High-intensity interval training in cardiac rehabilitation (HIIT or MISS UK): A multi-centre randomised controlled trial

BACKGROUND

There is a lack of international consensus regarding the prescription of high-intensity interval exercise training (HIIT) for people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).

AIM

To assess the clinical effectiveness and safety of low-volume HIIT compared with moderate intensity steady-state (MISS) exercise training for people with CAD.

METHODS

We conducted a multi-centre RCT, recruiting 382 patients from 6 outpatient CR centres. Participants were randomised to twice-weekly HIIT (n = 187) or MISS (n = 195) for 8 weeks. HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. MISS was 20-40 minutes of moderate intensity continuous exercise (60-80% maximum capacity). The primary outcome was the change in cardiorespiratory fitness (peak oxygen uptake, VO2 peak) at 8-week follow-up. Secondary outcomes included cardiovascular disease risk markers, cardiac structure and function, adverse events, and health-related quality of life.

RESULTS

At 8 weeks, VO2  peak improved more with HIIT (2.37 mL.kg-1.min-1; SD, 3.11) compared with MISS (1.32 mL.kg-1.min-1; SD, 2.66). After adjusting for age, sex and study site, the difference between arms was 1.04 mL.kg-1.min-1 (95% CI, 0.38 to 1.69; p = 0.002). Only 1 serious adverse event was possibly related to HIIT.

CONCLUSIONS

In stable CAD, low-volume HIIT improved cardiorespiratory fitness more than MISS by a clinically meaningful margin. Low-volume HIIT is a safe, well tolerated, and clinically effective intervention that produces short-term improvement in cardiorespiratory fitness. It should be considered by all CR programmes as an adjunct or alternative to MISS.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02784873. https://clinicaltrials.gov/ct2/show/NCT02784873.

Randomized, Double-Blind, Crossover, Clinical-End-Point Pilot Study to Examine the Use of Exhaled Nitric Oxide as a Bioassay for Dose Separation of Inhaled Fluticasone Propionate

This was a randomized, double-blind, crossover, clinical-end-point pilot study examining the hypothesis that inhaled fluticasone propionate decreases exhaled nitric oxide (eNO) concentrations within a week of beginning treatment and shows evidence of dose separation across the marketed dose range. Subjects had a ≥6-month history of asthma and screening eNO ≥60 parts per billion. At the start of each treatment period, eNO was ≥55 parts per billion, and forced expiratory volume in 1 second was ≥50% predicted. Subjects attended a clinic visit daily on consecutive mornings during each of 3 1-week treatment periods to measure eNO and receive once-daily doses of 100/50, 250/50, or 500/50 fluticasone propionate/salmeterol combination product (Advair^® Diskus). Daily eNO value recorded was the highest of 3 measurements; 1 inhalation of treatment was then administered. Procedures were repeated for 3 treatment cycles, separated by 14-day minimum washouts. A total of 105 subjects were screened; 22 were randomized; and 17 completed all treatments. Mean percentage eNO decrease (standard deviation) from day 1 baseline for each treatment period was 36.6 (±18.7), 45.3 (±16.5), and 54.6 (±12.5) with Advair^® 100/50, 250/50, and 500/50, respectively. Mean percentage decrease in eNO across each treatment (dose) was modeled using a mixed-model ANOVA. Although the overall treatment was significant (P = .0015), because of the relatively small sample size and within-subject variability, only the 100/50 vs 500/50 (P = .0003) and 250/50 vs 500/50 (P = .047) treatments were significantly different.

Estimated peak functional capacity: an accurate method for assessing change in peak oxygen consumption after cardiac rehabilitation?

OBJECTIVE

Cardiopulmonary exercise testing (CPET) is the 'gold standard' method of determining VO_2peak . When CPET is unavailable, VO_2peak may be estimated from treadmill or cycle ergometer workloads and expressed as estimated metabolic equivalents (METs). Cardiac rehabilitation (CR) programmes use estimated VO_2peak (METs) to report changes in cardiorespiratory fitness (CRF). However, the accuracy of determining changes in VO_2peak based on estimated functional capacity is not known.

METHODS

A total of 27 patients with coronary heart disease (88·9% male; age 59·5 ± 10·0 years, body mass index 29·6 ± 3·8 kg m^-2 ) performed maximal CPET before and after an exercise-based CR intervention. VO_2peak was directly determined using ventilatory gas exchange data and was also estimated using the American College of Sports Medicine (ACSM) leg cycling equation. Agreement between changes in directly determined VO_2peak and estimated VO_2peak was evaluated using Bland-Altman limits of agreement (LoA) and intraclass correlation coefficients.

