survey 2007–2012 cycles were included (n=10 428). Diet quality was determined using the Alternative Healthy Eating Index (AHEI-2010). Pre-bronchodilator measurements of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and the FEV₁/FVC were described. Calibrated lower limit of normal (LLN) estimates were derived to determine prevalence of spirometric restriction (FVC<LLN) and COPD (FEV₁/FVC ratio<LLN). Population-weighted linear and logistic regression models were used to investigate the association of AHEI-2010 and respiratory outcomes.

Results

The mean±SD AHEI was 45.3±12.2, equivalent to meeting 41% of the daily recommendations for optimal diet quality. Those in the highest quartile of AHEI had better FEV₁ (adjusted (a)β 47.92, 95% CI 2.27–93.57) and FVC (aβ 80.23, 95% CI 34.03–126.42; p-value interaction (*) of AHEI and smoking >0.05) compared to those in quartile 1. Higher AHEI was also associated with lower odds of spirometric restriction (OR 0.23, 95% CI 0.08–0.67; p-value AHEI*ethnicity >0.05).

Conclusions

Diet quality was independently associated with better FEV₁ and FVC and with lower odds of spirometric restriction. These findings highlight the need for research to further elucidate the possible beneficial role of diet in the preservation of lung function.

In this nationally representative population-based study of US adults, diet quality measured by the AHEI-2010 was low. Better diet quality was associated with better lung function, and with lower prevalence of spirometric restriction.https://bit.ly/3you2Tf

COVID-19 impact on the health and emotional well-being of the general population

 

A tremendous number of studies describe results on the evolution of the COVID-19 impact on infected patients, hospital admissions, deaths, mental health and well-being of the population. However, there are hardly any reports on its impact and evolution since the beginning of the pandemic with clinical, contextual and individual perception information. Our work describes the research project called Health Care and Social Survey (ESSOC, Encuesta Sanitaria y SOCial). It arises from the need to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response in the different affected populations. It is linked to official statistical operations included in the Andalusian Regional Government and has also been granted a favorable opinion by the Research Ethics Committee. The ESSOC is based on a Real-World Data design. It integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries. The surveys have an overlapping panel design with a total of over 22,000 effective interviews being carried out over three years from the beginning of the state of alarm in Spain. Their geographical scope is the Autonomous Region of Andalusia (8.4MM people, the fifth most populated region in Europe), and the population scopes are general population, population residing in disadvantaged areas, and population over the age of 55. The conceptual approach of this study encompasses all aspects affecting health that will contribute to an extraordinary increase in the current knowledge of the impact of the COVID-19 pandemic. Its results will be very useful for cross-disciplinary comparisons in population-based studies, and the methodology developed will serve as a model to be applied in other epidemiological studies.

Key messages

It is needed to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response. Our research project integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries.

Rheumatoid meningitis: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Rheumatoid meningitis (RM) is a neurological complication of rheumatoid arthritis (RA). Current evidence is based on case reports and partial reviews.

METHODS

This is a systematic review and meta-analysis following the PRISMA statement. The aim is to describe the characteristics of the disease, including clinical, imaging and laboratory findings, treatment, outcomes and prognosis reported in the literature.

RESULTS

In all, 103 studies with 130 cases were included. RM affected adults with an average age of 62 years, with or without a previous RA diagnosis. RA activity and time with the disease were associated with a worse prognosis. Most common clinical manifestations were transient focal neurological signs (64.6%), systemic symptoms (51.3%), episodic headache (50.4%) and neuropsychiatric alterations (47.7%). Joint manifestations were present in only 27.4% of cases. Brain magnetic resonance imaging showed unilateral or bilateral involvement, predominantly frontoparietal. Both pachymeninges and leptomeninges were affected, the latter more frequently (82.88%). The laboratory findings included increased levels of rheumatoid factor (89.71%), anti-cyclic citrullinated peptide (89.47%), C-reactive protein (82.54%) and erythrocyte sedimentation rate (81.81%). Cerebrospinal fluid analysis showed an increase in the protein level (76.14%), with pleocytosis (85.19%) of mononuclear predominance (89.19%). Biopsy was performed in 72.52% of the patients. Corticosteroid pulse therapy was the main induction therapy. Disease relapse occurred in 31.17% of patients, whilst 54.54% had a full recovery.

CONCLUSIONS

Rheumatoid meningitis must be considered in adult patients with or without RA diagnosis, high-dose corticosteroid induction therapy should be installed and maintenance therapy plays a key role. It is not recommended to use anti-TNF as an induction therapy. Nowadays, RM has a significantly better outcome. These findings may aid clinicians in timely RM diagnosis and treatment, thus improving its outcomes.

Household Food Insecurity, Lung Function, and COPD in US Adults

Increasing epidemiological evidence suggests that optimal diet quality helps to improve preservation of lung function and to reduce chronic obstructive pulmonary disease (COPD) risk, but no study has investigated the association of food insecurity (FI) and lung health in the general population. Using data from a representative sample of US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2007–2012 cycles, we investigated the association between FI with lung function and spirometrically defined COPD in 12,469 individuals aged ≥ 18 years of age. FI (high vs. low) was defined using the US Department of Agriculture’s Food Security Scale). Population-weighted adjusted regression models were used to investigate associations between FI, and forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), their ratio, and spirometrically defined restriction (FVC below the lower limit of normal) and airflow obstruction (COPD). The prevalence of household FI was 13.2%. High household FI was associated with lower FVC (adjusted β-coefficient −70.9 mL, 95% CI −116.6, −25.3), and with higher odds (OR) of spirometric restriction (1.02, 95% CI 1.00, 1.03). Stratified analyses showed similar effect sizes within specific ethnic groups. High FI was associated with worse lung health in a nationally representative sample of adults in the US.

Relationship between age at giving fortified powdered cow's milk and cessation of breastfeeding on the nutritional status of a Chilean child cohort followed from birth to 3 years of age

BACKGROUND/OBJECTIVES

To examine how much of the variation in weight-for-height (WHZ) z-scores were associated with age at which breastfeeding ceased and provision of fortified cow's milk (Leche Purita Fortificada, LPF) commenced in a cohort of children studied from birth to 3 years of age.

SUBJECTS/METHODS

Longitudinal data were obtained from routine medical check-ups on 8373 children from nine Chilean counties through convenience sampling. WHZ z-scores were generated at six-monthly intervals using WHO 2006 standards from birth to 3 years old (seven measurements). Age of cessation of breastfeeding and age of commencement of LPF were the independent variables. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements. Binomial generalised estimating equations (GEE) were used to analyse the effect of each independent variable on the change from normal to overweight, and normal to obese over the seven measurements.

