Evaluating the impact of minimum unit pricing for alcohol in Scotland: a theory-based synthesis of the evidence

BACKGROUND

In May 2018, the Scottish Government set a minimum unit price (MUP) of £0·50 per unit of alcohol sold in Scotland to reduce alcohol-related health harms. We synthesised evidence to establish the effects of MUP on alcohol-related health and social harms, at population level and within specific societal groups.

METHODS

We did a theory-based synthesis of academic and grey research evidence about impacts of MUP in Scotland, including compliance, price, consumption, health outcomes, social outcomes, public attitudes, and the alcoholic drinks industry. We searched the Public Health Scotland's MUP evaluation portfolio and relevant grey and academic literature for studies published between Jan 1, 2018, and Jan 31, 2023. We conducted systematic searches and screening of bibliographic databases (Scopus, Public Health Database, EconLit, MEDLINE, ProQuest Public Health, Social Policy and Practice, NHS Scotland Knowledge Network Library Search, medRxiv, bioRxiv, SSRN, Idox Knowledge Exchange, Social Policy & Practice, and Google Search). Search terms were tailored to specific databases but included variants of the terms "minimum unit pricing", "alcohol", and "policy". Eligibility literature included English-language research into impacts of MUP on either the population of Scotland or a specific subpopulation. We excluded conference abstracts, literature reviews, articles that did not report research, and research based solely on data from before the introduction of MUP.

FINDINGS

We included 40 reports in our analysis. On the balance of evidence, MUP improved population-level health outcomes, demonstrated most starkly by a 13·4% reduction in alcohol-attributable deaths in Scotland compared with England. There was no evidence of substantial negative effects on the alcoholic drinks industry or social harms at the population level. While population-level outcomes were predominantly positive, some qualitative evidence suggests that MUP might have exacerbated health and social harms for some individuals or groups, especially those with alcohol dependence who were financially vulnerable.

INTERPRETATION

MUP in Scotland has been effective in reducing alcohol-related health harms, with little evidence of any effect on social harms. If MUP continues, policymakers should consider raising the £0·50 per unit threshold and supplementing the intervention with policies or services to address any unintended negative effects experienced by specific groups. The synthesis is persuasive due to the prospective, theory-based design of the evaluation portfolio and the quality and comprehensiveness of the evidence.

FUNDING

Scottish Government.

Child and adolescent health in Europe: Towards meeting the 2030 agenda

Background

Childhood and adolescence are critical stages for a healthy life. To support countries in promoting health and development and improving health care for this age group, the WHO Regional Office for Europe developed the European strategy for child and adolescent health 2015-2020, which was adopted by all countries. This paper reports progress in the strategy's implementation until 2020.

Methods

A survey was sent to all ministries of health of the 53 Member States of the WHO European Region. Responses were received from 45 Member States. Results are presented in this paper.

Results

The European Region made overall progress in recent years, but increasing levels of overweight and obesity among children, adolescent mental health and low breastfeeding rates are recognized as key national challenges. Although forty-one countries adopted a national child and adolescent health strategy, only eight countries involve children in their review, development and implementation stages. Two-thirds of countries have a strategy for health-promoting schools and a school curriculum for health education. One-third of countries do not have legislation against marketing of unhealthy foods and beverages to children. Most countries reported routine assessment for developmental difficulties in children, but less than a quarter collected and reported data on children who are developmentally on track. There are major gaps in data collection for migrant children. Hospitalization rates for young children vary five-fold across the region, indicating over-hospitalization and access problems in some countries. Only ten countries allow minors access to health care without parental consent based on their maturity and only eleven countries allow school nurses to dispense contraceptives to adolescents without a doctor's prescription.

Conclusions

This paper shows the progress in child and adolescent health made by countries in Europe until 2020 and key areas where additional work is needed to move the 2030 agenda forward. The survey was undertaken before the COVID-19 pandemic and the war in Ukraine. Both will likely exacerbate many of the observed problems and potentially reverse some gains reported. A renewed commitment is needed.

Structural validity of a brief scale adapted to measure adolescent spiritual health

Spiritual health is established as an important protective health asset in child populations. Measurement and assessment of this elusive concept are, however, challenging. Brief and age-appropriate instruments are required for surveys and related population health research. One longstanding model describing child spirituality suggests that scales and measures consider four standard domains describing connections to self, others, nature, and the transcendent. In this validation study, we tested the structural validity and internal consistency of a brief, literacy-level appropriate instrument for adolescents that was based on prior adaptations of this model. The 2018 cross-national study population included 47,180 children aged 11–15 years from 9 countries. Based upon theory, factor pattern matrices, and Scree plots, the exploratory factor analysis best supported the four-factor model, with items organized according to the original four domains. Internal consistency of the items was acceptable (alpha>.7) to good (alpha>.8) within domains, again within each of the 9 countries. The confirmatory factor analysis again supported the four-factor model (by country, SRMR: 0.020 to 0.042; and AGFI and NFI fit: >0.98). Model fit indices for the four-factor model were improved compared with its unidimensional version. Moving forward, our analysis establishes the structural validity and internal consistency of this adapted brief spiritual health instrument to be used in surveys of adolescents.

The Nab experiment: A precision measurement of unpolarized neutron beta decay

Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.