RESULTS

Directly determined VO_2peak did not increase following CR (0·5 ml kg^-1 min^-1 (2·7%); P = 0·332). Estimated VO_2peak increased significantly (0·4 METs; 1·4 ml kg^-1  min^-1 ; 6·7%; P = 0·006). The mean bias for estimated VO_2peak versus directly determined VO_2peak was 0·7 ml kg^-1  min^-1 (LoA -4·7 to 5·9 ml  kg^-1  min^-1 ). Aerobic efficiency (ΔVO₂ /ΔWR slope) was significantly associated with estimated VO_2peak measurement error.

CONCLUSION

Change in estimated VO_2peak derived from the ACSM leg cycling equation is not an accurate surrogate for directly determined changes in VO_2peak . Our findings show poor agreement between estimates of VO_2peak and directly determined VO_2peak . Applying estimates of VO_2peak to determine CRF change may over-estimate the efficacy of CR and lead to a different interpretation of study findings.

Cerebrospinal Fluid Analysis in Recumbent Adult Dairy Cows With or Without Spinal Cord Lesions

Background

Diagnosis of central nervous system (CNS) lesions in recumbent dairy cattle (RDC) is challenging because neurologic examination is limited and medical imaging often is challenging or unrewarding. Cerebrospinal fluid (CSF) analysis is useful in the diagnosis of CNS disorders in cattle. However, its utility in identifying spinal cord lesions in RDC remains to be evaluated.

Hypothesis/Objectives

We hypothesized that CSF analysis would discriminate between RDC with and without spinal cord lesions.

Animals

Twenty‐one RDC with spinal cord lesions (RDC+) and 19 without (RDC−) were evaluated.

Methods

Spinal cord lesions were confirmed at necropsy. Signalment, clinical findings, and CSF results were compared retrospectively. Total nucleated cell count and differential, protein concentration, and red blood cell count in RDC+ and RDC− were compared.

Results

Neoplasia, trauma, and infectious processes were the most frequent spinal cord lesions identified. Cerebrospinal fluid protein concentrations and TNCC were significantly higher in RDC+ compared to RDC− (P = .0092 and P = .0103, respectively). Additionally, CSF protein concentrations and TNCC in RDC− were lower than previously published reference ranges. Using an interpretation rule based on CSF protein concentration and TNCC, it was possible to accurately identify 13 RDC with spinal cord lesions and 6 RDC without lesions. It was not possible to determine spinal cord status in the remaining 18 RDC.

Conclusions and Clinical Importance

Cerebrospinal fluid analysis is valuable in the evaluation of spinal cord status in RDC. The prognosis associated with these findings remains to be determined.

Sibling teenage pregnancy and clinic-referred girls' condom use: The protective role of maternal monitoring

Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents' condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy.

18F-RB390: innovative ligand for imaging the T877A androgen receptor mutant in prostate cancer via positron emission tomography (PET)

BACKGROUND

Detecting prostate cancer before spreading or predicting a favorable therapy are challenging issues for impacting patient's survival. Presently, 2-[(18) F]-fluoro-2-deoxy-D-glucose ((18) F-FDG) and/or (18) F-fluorocholine ((18) F-FCH) are the generally used PET-tracers in oncology yet do not emphasize the T877A androgen receptor (AR) mutation being exclusively present in cancerous tissue and escaping androgen deprivation treatment.

METHODS

We designed and synthesized fluorinated 5α-dihydrotestosterone (DHT) derivatives to target T877A-AR. We performed binding assays to select suitable candidates using COS-7 cells transfected with wild-type or T877A AR (WT-AR, T877A-AR) expressing plasmids and investigated cellular uptake of candidate (18) F-RB390. Stability, biodistribution analyses and PET-Imaging were assessed by injecting (18) F-RB390 (10MBq), with and without co-injection of an excess of unlabeled DHT in C4-2 and PC-3 tumor bearing male SCID mice (n = 12).

RESULTS

RB390 presented a higher relative binding affinity (RBA) (28.1%, IC50  = 32 nM) for T877A-AR than for WT-AR (1.7%, IC50  = 357 nM) related to DHT (RBA = 100%). A small fraction of (18) F-RB390 was metabolized when incubated with murine liver homogenate or human blood for 3 hr. The metabolite of RB390, 3-hydroxysteroid RB448, presented similar binding characteristics as RB390. (18) F-RB390 but not (18) F-FDG or (18) F-FCH accumulated 2.5× more in COS-7 cells transfected with pSG5AR-T877A than with control plasmid. Accumulation was reduced with an excess of DHT. PET/CT imaging and biodistribution studies revealed a significantly higher uptake of (18) F-RB390 in T877A mutation positive xenografts compared to PC-3 control tumors. This effect was blunted with DHT.