RESULTS

ANOVA indicated that children given LPF milk before 3 months of age had, on average, higher mean WHZ of about 0.11 SD from 18 months of age onwards (p < 0.001). GEE analyses showed that children given LPF before 3 months of age were significantly more likely to be overweight or obese (OR = 1) compared with children given LPF later (overweight OR: 0.809-0.970, p = 0.009, obese (OR: 0.666-0.901, p = 0.001).

CONCLUSIONS

Early intake of LPF increases WHZ and is a risk factor for overweight and obesity in young children, while prolonged breastfeeding acts as protective factor against obesity.

[Massive rotator cuff injury: arthroscopic treatment with upper capsular reconstruction]

Massive rotator cuff injuries (LMMRs) are those breaks of more than 5 cm either the anteroposterior plane, or lateromedial plane. Some authors consider them to be complete ruptures of at least two rotator cuff tendons. The clinical case of a 63-year-old man with this type of injury that was resolved by the superior capsule reconstruction technique is presented, technical details and some of the literature review to carry out the procedure are shown.

Education and Socioeconomic Level of Mothers Are Negatively Associated with the Diet Quality of Their Offspring– Evidence from the 2015 Colombian Nutrition Survey

Objectives

To analyze the association between maternal education level and socio-economic status (SES), and diet quality of Colombian children.

Methods

The National Nutrition Survey (ENSIN) 2015 was a cross-sectional survey examining general health and dietary intake in a representative sample of Colombian children and adults. The Alternative Healthy Eating Index (AHEI), an indicator of adherence to diet quality, was calculated using a single 24 h recall questionnaire administered to 11,641 children aged 6–17y (5470 females, 6171 males). Diet quality was considered low, intermediate or high if the median AHEI score ranged between 17.0–44.0; 44.5–54.0; or 54.5–74.0, respectively. Maternal education was categorized as having: incomplete elementary school or less, complete primary or incomplete high school, complete high school or incomplete university, or professional degree or higher. A validated wealth index (quintiles) was used to define SES. These two risk factors were fitted in an adjusted linear regression model to investigate their association with children's diet quality.

Results

The median AHEI score was 43.7 (IQR: 35.7–51.5) A fifth of the mothers had the lowest educational level, whilst 5.7% reported having a professional degree or higher education. Increasing maternal education level was negatively associated with diet quality (p-trend &lt; 0.001). Children of women with the highest educational level had, on average, 2.7 lower units of AHEI compared to those of mothers with the lowest education level (P &lt; 0.001). Similarly, SES was negatively associated with diet quality (p-trend &lt; 0.001). Children in the highest SES quintile had a mean 4.7 lower units of AHEI compared those in the lowest SES (P &lt; 0.001).

Conclusions

Higher maternal education and SES were associated with lower diet quality in Colombian children. The findings suggest that Colombia is experiencing a pattern 4 of the Nutrition Transition (‘Western’ style diet), which is a known risk factor for non-communicable diseases.

Funding Sources

GMG was supported by the Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) (Fondo para Investigación en Salud-FIS-). MRD was funded by COLCIENCIAS (Convocatoria 647). FDCM was funded by the Fulbright Commission and the Fundação para a Ciência e Tecnologia (SFRH/BD/144,563/2019).

Awareness, Understanding and Use of the ‘Traffic Light’ Food Labelling Policy and Educational Level in Ecuador – Findings from the National Nutrition Survey 2018

Objectives

To examine the association between awareness, understanding and use of the traffic light food labelling policy (TLFL) and educational level in children and adults from Ecuador.

Methods

Data from the National Health and Nutrition Survey (ENSANUT) 2018 (40,938 participants aged 10y–98y) was used. Awareness, understanding and use of TLFL were ascertained with the questions ‘do you know/have you seen the TLFL in foods? [yes/no]’; ‘do you understand the TLFL in foods’ [yes/no]; and ‘do you consider that the TLFL helps you with food purchase decisions? (a little or nothing [reference]/some/a lot)’, respectively. Education was categorized as illiterate [reference]; primary school [incomplete/complete]; high school [incomplete/complete]; and higher education. Age, sex, residence (rural/urban), income, poverty index (unsatisfied basic needs) were included as potential confounders. Adjusted multivariable regressions were used to investigate the association of TLFL and education (reported as odds ratios [OR] and 95% confidence intervals [95%CI]), using sampling weights, and Akaike's Information Criterion to select the most optimal models.

Results

31,028 participants (79%) reported to be aware of the TLFL, of whom 88% said they understood. Amongst the latter, only 21% reported to use TLFL when purchasing foods. Increasing education was associated with increased odds of awareness and understanding of TLFL (p-values: 0.004, 0.005, respectively) but not with its use. Compared to the lowest education, those with the highest educational level had the highest odds of being aware of and understanding the TLFL, OR 1.54 (95% CI 1.48; 1.61) and OR 1.28 (95% CI 1.19;1.39), respectively.

Conclusions

Whilst awareness and understanding of TLFL is relatively high in the Ecuadorian population, its use remains low. These findings highlight the need to strengthen public health policies that increase the use of food labelling as reference to make healthier decisions about food purchase, particularly amongst individuals from more vulnerable educational and socio-economic background.

Funding Sources

AR is funded by an MPH Fellowship and FDCM by a Grant for Research, both awarded by the Fulbright Commission; GMG is funded by COLCIENCIAS (Fondo para Investigacion en Salud -FIS-).

First inter-laboratory comparison of Echinococcus granulosus sensu lato diagnosis in Latin America

OBJECTIVE

To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay.

METHODS

National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 - November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient.

RESULTS

Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories' test protocols showed substantial heterogeneity that could partially explain poor concordance of results.

CONCLUSION

The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.

Effectiveness of sampling methods employed for Acanthamoeba keratitis diagnosis by culture

PURPOSE

This retrospective, observational study was designed to evaluate the effectiveness of the sampling methods commonly used for the collection of corneal scrapes for the diagnosis of Acanthamoeba keratitis (AK) by culture, in terms of their ability to provide a positive result.

METHODS

A total of 553 samples from 380 patients with suspected AK received at the Parasitology Section of the Public Health Institute of Chile, between January 2005 and December 2015, were evaluated. A logistic regression model was used to determine the correlation between the culture outcome (positive or negative) and the method for sample collection. The year of sample collection was also included in the analysis as a confounding variable.