Family composition and age at menarche: Findings from the international Health Behaviour in School-aged Children study

Background

Early menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. This article assesses the association of different family compositions with the age at menarche. Pathways are explored which may explain any association between family characteristics and pubertal timing.

Methods

Cross-sectional, international data on the age at menarche, family structure and covariates (age, psychosomatic complaints, media consumption, physical activity) were collected from the 2009–2010 Health Behaviour in School-aged Children (HBSC) survey. The sample focuses on 15-year old girls comprising 36,175 individuals across 40 countries in Europe and North America (N = 21,075 for age at menarche). The study examined the association of different family characteristics with age at menarche. Regression and path analyses were applied incorporating multilevel techniques to adjust for the nested nature of data within countries.

Results

Living with mother (Cohen’s d = .12), father (d = .08), brothers (d = .04) and sisters (d = .06) are independently associated with later age at menarche. Living in a foster home (d = −.16), with ‘someone else’ (d = −.11), stepmother (d = −.10) or stepfather (d = −.06) was associated with earlier menarche. Path models show that up to 89% of these effects can be explained through lifestyle and psychological variables.

Conclusions

Earlier menarche is reported amongst those with living conditions other than a family consisting of two biological parents. This can partly be explained by girls’ higher Body Mass Index in these families which is a biological determinant of early menarche. Lower physical activity and elevated psychosomatic complaints were also more often found in girls in these family environments.

Developing a taxonomy to characterise trusted adult support in the lives of adolescents

Introduction

A systematic review of trusted adult interventions for adolescents revealed that there was no common terminology, agreed explicit definition, or detail, regarding the personal qualities, functions and roles fulfilled by trusted adults that was used consistently across the papers. To provide clarity, we therefore aimed to produce a taxonomy of trusted adult input, using evidence drawn from our review.

Methods

Data from the review findings were used to compile the taxonomy, moving from the general to the more specific, in a four stage process. This involved: (1) compilation of elements described in individual papers, (2) grouping of elements derived from stage 1 into categories, (3) examination of context and nature of the relationship, (4) development of a categorisation of trusted adult input.

Findings

The resulting taxonomy encapsulates core essential qualities provided by people acting in trusted adult or mentoring roles, and gives details relating to what a young person might expect from individuals they put their trust in. The taxonomy consists of six categories relating to: delivery context, roles of trusted adults, nature of support, personal qualities, actions/functions, and impact.

Conclusions

The taxonomy describes key elements that define the trusted adult role, and has the potential to inform the development of policies and guidelines relating to support provision. It may be used as a framework for the reporting of trusted adult interventions within research, and act as a helpful guide if a young person is in doubt about the behaviour or qualities displayed by an adult in their environment.

First Observation of P-odd γ Asymmetry in Polarized Neutron Capture on Hydrogen

We report the first observation of the parity-violating gamma-ray asymmetry A_{γ}^{np} in neutron-proton capture using polarized cold neutrons incident on a liquid parahydrogen target at the Spallation Neutron Source at Oak Ridge National Laboratory. A_{γ}^{np} isolates the ΔI=1, ^{3}S_{1}→^{3}P_{1} component of the weak nucleon-nucleon interaction, which is dominated by pion exchange and can be directly related to a single coupling constant in either the DDH meson exchange model or pionless effective field theory. We measured A_{γ}^{np}=[-3.0±1.4(stat)±0.2(syst)]×10^{-8}, which implies a DDH weak πNN coupling of h_{π}^{1}=[2.6±1.2(stat)±0.2(syst)]×10^{-7} and a pionless EFT constant of C^{^{3}S_{1}→^{3}P_{1}}/C_{0}=[-7.4±3.5(stat)±0.5(syst)]×10^{-11}  MeV^{-1}. We describe the experiment, data analysis, systematic uncertainties, and implications of the result.

The relationship between a trusted adult and adolescent outcomes: a protocol of a scoping review

BACKGROUND

Although documentation of harm towards children and young people has existed for centuries, it was not until the 1960s that it became a specific focus for health professionals. Since that time, the importance of protective social networks has become better understood. The concept of trusted adults has come into sharper focus, with children being encouraged to develop networks of dependable adults to turn to for support in times of need. While many child protection processes highlight risks to younger children, there has been less emphasis on older children. The role of trusted adults may be particularly important during adolescence, due to burgeoning independence, developing sexuality, relationship formation, and associated vulnerabilities. While important choices relating to health and education are made during this period, there is little formal evidence relating to the impact of trusted adults on such outcomes. This review therefore aims to focus on the role and influence of trusted adults for adolescents.

METHODS

This study is a scoping review. A broad range of databases will be searched, including MEDLINE, ERIC, Education Abstracts, Web of Science, ASSIA, Sociological Abstracts, and PsycINFO. Predefined inclusion/exclusion criteria will be used, with a focus on outcomes relating to health and education. Two reviewers will blind screen papers independently at all screening stages, with conflicts being resolved by a third reviewer. Quantitative and qualitative studies, as well as unpublished (grey) literature/reports, will be included. We will use the World Health Organization's 'second decade' definition of adolescence. We aim to collate and map evidence in a broad overview and produce meta-analyses of homogenous data. Where this is not possible, a narrative summary will be produced.