CONCLUSION

Given the differential binding capacity and the favorable radioactivity pattern, (18) F-RB390 represents the portrayal of the first imaging ligand with predictive potential for mutant T877A-AR in prostate cancer for guiding therapy. Prostate 75:348-359, 2015. © 2014 Wiley Periodicals, Inc.

Variability of automated carotid intima-media thickness measurements by novice operators

Carotid intima-media thickness (C-IMT) measurements provide a non-invasive assessment of subclinical atherosclerosis. The aim of the study was to assess the inter- and intra-observer variability of automated C-IMT measurements undertaken by two novice operators using the Panasonic CardioHealth Station. Participants were free from cardio-metabolic disease, and each underwent serial bilateral C-IMT ultrasound measurements. Immediate interoperator measurement variability was calculated by comparing initial measurements taken by two operators. Immediate retest variability was calculated from two consecutive measurements and longer term variability was assessed by conducting a further scan 1 week later. Fifty apparently healthy participants (n = 20 females), aged 26·2 ± 5·0 years, were recruited. Operator 1 recorded a median (interquartile range) right and left-sided C-IMT of 0·471 mm (0·072 mm) and 0·462 mm (0·047 mm). Female's right and left C-IMT were 0·442 mm (0·049 mm) and 0·451 mm (0·063 mm), respectively. The limits of agreement (LoA) for immediate interoperator variability were -0·063 to 0·056 mm (mean bias -0·003 mm). Operator 1's immediate retest intra-operator LoA were -0·057 to 0·046 mm (mean bias was -0·005 mm). One-week LoA were -0·057 to 0·050 mm (mean bias -0·003 mm). Operator 2 recorded median right and left-sided C-IMT of 0·467 mm (0·089 mm) and 0·458 mm (0·046 mm) for males, respectively, whilst female measurements were 0·441 mm (0·052 mm) and 0·444 mm (0·054 mm), respectively. Operator 2's intra-operator immediate retest LoA were -0·056 to 0·056 (mean bias <-0·001 mm). Intra-operator LoA at 1 week were -0·052 to 0·068 mm (mean bias 0·008 mm). Novice operators produce acceptable short-term and 1-week inter- and intra-operator C-IMT measurement variability in healthy, young to middle-aged adults using the Panasonic CardioHealth Station.

Validation of an ultrasound imaging technique of the tympanic bullae for the diagnosis of otitis media in calves

Background

Otitis media is a common disease in calves that can be subclinical, making antemortem on‐farm diagnosis challenging.

Objectives

To evaluate the sensitivity and specificity of ultrasonography of tympanic bullae for the diagnosis of clinical and subclinical otitis media and to evaluate the reproducibility of the technique.

Animals

Forty calves 19–50 days of age were selected from a veal calf farm.

Methods

Prospective study. Ultrasonography was first performed on the farm by ultrasonographer A (US A). Ultrasonography was repeated by ultrasonographer A (US A') and another ultrasonographer (US B) at the Centre Hospitalier Universitaire Vétérinaire. Images were later reread by both examiners and a diagnosis was recorded. The calves were euthanized and submitted for necropsy, and histopathologic diagnosis was used as the gold standard.

Results

Forty‐five bullae were affected by otitis media and 35 bullae were normal. Sensitivity and specificity of the ultrasound technique ranged from 32 to 63% and 84 to 100%, respectively, depending on the examiner and classification of suspicious ultrasonography results. Kappa analysis to evaluate interobserver agreement between A' and B yielded a к value of 0.53. Agreement within the same examiner (A versus A') yielded a к value of 0.48, and real‐time ultrasound versus rereading of recorded images for A' and B yielded к values of 0.58 and 0.75, respectively.

Conclusions

Sensitivity and specificity of the ultrasound imaging technique are, respectively, low and high for diagnosis of clinical and subclinical otitis media in calves, with moderate reproducibility.

Anthropometry and blood pressure changes in a Caribbean adolescent population of African ancestry: an evaluation of longitudinal data using a multilevel mixed regression approach

OBJECTIVE

The aim of this study was to determine the effect of growth pattern on blood pressure changes in an adolescent population of African ancestry based on longitudinal data and to compare this with estimates derived from cross-sectional data.

METHODS

Participants had measurements of weight, height, blood pressure and percentage body fat taken annually using standardized procedures. Annual blood pressure and anthropometry velocities as well as one- and three-year interval gender specific tracking coefficients were computed. We investigated whether changes in blood pressure could be explained by measures of growth using a multilevel mixed regression approach.