RESULTS

Three hundred and sixty-five samples (27%) from 122 patients (32.1%) were positive by culture. The distribution of sample types was as follows: 142 corneal scrapes collected using a modified bezel needle (a novel method developed by a team of Chilean corneologists), 176 corneal scrapes obtained using a scalpel, 50 corneal biopsies, 30 corneal swabs, and 155 non-biological materials including contact lens and its paraphernalia. Biopsy provided the highest likelihood ratio for a positive result by culture (1.89), followed by non-biological materials (1.10) and corneal scrapes obtained using a modified needle (1.00). The lowest likelihood ratio was estimated for corneal scrapes obtained using a scalpel (0.88) and cotton swabs (0.78).

CONCLUSION

Apart from biopsy, optimum corneal samples for the improved diagnosis of AK can be obtained using a modified bezel needle instead of a scalpel, while cotton swabs are not recommended.

Meal-exercise challenge and physical activity reduction impact on immunity and inflammation (MERIIT trial)

BACKGROUND

The effect of a pre-exercise meal as countermeasure to exercise induced immunodepression is poorly known. Also, sedentary behavior is associated with increased cardiometabolic risk but studies on immune changes are lacking. Therefore, we aimed to assess: 1) the impact of a pre-exercise Mediterranean meal (MdM) compared with a fast-food type meal (FFM) on exercise-induced immunological changes and 2) the impact of an induced acute period of sedentary behavior on neuro-immune-endocrine status.

METHODS

/Design: This is a two steps clinical trial including: (a) randomized crossover clinical trial, comparing the effect a high-fat/low-nutrient dense meal, FFM, with an isoenergetic similar high-nutrient dense meal, MdM, in the immune response to an exercise challenge (EC) and (b) a pilot trial assessing the neuro-immune-endocrine change induced by acute decreasing by half the usual physical activity level.

RESULTS

A total of 46 participants (26 females), median aged 25 years were included. Of those 39-completed protocol, including overweight, physical active and inactive and participants with asthma. There were no differences in the EC between interventions. Dietary factors and physical activity were closely monitored during interventions and kept similar. During physical inactivity induction, 31% reached the target of 50% reduction in mean step number and 77% reached a 30% reduction.

CONCLUSION

The use of a pre-exercise meal to modulate immune response and the understanding of the immunological impact of physical inactivity might help to establish future recommendations on how to practice exercise in a safer way and to recognize the potential impact of inactivity.

Fish, omega-3 long-chain fatty acids, and all-cause mortality in a low-income US population: Results from the Southern Community Cohort Study

BACKGROUND

We examined associations between fish and n-3 LCFA and mortality in a prospective study with a large proportion of blacks with low socio-economic status.

METHODS AND RESULTS

We observed 6914 deaths among 77,604 participants with dietary data (follow-up time 5.5 years). Of these, 77,100 participants had available time-to-event data. We investigated associations between mortality with fish and n-3 LCFA intake, adjusting for age, race, sex, kcal/day, body mass index (BMI), smoking, alcohol consumption, physical activity, income, education, chronic disease, insurance coverage, and meat intake. Intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower mortality among all participants. Analysis of trends in overall mortality by quintiles of intake showed that intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower risk of total mortality among all participants. When participants with chronic disease were excluded, the observed association remained only between intakes of baked/grilled fish, while fried fish was associated with lower risk of mortality in participants with prevalent chronic disease. The association between n-3 LCFA intake and lower risk of mortality was significant among those with diabetes at baseline. There was an inverse association of mortality with fried fish intake in men, but not women. Total fish and baked/grilled fish intakes were associated with lower mortality among blacks while fried fish intake was associated with lower mortality among whites. Effect modifications were not statistically significant.

CONCLUSION

Our findings suggest a modest benefit of fish consumption on mortality.

Empirical study of correlated survival times for recurrent events with proportional hazards margins and the effect of correlation and censoring

Background

In longitudinal studies where subjects experience recurrent incidents over a period of time, such as respiratory infections, fever or diarrhea, statistical methods are required to take into account the within-subject correlation.

Methods

For repeated events data with censored failure, the independent increment (AG), marginal (WLW) and conditional (PWP) models are three multiple failure models that generalize Cox’s proportional hazard model. In this paper, we revise the efficiency, accuracy and robustness of all three models under simulated scenarios with varying degrees of within-subject correlation, censoring levels, maximum number of possible recurrences and sample size. We also study the methods performance on a real dataset from a cohort study with bronchial obstruction.

Results

We find substantial differences between methods and there is not an optimal method. AG and PWP seem to be preferable to WLW for low correlation levels but the situation reverts for high correlations.

Conclusions

All methods are stable in front of censoring, worsen with increasing recurrence levels and share a bias problem which, among other consequences, makes asymptotic normal confidence intervals not fully reliable, although they are well developed theoretically.

Purine-rich foods, protein intake, and the prevalence of hyperuricemia: the Shanghai Men's Health Study

BACKGROUND AND AIMS

Diet may play an important role in the development of hyperuricemia and gout. However, the association between dietary factors and hyperuricemia remains unclear, and few studies have investigated direct links between food intake and hyperuricemia. The aim of this study was to investigate associations between high purine-content foods and protein intake with the prevalence of hyperuricemia by using data from a cross-sectional study of 3978 men aged 40-74 yrs living in Shanghai, China.

METHODS AND RESULTS

Hyperuricemia was defined as blood uric acid level >7.0 mg/dl. One quarter of this population had hyperuricemia. Dietary information was collected by using a food frequency questionnaire. We collected information on anthropometric measurements and lifestyle factors and other potential confounding factors and disease history via interviews. Total protein consumption was not associated with hyperuricemia. We found a positive association between protein from animal sources and prevalence of hyperuricemia and an inverse association between protein from plant sources and hyperuricemia. However, these associations failed to reach significance in mutually adjusted analysis. Seafood intake was associated with higher prevalence of hyperuricemia. The ORs for quintiles of seafood intake (including fish and shellfish) were 1.00, 1.49, 1.35, 1.34, and 1.56 (p for trend: 0.01). An inverse association approaching significance between soy food consumption and hyperuricemia was observed (ORs: 1.00, 0.90, 0.70, 0.89, and 0.77 for quintiles of intake; p for trend: 0.07). No associations between consumption of purine-rich vegetables or meat and prevalence of hyperuricemia were observed.

CONCLUSIONS

Our data suggest a direct association between seafood consumption and hyperuricemia and an inverse association between consumption of soy food and hyperuricemia among middle-aged, Chinese men.