DISCUSSION

There appears to be sparse knowledge regarding the role of trusted adults for adolescents. Potential benefits to health and wellbeing may impact on educational attainment, and vice versa. These areas are of particular relevance during the second decade, when decisions that affect future direction, achievement, and wellbeing are being made. The increased understanding of the role of trusted adults provided by this review may help to inform practice and policy and lead to potential benefits for the health and education of adolescents.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD 42017076739.

Trends in the sexual behaviour of 15-year olds in Scotland: 2002-14

Background

Early sexual initiation and inadequate contraceptive use can place adolescents at increased risk of unplanned pregnancy and sexually transmitted infections. These behaviours are patterned by gender and may be linked to social inequalities. This paper examines trends in sexual initiation and contraceptive use by gender and family affluence for Scottish adolescents.

Methods

Cross-sectional data from four nationally representative survey cycles (2002, 2004, 2010, 2014) (n = 8895) (mean age = 15.57) were analysed. Logistic regressions examined the impact of survey year on sexual initiation, condom use and birth control pill (BCP) use at last sex; as well as any changes over time in association between family affluence and the three sexual behaviours. Analyses were stratified by gender.

Results

Between 2002 and 2014, adolescent males and females became less likely to report having had sex. Low family affluence females were more likely to have had sex than high family affluence females, and this relationship did not change over time. Condom use at last sex was reported less by males since 2002, and by females since 2006. Low family affluence males and females were less likely to use condoms than high family affluence participants, and these relationships did not change over time. There were no effects of time or family affluence for BCP use.

Conclusion

There has been a reduction in the proportion of 15-year olds in Scotland who have ever had sex, but also a decrease in condom use for this group. Economic inequalities persist for sexual initiation and condom use.

Self-reported weight and predictors of missing responses in youth

OBJECTIVE

The aims of the present manuscript are to analyse self-reported data on weight, including the missing data, from the 2014 Scottish Health Behaviour in School-Aged Children (HBSC) Study, and to investigate whether behavioural factors related with overweight and obesity, namely dietary habits, physical activity and sedentary behaviour, are associated with weight non-response.

RESEARCH METHODS & PROCEDURES

10839 11-, 13- and 15-year-olds participated in the cross-national 2014 Scottish HBSC Study. Weight missing data was evaluated using Little's Missing Completely at Random (MCAR) test. Afterwards, a fitted multivariate logistic regression model was used to determine all possible multivariate associations between weight response and each of the behavioural factors related with obesity.

RESULTS

58.9% of self-reported weight was missing, not at random (MCAR p < 0.001). Weight was self-reported less frequently by girls (19.2%) than by boys (21.9%). Participants who reported low physical activity (OR 1.2, p < 0.001), low vegetable consumption (OR 1.24, p < 0.001) and high computer gaming on weekdays (OR 1.18, p = 0.003) were more likely to not report their weight.

CONCLUSIONS

There are groups of young people in Scotland who are less likely to report their weight. Their weight status may be of the greatest concern because of their poorer health profile, based on key behaviours associated with their non-response. Furthermore, knowing the value of a healthy weight and reinforcing healthy lifestyle messages may help raise youth awareness of how diet, physical activity and sedentary behaviours can influence weight.

Trends in Adolescent Overweight Perception and Its Association With Psychosomatic Health 2002-2014: Evidence From 33 Countries

PURPOSE

Perceiving oneself as overweight is common and strongly associated with adolescents' subjective well-being. The prevalence of overweight perceptions and their impact on well-being may have increased over the past decade due to an increase in the salience of weight-related issues. This study examines trends (2002-2014) in the prevalence of adolescent overweight perceptions and their association with psychosomatic complaints.

METHODS

Data from 15-year-old adolescents were obtained between 2002 and 2014 in four rounds of the Health Behaviour in School-aged Children study in 33 countries in Europe and North America (N = 187,511). Design-adjusted logistic regressions were used to quantify changes in overweight perceptions over time. Linear modeling was used to assess change in the association between perceived overweight and self-reported psychosomatic complaint burden, adjusting for overweight status.

RESULTS

Among boys, 10 of 33 countries saw an increase in overweight perceptions between 2002 and 2014, with Russia, Estonia, and Latvia showing the most pronounced year-on-year increases. Only England, France, Germany, and Norway saw an increase in the positive association between overweight perceptions and psychosomatic complaints among boys. Among girls, most countries (28/33) saw no change in the prevalence of overweight perceptions, with the prevalence over 40% in most nations. However, in 12 countries, the association between overweight perceptions and psychosomatic complaints increased among girls, with particularly strong changes seen in Scotland and Norway.

CONCLUSIONS

Evidence is presented which suggests that for adolescent girls in 12 Northern and Western European countries and for boys in four perceiving oneself as overweight may be increasingly deleterious for psychosomatic health.

Ultrasound as a Visual Feedback Aid for the Hearing-Impaired

Ultrasound was explored as a visual feedback aid to assist in improving the speech of the deaf and hard of hearing. A mechanical sector real-time scanner produced images of the volunteer's tongue while a speech pathologist provided therapeutic intervention. Pre and postarticulation tests were administered to evaluate change in speech.