RESULTS

The results showed that systolic blood pressure (SBP) increased by 1.27 and 3.09 mmHg per year among females and males, respectively. Similarly, diastolic blood pressure (DBP) increased by 1.16 and 1.92 mmHg per year among females and males, respectively. Multilevel analyses suggested that weight, body mass index, percentage body fat and height were the strongest anthropometric determinants of blood pressure change in this population. The results also suggest that there are gender differences in the relative importance of these anthropometric measures with height playing a minor role in predicting blood pressure changes among adolescent females. With the exception of DBP at 18 years among females, there were no significant differences between mean blood pressure generated from cross-sectional and longitudinal data by age in both males and females.

CONCLUSION

Anthropometric measures are important covariates of age-related blood pressure changes and cross-sectional data may provide a more cost-effective and useful proxy for generating age-related blood pressure estimates in this population.

[Sputum smear conversion during intensive TB treatment phase according to HIV status, in hospitalised patients in Togo]

METHOD

We prospectively studied patients with pulmonary TB, with or without HIV-1 co-infection, from December 1, 2007 to December 1, 2008. Two groups of patients naive for TB and antiretroviral treatment (group A: 96 co-infected TB/HIV and group B: 171 TB infected but HIV negative) were selected randomly. The CD4 count was assessed according to HIV status, and all patients received RHEZ TB treatment for 2 months. Pulmonary smear was assessed at two weeks, four weeks, six weeks, and eight weeks.

RESULT

Two hundred and sixty seven patients were treated (26.6% of admissions). The mean age was 34.62 ± 11 years and the sex ratio was 1.3. A proportion of 35.75% patients were HIV co-infected with a median CD4 count at 157 cells per millimeter cube. The sputum smear conversion was obtained for more than 87.5% of patients in group A and 24.56% in group B at two weeks; 94% of patients in group A and 61.83% in group B at four weeks; 100% of patients in group A and 87.33% in group B at six weeks, and 100% of patients in group A and 96.77% in group B at eight weeks. P<0.05 at six weeks.

CONCLUSION

HIV infected TB patients were more susceptible to treatment than TB/HIV infected patients in the first six weeks.

Reproducibility of the airway response to an exercise protocol standardized for intensity, duration, and inspired air conditions, in subjects with symptoms suggestive of asthma

BACKGROUND

Exercise testing to aid diagnosis of exercise-induced bronchoconstriction (EIB) is commonly performed. Reproducibility of the airway response to a standardized exercise protocol has not been reported in subjects being evaluated with mild symptoms suggestive of asthma but without a definite diagnosis. This study examined reproducibility of % fall in FEV1 and area under the FEV1 time curve for 30 minutes in response to two exercise tests performed with the same intensity and duration of exercise, and inspired air conditions.

METHODS

Subjects with mild symptoms of asthma exercised twice within approximately 4 days by running for 8 minutes on a motorized treadmill breathing dry air at an intensity to induce a heart rate between 80-90% predicted maximum; reproducibility of the airway response was expressed as the 95% probability interval.

RESULTS

Of 373 subjects challenged twice 161 were positive (≥ 10% fall FEV1 on at least one challenge). The EIB was mild and 77% of subjects had <15% fall on both challenges. Agreement between results was 76.1% with 56.8% (212) negative (< 10% fall FEV1) and 19.3% (72) positive on both challenges. The remaining 23.9% of subjects had only one positive test. The 95% probability interval for reproducibility of the % fall in FEV1 and AUC0-30 min was ± 9.7% and ± 251% for all 278 adults and ± 13.4% and ± 279% for all 95 children. The 95% probability interval for reproducibility of % fall in FEV1 and AUC0-30 min for the 72 subjects with two tests ≥ 10% fall FEV1 was ± 14.6% and ± 373% and for the 34 subjects with two tests ≥ 15% fall FEV1 it was ± 12.2% and ± 411%. Heart rate and estimated ventilation achieved were not significantly different either on the two test days or when one test result was positive and one was negative.

CONCLUSIONS

Under standardized, well controlled conditions for exercise challenge, the majority of subjects with mild symptoms of asthma demonstrated agreement in test results. Performing two tests may need to be considered when using exercise to exclude or diagnose EIB, when prescribing prophylactic treatment to prevent EIB and when designing protocols for clinical trials.

Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma

BACKGROUND

Asthma can be difficult to diagnose, but bronchial provocation with methacholine, exercise or mannitol is helpful when used to identify bronchial hyperresponsiveness (BHR), a key feature of the disease. The utility of these tests in subjects with signs and symptoms of asthma but without a clear diagnosis has not been investigated. We investigated the sensitivity and specificity of mannitol to identify exercise-induced bronchoconstriction (EIB) as a manifestation of BHR; compared this with methacholine; and compared the sensitivity and specificity of mannitol and methacholine for a clinician diagnosis of asthma.

METHODS

509 people (6-50 yr) were enrolled, 78% were atopic, median FEV1 92.5% predicted, and a low NAEPPII asthma score of 1.2. Subjects with symptoms of seasonal allergy were excluded. BHR to exercise was defined as a > or = 10% fall in FEV1 on at least one of two tests, to methacholine a PC20 < or = 16 mg/ml and to mannitol a 15% fall in FEV1 at < or = 635 mg or a 10% fall between doses. The clinician diagnosis of asthma was made on examination, history, skin tests, questionnaire and response to exercise but they were blind to the mannitol and methacholine results.

RESULTS

Mannitol and methacholine were therapeutically equivalent to identify EIB, a clinician diagnosis of asthma, and prevalence of BHR. The sensitivity/specificity of mannitol to identify EIB was 59%/65% and for methacholine it was 56%/69%. The BHR was mild. Mean EIB % fall in FEV1 in subjects positive to exercise was 19%, (SD 9.2), mannitol PD15 158 (CI:129,193) mg, and methacholine PC20 2.1(CI:1.7, 2.6) mg/ml. The prevalence of BHR was the same: for exercise (43.5%), mannitol (44.8%), and methacholine (41.6%) with a test agreement between 62 & 69%. The sensitivity and specificity for a clinician diagnosis of asthma was 56%/73% for mannitol and 51%/75% for methacholine. The sensitivity increased to 73% and 72% for mannitol and methacholine when two exercise tests were positive.

CONCLUSION

In this group with normal FEV1, mild symptoms, and mild BHR, the sensitivity and specificity for both mannitol and methacholine to identify EIB and a clinician diagnosis of asthma were equivalent, but lower than previously documented in well-defined populations.

TRIAL REGISTRATION

This was a multi-center trial comprising 25 sites across the United States of America.

To share or not to share: When do toddlers respond to another's needs?

The developmental origins of sharing remain little understood. Using procedures adapted from research on prosocial behavior in chimpanzees, we presented 18- and 25-month-old children with a sharing task in which they could choose to deliver food to themselves only, or to both themselves and another person, thereby making it possible for them to share without personal sacrifice. The potential recipient, a friendly adult, was either silent about her needs and wants or made them explicit. Both younger and older toddlers chose randomly when the recipient was silent. However, when the recipient vocalized her desires 25-month-olds shared whereas younger children did not. Thus, we demonstrate that children voluntarily share valued resources with others by the end of the second year of life, but that this depends on explicit communicative cues about another's need or desire.

The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines

OBJECTIVES

The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA).

METHODS

A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file.

RESULTS

HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/microL.

CONCLUSION

The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

Diagnosis of aged prescribed burning plumes impacting an urban area

An unanticipated wind shift led to the advection of plumes from two prescribed burning sites that impacted Atlanta, GA, producing a heavy smoke event late in the afternoon on February 28, 2007. Observed PM2.5 concentrations increased to over 140 microg/m3 and O3 concentrations up to 30 ppb in a couple of hours, despite the late hour in February when photochemistry is less vigorous. A detailed investigation of PM2.5 chemical composition and source apportionment analysis showed that the increase in PM2.5 mass was driven mainly by organic carbon (OC). However, both results from source apportionment and an observed nonlinear relationship between OC and PM2.5 potassium (K) indicate that the increased OC was not due solely to primary emissions. Most of the OC was water-soluble organic carbon (WSOC) and was dominated by hydrophobic compounds. The data are consistent with large enhancements in isoprenoid (isoprene and monoterpenes) and other volatile organic compounds emitted from prescribed burning that led to both significant O3 and secondary organic aerosol (SOA) production. Formation of oligomers from oxidation products of isoprenoid compounds or condensation of volatile organic compounds (VOCs) with multiple functional groups emitted during prescribed burning appears to be a major component of the secondary organic contributor of the SOA. The results from this study imply that enhanced emissions due to the fire itself and elevated temperature in the burning region should be considered in air quality models (e.g., receptor and emission-based models) to assess impacts of prescribed burning emissions on ambient air quality.

Blood pressure and its correlates in Tobagonian adolescents

OBJECTIVE

To determine age-specific patterns and correlates of blood pressure (BP) in Tobagonian adolescents.

METHODS

Blood pressure, weight and heights were measured using standardized procedures. Age-height and gender-specific BP levels were established and compared with those established for adolescents in the United States of America, the United Kingdom and Jamaica.