Lifestyle determinants of C-reactive protein in middle-aged, urban Chinese men

BACKGROUND AND AIM

Increased levels of C-reactive protein (CRP), common in aging populations, are associated with higher risk for chronic diseases, including diabetes and coronary heart disease. The aim of this study was to investigate associations between lifestyle factors and high CRP among middle-aged men living in Shanghai, China.

METHODS AND RESULTS

In this cross-sectional study, 3978 urban Chinese men aged 40-74 years who were free of type-2 diabetes at baseline provided fasting blood samples, anthropometric measurements and information on lifestyle factors and disease history. Dietary patterns were assessed by factor analysis. Participants were categorised into two groups according to CRP level: normal (≤ 3 mg/L) and high (> 3 mg/L). Associations between CRP categories and lifestyle factors were investigated by using logistic regression. Obesity, weight gain, cigarette smoking and alcohol intake were positively associated with high CRP levels, while physical activity and a dietary pattern with high consumption of fruit were inversely related to high CRP levels. A positive trend of marginal significance between quintiles of a dietary pattern with high consumption of meat and high CRP levels was also observed. No association between tea intake and CRP level was observed.

CONCLUSIONS

Components of an adverse lifestyle were associated with high CRP levels. Obesity, smoking and alcohol intake were associated with high CRP, a biomarker of low-grade inflammation in middle-aged men, while a dietary pattern rich in fruit and high physical activity were inversely associated with the prevalence of high CRP.

Risk of brain tumours in relation to estimated RF dose from mobile phones: results from five Interphone countries

Objectives

The objective of this study was to examine the associations of brain tumours with radio frequency (RF) fields from mobile phones.

Methods

Patients with brain tumour from the Australian, Canadian, French, Israeli and New Zealand components of the Interphone Study, whose tumours were localised by neuroradiologists, were analysed. Controls were matched on age, sex and region and allocated the ‘tumour location’ of their matched case. Analyses included 553 glioma and 676 meningioma cases and 1762 and 1911 controls, respectively. RF dose was estimated as total cumulative specific energy (TCSE; J/kg) absorbed at the tumour's estimated centre taking into account multiple RF exposure determinants.

Results

ORs with ever having been a regular mobile phone user were 0.93 (95% CI 0.73 to 1.18) for glioma and 0.80 (95% CI 0.66 to 0.96) for meningioma. ORs for glioma were below 1 in the first four quintiles of TCSE but above 1 in the highest quintile, 1.35 (95% CI 0.96 to 1.90). The OR increased with increasing TCSE 7+ years before diagnosis (p-trend 0.01; OR 1.91, 95% CI 1.05 to 3.47 in the highest quintile). A complementary analysis in which 44 glioma and 135 meningioma cases in the most exposed area of the brain were compared with gliomas and meningiomas located elsewhere in the brain showed increased ORs for tumours in the most exposed part of the brain in those with 10+ years of mobile phone use (OR 2.80, 95% CI 1.13 to 6.94 for glioma). Patterns for meningioma were similar, but ORs were lower, many below 1.0.

Conclusions

There were suggestions of an increased risk of glioma in long-term mobile phone users with high RF exposure and of similar, but apparently much smaller, increases in meningioma risk. The uncertainty of these results requires that they be replicated before a causal interpretation can be made.

Estimation of RF energy absorbed in the brain from mobile phones in the Interphone Study

Objectives

The objective of this study was to develop an estimate of a radio frequency (RF) dose as the amount of mobile phone RF energy absorbed at the location of a brain tumour, for use in the Interphone Epidemiological Study.

Methods

We systematically evaluated and quantified all the main parameters thought to influence the amount of specific RF energy absorbed in the brain from mobile telephone use. For this, we identified the likely important determinants of RF specific energy absorption rate during protocol and questionnaire design, we collected information from study subjects, network operators and laboratories involved in specific energy absorption rate measurements and we studied potential modifiers of phone output through the use of software-modified phones. Data collected were analysed to assess the relative importance of the different factors, leading to the development of an algorithm to evaluate the total cumulative specific RF energy (in joules per kilogram), or dose, absorbed at a particular location in the brain. This algorithm was applied to Interphone Study subjects in five countries.

Results

The main determinants of total cumulative specific RF energy from mobile phones were communication system and frequency band, location in the brain and amount and duration of mobile phone use. Though there was substantial agreement between categorisation of subjects by cumulative specific RF energy and cumulative call time, misclassification was non-negligible, particularly at higher frequency bands. Factors such as adaptive power control (except in Code Division Multiple Access networks), discontinuous transmission and conditions of phone use were found to have a relatively minor influence on total cumulative specific RF energy.

Conclusions

While amount and duration of use are important determinants of RF dose in the brain, their impact can be substantially modified by communication system, frequency band and location in the brain. It is important to take these into account in analyses of risk of brain tumours from RF exposure from mobile phones.

Perceived discrimination and health by gender, social class, and country of birth in a Southern European country

OBJECTIVES.: This study aimed to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class. METHODS.: We used a cross-sectional design. Data were collected as part of the 2006 Spanish Health Interview Survey. The present analysis was restricted to the population aged 16-64 years (n=23,760). Five dependent variables on health obtained through the questionnaire were examined. Perceived discrimination was the main independent variable. We obtained the prevalence of perceived discrimination. Logistic regression models were fitted. RESULTS.: Perceived discrimination was higher among populations originating from low income countries and among women and showed positive and consistent associations with all poor health outcomes among men and with 3 poor health outcomes among women. Poor mental health showed the largest difference between people who felt and those who did not feel discriminated (prevalence for these 2 groups among men was 42.0% and 13.3%, and among women, was 44.7% and 22.8%). The patterns found were modified by gender, country of birth, and social class. CONCLUSION.: This study has found a consistent relationship of discrimination with five health indicators in Spain, a high-income Southern European country. Public policies are needed that aim to reduce discrimination.

[Changes in the population smoking patterns: Barcelona, 1983-2006]

OBJECTIVE

To describe the distribution of smoking in the population and to assess existing trends.

SUBJECTS AND METHODS

Cross sectional study in a sample of the resident non-institutionalized population over 14 years of age (n = 6,050) in Barcelona (Catalonia, Spain) using the Health Survey of 2006 and comparing trends for 1983-2006 with previous surveys. Independent variables included sex and age. Dependent variables were having ever been a smoker, quitting, and being a current smoker. Prevalence and proportions were estimated, stratifying or adjusting for age.