Ultrasound as a visual feedback aid may be potentially useful for improving articulation problems for some hearing-impaired speakers. Further research with this population needs to be carried out to explore the practicality of using ultrasound as a visual feedback aid and to gather quantitative data on the long-term effects of learning.

This study has demonstrated that typical real-time sector ultrasound scanners, of the type found in the field today, can be modified to produce useful images of the human tongue during speech production. It is yet unknown what specific type of scanner as well as frequency range is best suited for tongue placement imaging.

Developmental patterns of adolescent spiritual health in six countries

The spiritual health of adolescents is a topic of emerging contemporary importance. Limited numbers of international studies provide evidence about developmental patterns of this aspect of health during the adolescent years. Using multidimensional indicators of spiritual health that have been adapted for use within younger adolescent populations, we therefore: (1) describe aspects of the perceptions of the importance of spiritual health of adolescents by developmental stage and within genders; (2) conduct similar analyses across measures related to specific domains of adolescent spiritual health; (3) relate perceptions of spiritual health to self-perceived personal health status. Cross-sectional surveys were administered to adolescent populations in school settings during 2013–2014. Participants (n=45,967) included eligible and consenting students aged 11–15 years in sampled schools from six European and North American countries. Our primary measures of spiritual health consisted of eight questions in four domains (perceived importance of connections to: self, others, nature, and the transcendent). Socio-demographic factors included age, gender, and country of origin. Self-perceived personal health status was assessed using a simple composite measure. Self-rated importance of spiritual health, both overall and within most questions and domains, declined as young people aged. This declining pattern persisted for both genders and in all countries, and was most notable for the domains of “connections with nature” and “connections with the transcendent”. Girls consistently rated their perceptions of the importance of spiritual health higher than boys. Spiritual health and its domains related strongly and consistently with self-perceived personal health status. While limited by the 8-item measure of perceived spiritual health employed, study findings confirm developmental theories proposed from qualitative observation, provide foundational evidence for the planning and targeting of interventions centered on adolescent spiritual health practices, and direction for the study of spiritual health in a general population health survey context.

•

Spiritual health is recognized as one of four domains of health.

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Few quantitative studies exist describing patterns of spiritual health in child populations.

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We employed a series of items that describe perceptions of the importance of spiritual health and its domains in adolescents.

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We demonstrated strong developmental and gender-based patterns that were consistent across countries and cultures.

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Perceptions of the importance of spiritual health appear to be linked with adolescent health outcomes.

Fruit, Vegetable and Dietary Carotenoid Intakes Explain Variation in Skin-Color in Young Caucasian Women: A Cross-Sectional Study

Fruit and vegetables contain carotenoid pigments, which accumulate in human skin, contributing to its yellowness. This effect has a beneficial impact on appearance. The aim was to evaluate associations between diet (fruit, vegetable and dietary carotenoid intakes) and skin color in young women. Ninety-one Caucasian women (Median and Interquartile Range (IQR) age 22.1 (18.1–29.1) years, BMI 22.9 (18.5–31.9) kg/m²) were recruited from the Hunter region (Australia). Fruit, vegetable and dietary carotenoid intakes were estimated by a validated food frequency questionnaire. Skin color was measured at nine body locations (sun exposed and unexposed sites) using spectrophotometry. Multiple linear regression was used to assess the relationship between fruit and vegetable intakes and skin yellowness adjusting for known confounders. Higher combined fruit and vegetable intakes (β = 0.8, p = 0.017) were associated with higher overall skin yellowness values. Higher fruit combined fruit and vegetable intakes (β = 1.0, p = 0.004) were associated with increased unexposed skin yellowness. Combined fruit and vegetables plus dietary carotenoid intakes contribute to skin yellowness in young Caucasian women. Evaluation of interventions using improvements in appearance as an incentive for increasing fruit and vegetable consumption in young women is warranted.

Educational expectations and adolescent health behaviour: an evolutionary approach

OBJECTIVES

Previous research finds adolescents expecting to attend university are more likely to demonstrate health-promoting behaviour than those not expecting university attendance. This suggests public health improvements may be achievable by encouraging adolescents to adopt academic goals. We investigate confounders of this putative relationship, focusing on those identified by evolutionary theory.

METHODS

Multi-level logistic regression was used to analyse the 2010 Scottish Health Behaviour in School-aged Children survey (n = 1834).

RESULTS

Adolescents anticipating university attendance exhibited higher levels of engagement in health-protective behaviours (fruit and vegetable consumption, exercise and tooth brushing) and were more likely to avoid health-damaging behaviours (crisps, soft drink and alcohol consumption, tobacco and cannabis use, fighting and intercourse). These relationships persisted when controlling indicators of life history trajectory (pubertal timing, socioeconomic status and father absence). Pupil level: gender, age, perceived academic achievement and peer/family communication and school level: university expectations, affluence, leavers' destinations, exam performance and school climate were also adjusted.

CONCLUSIONS

Encouraging adolescents to consider an academic future may achieve public health benefits, despite social factors that might otherwise precipitate poor health via an accelerated life history trajectory.