RESULTS

Of the available population, 3749 or 84.9% participated in the study. Among Tobagonian adolescents, the mean one-year age increment in systolic blood pressure (SBP) was 3.6 (95% CI: 3.2, 3.9) mmHg in males and 1.5 (95% CI: 1.2, 1.8) mmHg in females. Likewise, the mean one-year increment in diastolic blood pressure (DBP) was 2.1 (95% CI: 1.7, 2.4) mmHg in males and 1.2 (95% CI: 0.9, 1.4) mmHg in females. There was an inversion of mean BP with age. Females 12-13 years having significantly higher mean SBP while those 15-18 years had lower SBP than their male counterparts. Similarly, females 12-14 years had significantly higher mean DBP while those 16-18 years had lower DBP than their male counterparts. Approximately, 6.1% (95% CI: 5.4, 7.0) and 8.2% (95% CI: 7.4, 9.1) of participants had elevated SBP and DBP based on the US reference standards. Adolescents from the UK had average SBP and DBP that were 10 mmHg higher and lower respectively than their Tobagonian counterparts while Jamaican adolescents had diastolic BP consistently lower than Tobagonian adolescents of similar age. Elevated BP was associated with overweight and family history of hypertension.

CONCLUSION

Growth and maturational factors are important determinants of blood pressure levels in this population. Furthermore, the wide variation in these key variables among possible BP referent populations necessitates the development of local blood pressure reference standards for Tobagonian adolescent populations.

Patient satisfaction and quality of life among persons attending chronic disease clinics in South Trinidad, West Indies

OBJECTIVE

Patient satisfaction and quality of life are increasingly being recognized as central elements in the monitoring and evaluation of healthcare. In this survey, the level of patient satisfaction and quality of life were investigated in regular attendees at public health chronic disease facilities in South Trinidad.

METHOD

A random sample of 200 clients attending the three public chronic disease clinics during the period August 12, 2002 to December 31, 2002, completed self-administered questionnaires consisting of socio-demographic, quality of life (SF 12) and health service items.

RESULTS

Participants had an average of four annual visits and 75% of them were 50 years and older. Approximately two-thirds of participants gave health and support staff a rating of good to excellent. Overall clinic experience was rated as poor to fair by 41.5%. Forty-five and a half per cent gave a rating of the explanations given by doctors and nurses about their illnesses. Fifty-three and a half per cent and 58% gave a poor to fair rating for the length of the waiting time and explanation offered when there was a significant delay in the starting times of clinics respectively. In regression analyses controlling for age, gender and number of illnesses, ratings of clinic experience and all categories of clinic staff were significantly associated with SF-12 mental and physical component summary scores.

CONCLUSION

The findings suggest that in this population of regular clinic attendees, levels of client satisfaction and numbers of illnesses are associated with subjective quality of life.

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

OBJECTIVE

To compare changes in bone mineral density (BMD) during 48 months between first-time depot medroxyprogesterone acetate (MPA) users, during use and after discontinuation, to controls.

DESIGN

Longitudinal study.

SETTING

Academic community.

PATIENT(S)

Women 18-35 years, newly initiating depot MPA (n = 178) and controls (n = 145) not using hormonal contraception.

MAIN OUTCOME MEASURE(S)

The BMD of the hip and spine, measured at 3-month intervals, by dual energy roentgen absorptiometry.

RESULTS

Hip and spine BMD declined during 48 months of depot MPA use by 7.7% +/- 0.11% (mean +/- SE) and 6.4% +/- 0.36%, respectively. The BMD of controls declined <or=1.6% +/- 0.30%. Hip and spine BMD loss slowed to <0.6% after 48 months of depot MPA use. After discontinuation, BMD increased from 0.3% to 2.0% per year depending on length of depot MPA use and bone site. The longest depot MPA users remained 4.7% and 2.9% lower than hip and spine baseline values, respectively, 18 months after discontinuation.

CONCLUSION(S)

Depot MPA-related BMD loss is substantial but occurs mostly during the first 2 years of DMPA use. Therefore, longer use may not substantially increase the risk of osteoporosis. The prolonged recovery time suggests the need to consider timing of use in relation to menopause or other factors that may impede bone remodeling.

Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception

OBJECTIVE

To compare longitudinal changes in weight, body fat, and ratio of central to peripheral fat mass among first-time depot-medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and to evaluate user characteristics associated with that change.

DESIGN

Prospective longitudinal study.

SUBJECTS

Healthy women, aged 18-35 y, using DMPA for contraception (n=178) and women using no hormonal contraception (n=145).