RESULTS

The prevalence of daily smokers was 27.3% for men and 20.6% for women. Age groups smoking more were 25-34 years for men and 35-44 for women. From 1983 to 2006 the decline for men was sharp, and the prevalence for women is now decreasing. The change accelerated progressively for men, in absolute and relative terms. Estimating the probability of quitting for smokers, there was an increase in cessations over this period. The proportion of smokers of an older age is now much smaller.

CONCLUSIONS

The evolution of the smoking epidemic over the last years shows promising trends. Quit rates have increased, and the decline in prevalence increases among men and has started in women. Smokers are increasingly becoming a minority, although to improve public health it would be desirable to speed the process of change.

Effect of dietary intake on the levels of biliary unsaturated free Fatty acids having inhibitory activity on mutagens

Unsaturated free fatty acids (FFAs), such as palmitoleic, oleic, linoleic, linolenic and arachidonic acids, have inhibitory actions on mutagenesis. These FFAs in bile may play a role in preventing cholecystopathy and their levels may be influenced by diet. However, the effects of dietary intake on biliary FFAs levels are not known. In order to examine possible associations between dietary habits and biliary FFAs levels, bile samples were collected from resected gallbladders of 114 Chilean female patients with gallstones, and FFAs were measured with an HPLC system. The long-term dietary intake of the patients was investigated through a semi-quantitative food frequency questionnaire. A high intake of vegetables was negatively correlated with the total FFA level (r = -0.264, P = 0.010). Positive correlations were found between fruit consumption and the lauric acid level (r = 0.200, P = 0.041), fish consumption and the levels of oleic (r = 0.370, P <0.0001), linolenic (r = 0.197, P = 0.038) and arachidonic (r = 0.200, P =0.035) acids, and consumption of foods fried in vegetable oil and the linoleic acid level (r = 0.269, P =0.004). Linoleic, linolenic, and arachidonic acids which may have an inhibitory effect on actions of unknown mutagens in bile appear to be increased by consumption of high levels of fish and fried foods.

Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women's Health Study

AIMS/HYPOTHESIS

The aim of this study was to examine the association between lifetime breast-feeding and the incidence of type 2 diabetes mellitus in a large population-based cohort study of middle-aged women.

METHODS

This was a prospective study of 62,095 middle-aged parous women in Shanghai, China, who had no prior history of type 2 diabetes mellitus, cancer or cardiovascular disease at study recruitment. Breast-feeding history, dietary intake, physical activity and anthropometric measurements were assessed by in-person interviews. The Cox regression model was employed to evaluate the association between breast-feeding and the risk of type 2 diabetes mellitus.

RESULTS

After 4.6 years of follow-up, 1,561 women were diagnosed with type 2 diabetes mellitus. Women who had breastfed their children tended to have a lower risk of diabetes mellitus than those who had never breastfed [relative risk (RR)=0.88; 95% CI, 0.76-1.02; p=0.08]. Increasing duration of breast-feeding was associated with a reduced risk of type 2 diabetes mellitus. The fully adjusted RRs for lifetime breast-feeding duration were 1.00, 0.88, 0.89, 0.88, 0.75 and 0.68 (p trend=0.01) for 0, >0 to 0.99, >0.99 to 1.99, >1.99 to 2.99, >2.99 to 3.99 and >or=4 years in analyses adjusted for age, daily energy intake, BMI, WHR, smoking, alcohol intake, physical activity, occupation, income level, education level, number of live births and presence of hypertension at baseline.

CONCLUSIONS/INTERPRETATION

Breast-feeding may protect parous women from developing type 2 diabetes mellitus later in life.

Dietary patterns in middle-aged Irish men and women defined by cluster analysis

Objectives:

To identify and characterise dietary patterns in a middle-aged Irish population sample and study associations between these patterns, sociodemographic and anthropometric variables and major risk factors for cardiovascular disease.

Design:

A cross-sectional study.

Subjects and methods:

A group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for glucose, lipids and homocysteine. Dietary intake was assessed using a standard food-frequency questionnaire adapted for use in the Irish population. The food-frequency questionnaire was a modification of that used in the UK arm of the European Prospective Investigation into Cancer study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed primarily by K-means cluster analysis, following initial principal components analysis to identify the seeds.

Results:

Three dietary patterns were identified. These clusters corresponded to a traditional Irish diet, a prudent diet and a diet characterised by high consumption of alcoholic drinks and convenience foods. Cluster 1 (Traditional Diet) had the highest intakes of saturated fat (SFA), monounsaturated fat (MUFA) and percentage of total energy from fat, and the lowest polyunsaturated fat (PUFA) intake and ratio of polyunsaturated to saturated fat (P:S). Cluster 2 (Prudent Diet) was characterised by significantly higher intakes of fibre, PUFA, P:S ratio and antioxidant vitamins (vitamins C and E), and lower intakes of total fat, MUFA, SFA and cholesterol. Cluster 3 (Alcohol & Convenience Foods) had the highest intakes of alcohol, protein, cholesterol, vitamin B12, vitamin B6, folate, iron, phosphorus, selenium and zinc, and the lowest intakes of PUFA, vitamin A and antioxidant vitamins (vitamins C and E). There were significant differences between clusters in gender distribution, smoking status, physical activity, body mass index, waist circumference and serum homocysteine concentrations.

Conclusion:

In this general population sample, cluster analysis methods yielded two major dietary patterns: prudent and traditional. The prudent dietary pattern is associated with other health-seeking behaviours. Study of dietary patterns will help elucidate links between diet and disease and contribute to the development of healthy eating guidelines for health promotion.

3D Segmentation with an application of level set-method using MRI volumes for image guided surgery

This paper proposes an innovation in the application for image guided surgery using a comparative study of three different method of segmentation. This segmentation method is faster than the manual segmentation of images, with the advantage that it allows to use the same patient as anatomical reference, which has more precision than a generic atlas. This new methodology for 3D information extraction is based on a processing chain structured of the following modules: 1) 3D Filtering: the purpose is to preserve the contours of the structures and to smooth the homogeneous areas; several filters were tested and finally an anisotropic diffusion filter was used. 2) 3D Segmentation. This module compares three different methods: Region growing Algorithm, Cubic spline hand assisted, and Level Set Method. It then proposes a Level Set-based on the front propagation method that allows the making of the reconstruction of the internal walls of the anatomical structures of the brain. 3) 3D visualization. The new contribution of this work consists on the visualization of the segmented model and its use in the pre-surgery planning.

Free fatty acid concentrations in gallbladder bile collected from Chilean patients with gallstones

OBJECTIVES

To evaluate the association between gallstones and biliary free fatty acids (FFAs) as the first attempt to clarify whether biliary FFAs relate to developing gallbladder cancer (GBC) in Chile, which has the highest mortality rate in the world.