Can dietary intake influence perception of and measured appearance? A systematic review

Appearance-based interventions have had some success in reducing smoking and sun exposure. Appearance may also motivate dietary behavior change if it was established that dietary improvement had a positive impact on appearance. The aims of this review are to evaluate the current evidence examining the relationship between dietary intake and appearance and to determine the effectiveness of dietary interventions on perceived or actual appearance. An electronic search of English-language studies up to August 2012 was conducted using Cochrane, MEDLINE, Embase, CINAHL, Web of Science, SCOPUS, and PsycINFO databases. Studies that included participants aged at least 18 years, that observed or altered dietary intake from actual food or dietary supplement use, and assessed appearance-related outcomes were considered eligible. Data from 27 studies were extracted and assessed for quality using standardized tools. Nineteen studies were assessed as being of "positive" and 4 of "neutral" quality. All observational studies (n = 4741 participants) indicated that there was a significant association between various aspects of dietary intake and skin coloration and skin aging. The majority (16 studies, 769 participants) evaluated the effect of dietary supplements on skin appearance among women. Only 1 study examined the effect of actual food intake on appearance. Significant improvements in at least 1 actual or perceived appearance-related outcome (facial wrinkling, skin elasticity, roughness, and skin color) following dietary intervention were shown as a result of supplementation. Further studies are needed in representative populations that examine actual food intake on appearance, using validated tools in well-designed high-quality randomized control trials.

You look familiar: how Malaysian Chinese recognize faces

East Asian and white Western observers employ different eye movement strategies for a variety of visual processing tasks, including face processing. Recent eye tracking studies on face recognition found that East Asians tend to integrate information holistically by focusing on the nose while white Westerners perceive faces featurally by moving between the eyes and mouth. The current study examines the eye movement strategy that Malaysian Chinese participants employ when recognizing East Asian, white Western, and African faces. Rather than adopting the Eastern or Western fixation pattern, Malaysian Chinese participants use a mixed strategy by focusing on the eyes and nose more than the mouth. The combination of Eastern and Western strategies proved advantageous in participants' ability to recognize East Asian and white Western faces, suggesting that individuals learn to use fixation patterns that are optimized for recognizing the faces with which they are more familiar.

15S-Hydroxyeicosatetraenoic acid activates peroxisome proliferator-activated receptor gamma and inhibits proliferation in PC3 prostate carcinoma cells

15-Lipoxygenase (15-LOX)-2 is expressed in benign prostate secretory cells and benign prostate produces 15S-hydroxyeicosatetraenoic acid (15S-HETE) from exogenous arachidonic acid (AA). In contrast, 15S-LOX-2 and 15S-HETE formation are reduced in prostate carcinoma (Pca). The mechanisms whereby reduced 15-LOX-2 may contribute to Pca development or progression are not known. We investigated the expression of peroxisome proliferator-activated receptor (PPAR) gamma in benign and malignant prostate tissues and the ability of 15S-HETE to activate PPARgamma-dependent transcription and modulate proliferation of the Pca cell line PC3. In contrast to benign prostate and similar to most Pca tissues, 15-LOX-2 mRNA was not detected in PC3 cells, and they did not produce detectable 15-HETE from [14C]AA. By reverse transcription-PCR, PPARgamma mRNA was present in 18 of 18 benign and 9 of 9 tumor specimens. The PPARgamma ligand BRL 49653 and 15S-HETE caused a dose-dependent inhibition of PC3 proliferation in a 14-day soft agar colony-forming assay (IC50 of 3 and 30 microM, respectively). 15S-HETE (10 microM) caused greater inhibition than 10 microM 15R-HETE. At 3 days, BRL 49653 and 15S-HETE caused a slight increase in cells in G0-G1 and a corresponding decrease in cells in S phase. In PC3 cells transiently transfected with a luciferase reporter linked to a PPAR response element, 1 microM BRL 49653 and 10 microM 15S-HETE caused approximately threefold and greater than twofold induction of PPAR-dependent transcription, respectively. By quantitative real-time reverse transcription-PCR and Northern analysis, 3-day treatment with BRL 49653 and 15S-HETE caused a reduction of PPARgamma expression but a marked up-regulation of the PPAR response element containing adipocyte type fatty acid binding protein. These results support the hypothesis that 15-LOX-2-derived 15S-HETE may constitute an endogenous ligand for PPARgamma in the prostate and that loss of this pathway by reduced expression of 15-LOX-2 may contribute to increased proliferation and reduced differentiation in prostate carcinoma.

Families with autosomal dominant brachydactyly type E, short stature, and severe hypertension

BACKGROUND

Rare, monogenic forms of hypertension may give insight into novel mechanisms relevant to essential hypertension. Autosomal dominant hypertension with brachydactyly has been documented in a single Turkish kindred; the gene was mapped to chromosome 12p.

OBJECTIVE

To describe the molecular genetics of additional families with autosomal dominant hypertension and brachydactyly.

DESIGN

Case series.

SETTING

Tertiary care medical centers.

PATIENTS

An 11-member Canadian family and a 7-member U.S. family, neither of Turkish background, with autosomal dominant hypertension and type E brachydactyly.

MEASUREMENTS

Clinical evaluation, genotyping, and haplotype analyses.