MEASUREMENTS

Weight, body fat, and the central distribution of fat, measured at 3-month intervals for 30 months, by electronic scale and dual-energy X-ray absorptiometry (DEXA). The ratio of central to peripheral distribution of body fat was computed by dividing the body fat in the conventional DEXA trunk region of interest (ROI) by the ROI's that encompass the arms, hips and legs.

RESULTS

Women using DMPA had a significantly greater increase in all measures of fatness than women using no hormonal method of contraception (P<0.03). The observed weight of DMPA users increased from a mean of 69.4 kg (s.d.=16.9) at baseline to 75.5 kg (s.d.=25.0) at 30 months; an increase of 6.1 kg (8.8.%). Fat mass increased from a mean of 25.3 kg (s.d.=12.6 kg) at baseline to 31.4 kg (s.d.=17.8); an increase of 6.1 kg (23.6%) in DMPA users. The ratio of central to peripheral fat mass in DMPA users changed from 0.95 (s.d.=0.155) at baseline to 1.01(s.d.=0.198) at 30 months. In contrast, weight, fat mass and the ratio of central to peripheral fat mass of control participants remained virtually unchanged over the same time period. Women with higher baseline physical activity levels had a smaller increase in body fat (P=0.003) and the fat ratio (P=0.03), but not weight (P=0.48). No other user characteristics including, smoking, past oral contraceptive use or previous pregnancies predicted change in level of fatness.

CONCLUSIONS

This study has demonstrated a change in body composition toward greater fatness and toward a central redistribution of fat among DMPA users as compared to controls and provides important information to be used when counseling women regarding contraceptive methods. Given the potential long-term implication of these changes, further study is recommended to determine whether the gains in fatness are reversed following DMPA discontinuation and to examine the role of progestins in the development and maintenance of obesity.

The quality of health research reporting by the daily newspapers in Trinidad and Tobago

In this study, the authors examined the scientific quality of health research reported in the three daily newspapers in Trinidad and Tobago. All medical research articles published for the period January 1 to December 31, 2003, were extracted using a standardized data collection form. The scientific quality of the articles was analyzed by taking into consideration various aspects of study design, as well as other issues associated with accurate reporting. Of the 321 eligible articles, 108 were collected from The Trinidad Express, 100 from The Trinidad Guardian and 113 from The Trinidad and Tobago Newsday. The percentages of articles reporting methodological components consistent with good scientific quality were as follows: objective(s) (99.7%), study design (79.8%), study procedure (70.1%), selection procedure (70.1%), description of participants (87.5%), control/matching group (74.9%), outcome variables (99.4%) and issues of validity and reliability (2.5%). In addition, the percentage of articles containing aspects of good report writing were as follows: authorship (71.3%), authors' affiliation (59.5%), location of the study (25.4%), source of the research material (83.1%), duration of the study (27.7%), study setting (72.0%), number of participants (74.1%), period in which the study was conducted (12.0%) and quantification of the results (66.7%). Observational studies were significantly more likely to be reported than experimental studies (71.5% versus 28.5%). Overall, articles reported in the Trinidad Express and the Trinidad and Tobago Newsday were of a better scientific quality than those in the Trinidad Guardian. These findings suggest a need to improve the overall scientific quality of reported health research in these newspapers by ensuring that reports answer the fundamental questions of what, why, who, where, when and how. This might be achieved by adopting a structured reporting format similar to that used by many peer-reviewed journals.

A content analysis of health research reported by the daily newspapers of Trinidad and Tobago

The ability to translate health research into useful information for the layperson requires both excellent scientific expertise and communication skills that are often foreign to journalist and editors. In this study, we assessed the content of health research articles published in the local daily newspapers for the year 2003. Issues considered included physical presentation, coverage, primary content of the article relative to the country health profile, accuracy of the article compared to its original publication, health model (ie preventative versus medical/curative) and tone (emotive nature of the report, stakeholder addressed). The authors identified 321 eligible articles as follows, The Trinidad Express (108), The Trinidad Guardian (100) and The Trinidad and Tobago Newsday (113). More than 90% of the reports appeared in the newspapers within two weeks of their original journal publication; 10.5% of the articles had over 50% newspaper readership coverage. Headlines were prominently displayed for 70% of articles while 86% of the written text were located on the top right and left quadrant of pages where the eye naturally falls during reading. Photographs accompanied 36% of the articles. Approximately 72.5% of articles accurately reflected the content of the original publication and 67% of them were classified as preventative. There were similar proportions of good (45%) and bad (47%) articles. The top five predominant themes were nutrition (24.3%), cancer (18.2%) women's health (17.6%), heart disease (14.2%) and mental health (10.3%). The findings suggest a tremendous effort by journalist and editors to provide relevant health information in a timely and attractive manner; however, this should not be at the expense of accuracy.