DESIGN AND METHODS

Gallbladder bile from 21 male and 129 female patients with gallstones from Santiago was collected, and their FFAs were measured. The results were compared with those observed in a similar previous study performed in Niigata and Kochi Prefectures which showed the highest and lowest mortality rates, respectively, for GBC in Japan.

RESULTS

Palmitoleic and linolenic acids compositions in Santiago patients were significantly lower than those in Niigata and Kochi patients, though these compositions in Niigata patients were significantly lower than those in Kochi patients. The levels of these FFAs compositions decreased in the order of Kochi, Niigata, and Santiago patients.

CONCLUSIONS

Decreased biliary FFAs compositions may relate to developing gallstones and subsequently GBC.

Multiple imputation procedures allow the rescue of missing data: an application to determine serum tumor necrosis factor (TNF) concentration values during the treatment of rheumatoid arthritis patients with anti-TNF therapy

Longitudinal studies aimed at evaluating patients clinical response to specific therapeutic treatments are frequently summarized in incomplete datasets due to missing data. Multivariate statistical procedures use only complete cases, deleting any case with missing data. MI and MIANALYZE procedures of the SAS software perform multiple imputations based on the Markov Chain Monte Carlo method to replace each missing value with a plausible value and to evaluate the efficiency of such missing data treatment. The objective of this work was to compare the evaluation of differences in the increase of serum TNF concentrations depending on the -308 TNF promoter genotype of rheumatoid arthritis (RA) patients receiving anti-TNF therapy with and without multiple imputations of missing data based on mixed models for repeated measures. Our results indicate that the relative efficiency of our multiple imputation model is greater than 98% and that the related inference was significant (p-value < 0.001). We established that under both approaches serum TNF levels in RA patients bearing the G/A -308 TNF promoter genotype displayed a significantly (p-value < 0.0001) increased ability to produce TNF over time than the G/G patient group, as they received successively doses of anti-TNF therapy.

Comparison of Cyclosporine Concentrations 2 Hours Post-Dose Determined Using 3 Different Methods and Trough Level in Pediatric Renal Transplantation

Immunosuppression has been one of the great challenges in pediatric recipients of kidney allografts. Cyclosporine (CsA) has evolved during the past 25 years of transplantation. It requires frequent blood level monitoring because of its narrow therapeutic window and interpatient and intrapatient variability. Neoral (Novartis) is no exception. Ideally, monitoring of blood levels should also include determination of the area under the time-concentration curve (AUC) to better target the therapeutic window, thus avoiding underdosing or overdosing, especially in pediatric patients. A single blood concentration measurement 2 hours after Neoral administration (C2) has been shown to be a more for accurate predictor of drug exposure than trough levels (C0). Therefore, its use may lead to reduction in the incidence and severity of cellular rejection and of CsA toxicity. Some studies have shown that the metabolites/CsA ratio is substantially lower using C2 than C0, however, the between-assay differences for C2 monitoring have not been considered. The purpose of this study was to evaluate CsA C0 and C2 levels, determined using monoclonal fluorescence polarization immunoassay (FPIA)/TDx and enzyme multiplied immunoassay (EMIT). CsA levels were determined using a radioimmunoassay (RIA) in 30 pediatric transplant recipients with stable renal function within 42.7 mean months follow-up. Mean age was 13.4 years; 15 children were girls; 23 patients were recipients of cadaveric kidneys. The mean CsA microemulsion dose was 5.7 mg/kg/d. The 3 methods showed a high correlation between C0 and C2 (r > or = 0.97). A linear regression slope was significantly higher for C0 than C2 (P < .001). The CsA concentrations both at C0 and C2 were significantly higher with FPIA than with RIA (P < .009) but no differences were found for EMITT (P = .2). The mean C0 level for FPIA was 22% and 26% higher than RIA and EMIT, respectively. The mean C2, for FPIA was 7% and 12% higher than RIA and EMIT, respectively. In conclusion, CsA levels determined using RIA or EMIT are better than using FPIA/Tx; also, C2 CsA levels are more accurate than C0 in pediatric transplantation patients.

Clustering of protective factors for glucose intolerance and insulin resistance: a cross-sectional study

AIMS

A cluster of interrelated factors: a body mass index (BMI) < 25 kg/m(2), moderate exercise and alcohol intake, non-smoking and a favourable dietary pattern has been linked with markedly reduced risk of Type 2 diabetes. The aim of this study was to estimate the prevalence of a similar low-risk group in a sample of middle-aged Irish men and women, and determine whether this cluster is associated with a reduced risk of glucose intolerance (IFG and Type 2 diabetes according to ADA/WHO criteria) and insulin resistance [homeostasis model assessment (HOMA) score in upper quartile of distribution].

METHODS

A cross-sectional study involving a stratified random sample of 1018 general practice patients, aged 50-69 years. We defined a low-risk group based on the following variables: BMI < 25 kg/m(2); waist-hip ratio < 0.85 for women and 0.90 for men; never smoking status; participation in medium to high level of physical activity; light drinking (3.5-7 units of alcohol per week) and a 'prudent' dietary pattern. Valid data were available for glucose tolerance status and HOMA score and all exposure variables from 684 and 671 participants, respectively.

RESULTS

A total of 7.5% of participants had none of the 'protective factors', 24.9% had one, 31.0% two, 23.3% three, 10.0% four, 3.0% five and 0.3% had six protective factors. In multivariate analyses the odds ratios for insulin resistance were 0.59, 0.48, 0.14 and 0.04 in persons with one, two, three and four or more low-risk factors, respectively, relative to those with none. Similar linear inverse trends were observed for glucose intolerance.

CONCLUSIONS

The findings are consistent with an inverse linear relation between a cluster of core protective, lifestyle-related factors and the prevalence of both glucose intolerance and insulin resistance.

Short-Term Homeostasis of REM Sleep Throughout a 12:12 Light:Dark Schedule in the Rat

STUDY OBJECTIVES

Intervals extending from the end of a rapid eye movement (REM) sleep episode until the triggering of the next tend to be longer when they follow a longer REM sleep episode. A short-term REM sleep homeostatic process has been hypothesized to explain this effect. The present study assessed and modeled the REM sleep episode-interval relationship and compared its expression at different phases of a 12:12 light: dark schedule.

DESIGN

Chronically implanted rats were continuously recorded for 3 consecutive days. Automated state scoring in 15-second epochs determined lengths of REM sleep episodes and intervals and non-rapid eye movement sleep and wakefulness content of intervals.