RESULTS

The mode of inheritance, the type E brachydactyly, and the propensity for stroke were consistent with autosomal dominant hypertension with brachydactyly. The same markers on chromosome 12p cosegregated with the phenotype in the families. A haplotype analysis strongly supported the conclusion that these families have a molecular defect in the same gene.

CONCLUSIONS

The syndrome of autosomal dominant hypertension and brachydactyly is not confined to patients of Turkish origin. All persons with brachydactyly should have their blood pressure measured, and the syndrome should be considered if hypertension is found.

Musculoskeletal injuries in adolescents

This article reviews the anatomy of the physis and the most common classification of injuries or fractures through the physis. The common apophyseal injuries of Osgood-Schlatter, Severs disease and iliac apophysitis, are reviewed in addition to a review of the most common osteochondritides, including Panner's disease and Osteochondritis Dessicans of the femur and talus. An understanding of these is key to diagnosis and treatment of adolescent musculoskeletal injuries. This article also reviews slipped capital femoral epiphysis, little leaguer's elbow, anterior cruciate and collateral ligament injuries, patella problems, ankle sprains and several common fractures in children.

Avoiding state intervention in not-for-profit/for-profit affiliations

States attorneys general recently have intervened in transactions involving not-for-profit organizations that wish to convert to or transfer assets to for-profit status. These interventions are significant for two reasons: first, they reflect a tendency amount state attorneys general to involve states in the governance of not-for-profit healthcare organizations, and second, they demonstrate that attorneys general are paying renewed attention to the legal obligation of such organizations to provide a community health benefit, which imposes a charitable trust on not-for-profit healthcare organizations and the fiduciary duties of care and loyalty to that charitable trust on the organizations' officers and directors. To avoid state intervention in such transactions, officers and directors of not-for-profit organizations need to understand the circumstances under which attorneys general justify such intervention, which include the undervaluation of the organization's charitable assets; lack of a private letter ruling from the IRS; failure to adequately consider alternatives to the transaction; conflicts with the best interest of the organization; and inadequate responses to the attorney general's requests for information.

Effects of cue validity upon performance in the attention cueing paradigm

Two experiments were run wherein normal subjects made choice reactions to targets preceded by location cues. Systematic manipulation of the predictive validity of the cue produced consistent advantages for subjects in the low as opposed to the high predictive validity condition. Performance advantages were observed in both response time and accuracy measures. The results are discussed with respect to models of visual orienting and controlled versus automatic processing.

IRS eases rules for physician representation on governing boards

In September 1996, the IRS eased its policy prohibiting extensive physician representation on governing boards of tax-exempt integrated delivery systems (IDSs). The IRS now allows increased physician participation on governing boards if the organizations institute conflict-of-interest safeguards that prohibit physicians from obtaining private inurements. A section of the Internal Revenue Code, enacted in 1996 by the Taxpayer Bill of Rights 2, strengthens the IRS's enforcement policy by providing targeted sanctions against individual violators of the private inurement rule rather than penalizing entire IDSs and the communities they serve by revoking their tax-exempt status.

Stress and performance: an application of Gray's three-factor arousal theory to basketball free-throw shooting

The suitability of Gray's (1975) three-factor arousal theory as a model of human performance under stress was investigated in a study of basketball free-throw shooting. Free-throw attempts, made by members of an NCAA Division I men's varsity team, were videotaped during one full season. On the basis of Gray's theory, we predicted that increased stress (assumed to be present in games as opposed to practices) would be associated with longer pre-shot preparations and a greater incidence of overthrow shots. The prediction was confirmed by the results. Moreover, we found that free-throws were more frequently overthrown when attempted during crucial rather than non-crucial game situations. Further tests of the utility of Gray's theory are suggested.

Resistance training-induced increases in muscle mass and performance in ponies

The purpose of this study was to determine whether 8 wk of progressive resistance exercise training would produce increases in strength and changes in foreleg muscle characteristics indicative of hypertrophy in ponies. Two mature 3- to 6-yr-old, male ponies (188 +/- 16 kg) were taught to carry sheets of lead over their saddle region (wither) while walking on a level treadmill at 1.9 m.s-1. This initial familiarization period was followed by 8 wk of training (3 d per wk), in which the ponies performed a series of progressive sets of weight carrying to fatigue. Each workout started with a 2-min walk at 1.9 m.s-1 followed by sets of weight carrying. The ponies carried 44.5 kg for the first set with increases of 22.3 kg per set until fatigue. Weights were applied and then removed for 60-90 s between sets using a chain hoist and sling apparatus. Measurements of forelimb girth, body weight, and total weight carried were recorded at each workout session. Ultrasound measurement of the diameters of the superdigital flexor muscles and muscle biopsies were performed before and after the 8-wk training period. Eight weeks of resistance training resulted in significant increases in peak weight carried (260%, P < 0.05) and total weight carried (1525%, P < 0.05) during each workout. Forelimb girth increased 12 +/- 1% (P < 0.05) with a corresponding 19 +/- 3% (P < 0.05) increase in muscle cross-sectional diameter. There were no changes (P > 0.05) in Type I muscle fiber area; however, there was a nonsignificant 26% increase in Type IIA+IIB fiber area. These data suggest that 8 wk of progressive resistance exercise training increase strength and cause changes in muscle size and characteristics consistent with hypertrophy.

Obstructive colitis: an analysis of 50 cases and a review of the literature

Obstructive colitis is an ulcero-inflammatory and necrotizing condition that occurs in the colon proximal to benign or malignant stenosing lesions. it is the result of ischemia due to impairment of blood supply secondary to elevation of the endoluminal pressure, distension of the colonic wall and other factors which impair adequate perfusion. The incidence among patients with colonic obstruction is reported at between 1 and 7%. Of 50 patients with this condition in this series, 30 female and 20 male, 2/3rds were well over 70 yrs of age. Obstruction was most common in the rectosigmoid. In half the patients this was due to adenocarcinoma, 24 were due to benign obstruction and 15 were caused by diverticular disease. Type, extent and depth of ischemic lesions were highly variable and comprised early mucosal hemorrhage and edema, ulcero-hemorrhagic lesions and transmural necrosis. There was always an abrupt transition between affected and normal bowel. A segment of preserved mucosa was usually present on the proximal side of the stenosis. In 16 patients massive dilatation with stretching and thinning of the bowel wall, associated with a blow-out type of perforation or with transmural necrosis, was observed and was considered to have resulted from a rapid rise of endoluminal pressure to high levels. The microscopic and macroscopic features are described in detail and histological factors discussed in relation to the pathological lesions encountered. Emphasis is placed upon the range of appearances and similarities are shared with other inflammatory colonic diseases, particularly idiopathic inflammatory bowel disease. The importance of recognition of this disease entity, not only by pathologists but by surgeons dealing with the disease at operation, is stressed.

Whole body protein metabolism and resting energy expenditure in pregnant Gambian women

Whole body protein metabolism and resting energy expenditure (REE) were measured at 11, 23, and 33 wk of pregnancy in nine pregnant (not malnourished) Gambian women and in eight matched nonpregnant nonlactating (NPNL) matched controls. Rates of whole body nitrogen flux, protein synthesis, and protein breakdown were determined in the fed state from the level of isotope enrichment of urinary urea and ammonia during a period of 9 h after a single oral dose of [15N]glycine. At regular intervals, REE was measured by indirect calorimetry (hood system). Based on the arithmetic end-product average of values obtained with urea and ammonia, a significant increase in whole body protein synthesis was observed during the second trimester (5.8 +/- 0.4 g.kg-1.day-1) relative to values obtained both for the NPNL controls (4.5 +/- 0.3 g.kg-1.day-1) and those during the first trimester (4.7 +/- 0.3 g.kg-1.day-1). There was a significant rise in REE during the third trimester both in the preprandial and postprandial states. No correlation was found between REE after meal ingestion and the rate of whole body protein synthesis.

Effect of malaria and fever on energy metabolism in Gambian children

The aim of the present study was to measure the changes in resting energy expenditure (REE) induced by malaria and to assess to what extent they are related to fever and nutritional status. The REE of 19 Gambian children (mean age +/- SEM, 9 +/- 1 y; weight, 24 +/- 2 kg; expected weight for height 86 +/- 1%) were measured with a hood system at repeated intervals at the onset of malaria crisis (test A), 3 to 4 d after therapy (test B), and 14 to 21 d later (test C). Axillary temperature averaged 39.2 +/- 0.1, 36.6 +/- 0.1, and 36.7 +/- 0.1 degrees C in the tests A, B, and C, respectively. REE in test A was significantly higher than REE in test B (223 +/- 10 versus 174 +/- 8 kJ/kg.d, p less than 0.0001), but in test C (169 +/- 8 kJ/kg.d), it did not differ from that observed in test B. The percentage of increase in REE was significantly correlated with the difference in axillary temperature (r = 0.46, p less than 0.05); the slope of the regression line indicated an increase of 6.9% in REE/degree C of fever. Furthermore, the individual increase in REE/degree C was correlated to the percentage of weight for height of the children (r = 0.54, p less than 0.05), indicating that the child's nutritional status influences the magnitude of the hypermetabolism due to fever. We concluded that Gambian children suffering from an acute episode of malaria have an increase in REE averaging 30%; however, REE promptly returns to baseline value a few days after the beginning of therapy.

Video image analysis of AgNOR distribution in the normal and adenomatous colorectum

The nucleolar organizer regions (AgNORs) have been studied by video image analysis in the normal colorectum and in adenomas arising there. Total AgNOR area was measured in conjunction with the total area of nuclei and expressed as a ratio. AgNORs are found to predominate in the proliferative regions of the normal mucosal crypt, and the ratio of AgNOR to nuclear area proved significantly greater in the normal colon than in the rectum and far greater in colorectal adenomas. Further, there is a significant difference between the ratio in tubular as opposed to villous patterns of adenomatous growth in the colon but not in the rectum. When classified according to their degree of dysplasia, adenomas in the rectum exhibit a significantly higher ratio of AgNOR to nuclear area as the degree of dysplasia increases in severity. This correlation is not shown in the colon.