SETTING

Individual sound-attenuated temperature-regulated boxes.

PARTICIPANTS

16 Sprague-Dawley rats.

INTERVENTIONS

Scheduled 12:12 light:dark cycle.

MEASUREMENTS AND RESULTS

The effect of REM sleep episode length is evidenced by a rising trend in the means and robust means of intervals and non-rapid eye movement content that follow REM sleep episodes of a given length. The relationship of robust means of intervals and REM sleep episode length was best fitted by a Gompertz sigmoid function. The parameters of the Gompertz equation were modulated throughout the 24 hours, presenting the highest amplitude and earliest rise in hours 1 to 4 after lights on and the lowest amplitude at the start of lights off. The modulation was also evident when only intervals with less than 3 minutes of wakefulness were considered.

CONCLUSIONS

Short-term REM sleep homeostasis is modulated throughout the 24 hours under a 12:12 light:dark regime. Its assessment may provide a useful measure of REM sleep propensity, regulation, and recurrence.

Prevalencia de sensibilización a látex en personal de pabellones quirúrgicos del Hospital Clínico de la Universidad de Chile

BACKGROUND

Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption.

AIM

To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital.

MATERIALS AND METHODS

Ninety five HCW (aged 37+/-10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method.

RESULTS

Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036).

CONCLUSIONS

Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.

Fine particulate matter and wheezing illnesses in the first year of life

BACKGROUND

Recent evidence implicates fine particulate matter (PM2.5), principally from vehicular exhaust, as a major cause of increased mortality and morbidity. However, there are limited data on the impact of PM2.5 on infant respiratory illnesses.

METHODS

We conducted a cohort study of 504 infants recruited at 4 months of age from primary health care units in southeastern Santiago, Chile. Project physicians followed infants through the first year of life via monthly check-ups and by appointments on demand. We obtained data for fine particulate matter, sulfur dioxide (SO2), and nitrogen dioxide (NO2) from the governmental monitoring network.

RESULTS

The most frequent diagnosis during follow-up was wheezing bronchitis, occurring 19.5 times per 100 infants per month. After adjusting for sex, socioeconomic level, family history of asthma, minimum temperature, and number of older siblings, we found that an increase of 10 microg/m of PM2.5 24-hour average was related to a 5% increase (95% confidence interval 0-9%) in the risk for wheezing bronchitis (1-day lag). This association was present for different lags, with a maximum observed for a 9-day lag (9%; 6-12%). No consistent association was detected with NO2 or SO2 ambient levels. Lower socioeconomic status and having older siblings were also associated with the risk of wheezing bronchitis. The association of PM2.5 and wheezing bronchitis was stronger among infants with a family history of asthma than among infants without.

CONCLUSIONS

Air pollution in the form of fine particulates, mostly from vehicular exhaust, may adversely affect infants' respiratory health with potential for chronic effects later in life.

Pediatric Renal Transplantation: 13 Years of Experience—Report From The Chilean Cooperative Multicenter Group

Between 1989 and 2002, 178 renal transplants were performed in 168 pediatric patients in Chile. The mean age was 10.9 +/- 3.7 years (range 1 to 17.9). End-state renal disease etiologies were: congenital renal hypoplasia/dysplasia, chronic glomerulonephritis, and reflux nephropathy. Seventy received a graft from a living donor (LD), and 108 from a cadaveric donor (CD). Only 9% received antibody induction. Acute rejection episodes were reported in 76 patients: 38% in LD recipients and 48% in CD recipients (P = NS). One-, 3-, and 5-year graft survivals were 88%, 84%, and 76%, respectively, for LD and 86%, 79%, and 68% for CD recipients. Actuarial graft survival was significantly better among those patients with serum creatinine < 1 mg/dL at 1 year posttransplant compared with those with creatinine > 1 mg/dL (P < .05). The graft survival rate has improved from the first period (1989 to 1996) to the second period (1997 to 2002); (P = .05). Patient survival rates at 1, 3, and 5 years were 98%, 98%, and 98%, respectively, for LD, and 95%, 94%, and 94% for CD. Global height/age Z-score decreased from -0.7 at birth to -1.5 when dialysis started, and to -2.4 at the time of transplantation. The Z-score height/age at 1, 3, and 5 years posttransplantation was -2.25, -2.24, and -2.5. No significant differences were observed in transplant outcomes comparing patients younger than 7 years with those older ones. In conclusion, pediatric renal transplant has been performed in Chile with acceptable morbidity. The patient and graft survivals are similar to the reported international experience. In the last period there was a significant improvement in graft survival.

A real-time quantitative PCR comparative study between rat optic and sciatic nerves: determination of neuregulin-1 mRNA levels

Injured axons from peripheral nervous system (PNS) possess the ability to regenerate. In contrast, regeneration of injured axons does not occur in the central nervous system (CNS) or occurs to a limited extent. Previous works have shown that rat sciatic nerve conditioned medium (CM) produced PC12 cells neuronal-like differentiation and neurite outgrowth. In the present work, we compared the expression of neuregulin-1s (NRG-1s) from rat sciatic and optic nerves as members of the PNS and CNS, respectively. Sciatic nerve CM showed a higher neurotrophic activity on PC12 cells than rat optic nerve CM. RT-PCR analysis verified the presence of all three types of NRG-1 mRNAs and their receptors in both types of nerves. Real-time quantitative PCR (QPCR) assays showed that the relative expression levels of all three types of NRG-1 mRNAs were higher in optic nerves than in sciatic nerves. Eleven-day cultured optic nerves showed an increased in NDF and SMDF when compared to freshly isolated optic nerves, whereas GGF decreased. However, 11-day-cultured sciatic nerves only showed an increase in SMDF mRNA. Western blots corroborated the differences in NRG-1 expression profile for both types of nerves and their CMs. Incubation of both CMs with the anti-pan-NRG-1 antibody showed that the neurotrophic activity of the optic nerve CM increased, whereas the sciatic nerve CM remained unchanged. These results indicated that different NRG-1 levels are expressed upon nerve degeneration and the balance between those levels and other neurotrophic factors could have an important role on nerve regeneration.

Prudent diet and the risk of insulin resistance

BACKGROUND AND AIM

Diet is a potentially modifiable risk factor for diabetes. Dietary patterns may exert greater effects on health than individual foods, nutrients or food groups. Data on associations between dietary patterns and the risk of insulin resistance and type 2 diabetes are sparse. The aim of the study was to examine associations between dietary patterns and the risk of insulin resistance.