Postprandial thermogenesis in lactating and non-lactating women from The Gambia

Postprandial thermogenesis was assessed by indirect calorimetry in 32 Gambian women classified into three groups as follows: 12 non-pregnant non-lactating and 10 lactating women studied during the dry season and 10 lactating women studied during the rainy season. The test meal consisted of a typical Gambian breakfast and its energy content corresponded to 30% of the individual's resting metabolic rate (RMR)/24 h. During the dry season, the postprandial thermogenesis of the lactating women averaged 6.0 +/- 0.4% of the test meal energy content and was similar to that observed in the non-pregnant non-lactating women studied during the same season (5.8 +/- 0.3%). In contrast, the postprandial thermogenesis of lactating women studied during the rainy, nutritionally unfavourable season was found to be significantly lower (4.9 +/- 0.5%). There was no significant difference in the pre- and postprandial respiratory quotients among groups. This leads to the conclusion that lactation does not alter the thermogenic response to food and that the reduction in postprandial thermogenesis observed in lactating women during the wet season constitutes an adaptive response to energy deficit allowing a saving of energy in periods of food restriction.

Is human lactation a particularly efficient process?

The recommended dietary allowances of many expert committees (UK DHSS 1979, FAO/WHO/UNU 1985, USA NRC 1989) have set out the extra energy requirements necessary to support lactation on the basis of an efficiency of 80 per cent for human milk production. The metabolic efficiency of milk synthesis can be derived from the measurements of resting energy expenditure in lactating women and in a matched control group of non-pregnant non-lactating women. The results of the present study in Gambian women, as well as a review of human studies on energy expenditure during lactation performed in different countries, suggest an efficiency of human milk synthesis greater than the value currently used by expert committees. We propose that an average figure of 95 per cent would be more appropriate to calculate the energy cost of human lactation.

A new procedure to assess the energy requirements of lactation in Gambian women

The combined 24-h energy expenditure (24-h EE) of mother and child was measured with a respiratory chamber (indirect calorimeter) in a group of 16 lactating Gambian women and was compared with that of a control group of 16 nonpregnant, nonlactating (NPNL) Gambian women. Breast-milk production (738 +/- 47 g/d: mean +/- SE) was adequate to allow a normal rate of growth of their 2-mo-old babies (28.0 +/- 2.4 g/d). The combined 24-h EE (mother and child) was higher (8381 +/- 180 kJ/d. P less than 0.001) than that of NPNL women (6092 +/- 121 kJ/d). Two-thirds of this differences could be attributed to the child's EE and one-third to a greater spontaneous physical activity of lactating women. The energy retained by the child for growth in conjunction with the calorimetric measurements allowed the calculation of the extra energy requirements for lactation, which were found to be 2100 kJ/d. These results confirm the values of the current dietary recommendations for lactation, based on the energy cost of milk production.

Stimulation by human chorionic gonadotropin of prostaglandin synthesis by early human placental tissue

Successful establishment of pregnancy is dependent on inhibition of clotting and suppression of the maternal immune response at the feto-maternal interface. Early human placental production of prostacyclin (PGI2) and prostaglandin E2 (PGE2) may be important in this process. To examine the possible role of these PGs, we studied PGE and 6-keto-PGF1 alpha (stable metabolite of PGI2) synthesis in human placental (9-17 weeks gestation) organ cultures, and monolayer cultures of purified trophoblasts. PGE2 appeared to be the major protanoid formed. Other arachidonic acid metabolites identified in placental organ culture were 6-keto-PGF1 alpha, thromboxane B2, PGF2 alpha, leukotriene B4, 5(S)-hydroxyeicosatetraenoic acid (5-HETE), 12-HETE, and 15-HETE. The synthesis of PGE and 6-keto-PGF1 alpha altered with gestation and was maximal in the younger placentas. Arachidonic acid (33 microM) stimulated and indomethacin (28 microM) inhibited PG production. hCG, including physiological concentrations, stimulated PGE and 6-keto-PGF1 alpha synthesis in placental organ cultures. This effect was most striking in the 9-12 week placentas, compared to 15-17 week placentas. A similar hCG-induced stimulation of PGE production occurred in monolayer cultures of trophoblasts. The addition of TSH, FSH, and LH indicated that this effect was specific for hCG. These data suggest that hCG may have a biological role in the regulation of PG synthesis in early human placenta.

Seasonal changes in 24-h and basal energy expenditures in rural Gambian men as measured in a respiration chamber

Adaptation of 24-h energy expenditure (24-h EE) to seasonal variations in food availability was studied, by using a respiration chamber, in 18 rural Gambian men on three occasions: period 1--at the end of the rainy season, which is characterized by low food availability; period 2--during the nutritionally favorable dry season; and period 3--at the onset of the following rainy season. From periods 1 to 2 body weight increased by 2.8 +/- 0.4 kg, and a rise in 24-h EE was observed (from 8556 +/- 212 kJ/d to 9166 +/- 224 kJ/d), which was correlated to weight change (r = 0.73, P less than 0.001). During period 3, 24-h EE averaged 8740 +/- 194 kJ/d. Diet-induced thermogenesis increased significantly from periods 1 to 2 (5.9 +/- 0.5% to 8.2 +/- 0.8%) and subsequently decreased to 3.6 +/- 0.6% during period 3. In rural Gambian men, metabolic adaptations in response to seasonal changes in food availability are reflected by a decrease in body weight, mainly manifested by a loss of fat-free mass accompanied by a decreased 24-h EE and a lowered diet-induced thermogenesis.