METHODS AND RESULTS

We performed a cross sectional study involving a group of 1018 men and women, sampled from 17 general practice lists in the South of Ireland, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided fasting blood samples for analysis of glucose, insulin and lipids. Dietary intake was assessed using a food frequency questionnaire. The food frequency questionnaire was a modification of the UK arm of the European Prospective Investigation into cancer, EPIC study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed by K cluster analysis. Insulin resistance was estimated on the basis of fasting glucose and insulin, using the glucose homeostasis model (HOMA scores). Insulin resistance was defined as the upper quartile of the HOMA scores. Three dietary patterns were identified by cluster analysis (traditional Irish diet, a prudent diet and an alcohol and convenience foods diet). Participants in clusters 1 (traditional Irish diet) and 3 (high alcohol and convenience foods) had a lower intake of more 'healthy' food groups (such as fruit, vegetables, low fat dairy products, poultry, fish and whole grain products) and higher intake of foods richer in total and SFA content (such as high fat dairy products, butter, meat and meat products). Cluster 2 (prudent dietary pattern) was characterized by a higher intake of food groups that are typically recommended in health promotion programs and a lower intake of meat (read meat), meat products, sweets, high fat dairy and white bread (white bread and unrefined cereal). The prudent diet had the lowest HOMA scores in analysis of covariance. The prevalence of insulin resistance in the prudent diet was lower than that in the traditional diet (OR=0.53; 95%CI, 0.33-0.85 in fully adjusted analysis).

CONCLUSION

A prudent diet may be associated with enhanced insulin sensitivity and a lower risk of type 2 diabetes.

Prevalence and lifestyle determinants of the metabolic syndrome

Participants with the metabolic syndrome are at risk of developing type 2 diabetes and coronary heart disease. The aim of this study was to determine the role of lifestyle risk factors in the development of the metabolic syndrome with particular reference to physical activity, smoking and alcohol consumption. We performed a cross sectional study of the prevalence of CVD risk factors and glucose intolerance, including type 2 diabetes involving a group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, giving a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided fasting blood samples for analysis of glucose, insulin and lipids. The metabolic syndrome was defined according to the current WHO criteria. The prevalence of the metabolic syndrome was 21.0% (95% C.I. 18.7% to 24.1%). In multivariate analyses with the metabolic syndrome as the dependent variable we observed a significant, independent inverse association with physical activity level (OR = 0.60; 95% CI, 0.39-0.90 for medium and OR = 0.51; 95% CI, 0.28-0.93) for high level of activity relative to the low level of activity group). Ex-drinkers had a higher prevalence of the syndrome in multivariate analysis relative to occasional drinkers, (OR = 2.38; 95% CI, 1.08-5.26). Prevalence of the metabolic syndrome was not significantly associated with current alcohol consumption or with smoking status. These data highlight the importance of physical inactivity in the aetiology of the metabolic syndrome.

Alcohol intake and insulin resistance. A cross-sectional study

BACKGROUND AND AIM

The development of insulin resistance is a critical step in the pathogenesis of type 2 diabetes. The effect of alcohol intake on insulin sensitivity/resistance is not well defined. The aim of this study was to examine the association between alcohol intake and insulin resistance in a sample of middle-aged men and women with data on a wide range of potential confounding factors, including diet.

METHODS

We performed a cross sectional study involving a group of 1018 men and women, sampled from 17 general practice lists in the South of Ireland, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and a food frequency questionnaire and provided fasting blood samples for analysis of glucose and insulin. Insulin resistance was estimated on the basis of fasting glucose and insulin, using the glucose homeostasis model (HOMA scores). Insulin resistance was defined as the upper quartile of the HOMA scores.

RESULTS

We found evidence of a U-shaped relationship between alcohol intake and insulin resistance fitted as a continuous variable (HOMA scores) with lowest levels in light drinkers (between 0.5 to 0.99 units per day) relative to the other drinking categories. However no significant association between alcohol intake and HOMA score was observed in fully adjusted analyses, including adjustment for dietary saturated fat and fruit and vegetables intake. In logistic regression analysis with insulin resistance (categorical) as the dependent variable, we observed that ex-drinkers were at higher risk of insulin resistance compared to occasional drinkers independently of age, sex, BMI and waist circumference, (OR=2.4, 95% CI, 1.1-5.7, p=0.04). On further adjustment for potential confounders including diet this association was also attenuated and was non-significant.

CONCLUSIONS

The reported effects of alcohol intake on insulin resistance may be confounded by other aspects of lifestyle, especially diet.

[Streptococci mutans: a semi-quantitative method to assess the risk to oral infection in preschool Chilean children]

BACKGROUND

Salivary infection due to Streptococci mutans is considered the main microbiological risk factor for the initiation of dental caries.

AIM

To evaluate a semi-quantitative method to assess Streptococci mutans salivary infection and compare it with the existing quantitative method.

PATIENT AND METHODS

Saliva samples were obtained from 650 preschool children aged 2 to 6 years old using a TYCSB liquid medium for counting Streptococci mutans. Results were compared with quantitative cultures.

RESULTS

There was a 99.3% linear correlation coefficient between both methods. The correlation coefficients with dental caries prevalence were 97% for the semi quantitative method and 90% for the quantitative method.

CONCLUSIONS

The semi-quantitative method to assess oral infection with Streptococci mutans, is accurate enough to be used in population studies and oral infection prevention programs in developing countries.

Quantitative relationship between salivary level of Streptococcus mutans and Candida albicans in children with Down's syndrome

OBJECTIVE

The actual work intends to establish a correlation between quantitative counts for Streptococcus mutans and Candida albicans in the saliva of patients with Down syndrome (DS), and in mentally deficient (MD) patients, with respect to a normal group (C ).

DESIGN OF THE STUDY

This study was performed in 166 children (49 DS, 60MD and 57C), whose saliva samples were grown on TYCSB agar and Sabouraud agar. Subsequently, microbiological analysis, scanning electron microscopy and aggregation assays were made. The results were statistically evaluated using the variance analysis (ANOVA) and the Student "t" test for unpaired data.

RESULTS

A correlation of 0.45 was found for group C, 0.55 in DS patients and 0.37 in MD patients, when comparing counts of S. mutans and C. albicans in saliva. Scanning electron microscopy analysis showed coaggregation between S. mutans and C. albicans and this was confirmed by in vitro experiments of S. mutans and C. albicans made on nitrocellulose filters.

CONCLUSIONS

This kind of association between bacteria and fungi contributes to justify a pathogenic synergy among several microorganisms, as well as some infectious local or systemic manifestations, depending on the immunity status of the patient.