Ethnicity, body image perception and weight-related behaviour among adolescent females attending secondary school in Trinidad

OBJECTIVE

The correlates of body image perception among an ethnically diverse group of adolescent females attending secondary school in Trinidad were investigated.

METHODS

A cross-sectional survey was carried out among adolescent females from selected secondary schools in Trinidad. Participants completed a self-administered questionnaire consisting of sociodemographic items and standardized psychometric instruments.

RESULTS

Two hundred and fifty-one students participated in the survey with an ethnic composition as follows: Indo-Trinidadian (35.9%), Afro-Trinidadian (28.7%), Indo-Afro mixed Trinidadian (21.9%) and other (13.5%). The results suggest that 2.4% of the participants reported having a medical diagnosis for an eating disorder Indo-Trinidadians had significantly greater body dissatisfaction than Indo-Afro-mixed Trinidadians but not more than Afro-Trinidadians (p = 0.04). Also, a significantly higher proportion of Indo-Trinidadians engaged in binge eating behaviour compared to the other ethnic groups (p < 0.001). Afro-Trinidadians were more likely to use vomiting as a mean of weight control compared to Indo- and Indo-Afro-mixed Trinidadian (p < 0. 05). Fifty-one per cent of participants had a negative body image perception. Altered body image perception was associated with a significant higher mean Body Shape Questionnaire BSQ 16 score (p < 0.001) and increased likelihood of reporting being diagnosed with an eating disorder (OR = 2.03, 95% CI: 1.78, 2.31; p = 0.01) compared to non-altered body image state. Eating Attitude Test (EAT-26) score was positively correlated with Drive-for-Thinness (p < 0.001) and BSQ16 (p < 0.001) scores and inversely correlated with the Rosenberg self-esteem score (p = 0.012).

CONCLUSION

In this group of adolescents, there are ethnic differences in the level of concern over body image and associated eating, and weight-related behaviour.

107 COMPARISON OF PRIMATE SPERM CRYOPRESERVATION PROTOCOLS: POST-THAW SPERM RECOVERY AND HYPERACTIVATION IN CULTURE

Cryopreservation of spermatozoa provides material for gene banking of genetically valuable males and offers convenience for in vitro fertilization (IVF). In addition, cryobanking of spermatozoa allows less frequent ejaculation collections from males. The present study compared the effectiveness of several published techniques in non-human primates to find the most efficient one for rhesus macaque (Macaca mulatta) semen cryopreservation. The effectiveness of each method was assessed by longevity (post-thaw motility % and duration) and ability to hyperactivate in culture in response to chemical activators (caffeine, dbcAMP) needed for rhesus sperm capacitation (Boatman and Bavister 1984 J. Reprod. Fertil. 71, 357-366). The ability to hyperactivate provides a reasonable assessment of the fertilizing capability of spermatozoa prior to performing IVF; the latter was impractical for this study, given the large number of treatments and endpoints. Spermatozoa were collected via electroejaculation from one male on three occasions to avoid confounding treatments with male effects. Each ejaculate was divided into one of four treatment groups for cryopreservation: Method A (Seier et al. 1993 J. Med. Primatol. 22, 355-359); Method B (Wei et al. 2000); Method C (Sanchez-Partida et al. 2000, Biol. Reprod. 63, 1092-1097); and Method D (Isachenko et al. 2005 Reprod. Biomed. Online 10, 350-354). Protocols were followed according to each published technique. Upon thawing, each sample was split into different incubation conditions: 37�C, 5% CO2 in air or room temperature for 0-24 h. One dose of activators was used according to standard protocol. Statistical analyses of motility rates were performed using 2 � 2 G tests (Sokal and Rohlf 1981 Biometry. New York: W. H. Freeman Co.) to determine significance. Samples cryopreserved using method D did not survive the method (motility = 0) and were not included in the statistical analysis. Methods A-C all demonstrated reasonable post-thaw motility recovery rates (68%, 73%, and 62%, respectively) and underwent capacitation within 30 min of exposure to activators. Sperm motility decreased over time in culture within each treatment at 37�C. However, spermatozoa in Method A were significantly less motile at 4 and 24 h than those in Methods B and C, and Method B spermatozoa were significantly less motile at 24 h than those in Method C. Sperm motility also decreased over time in samples incubated at room temperature, with motility of sperm in Method A motility being significantly less at 24 h than that of sperm in Methods B and C. Method C best preserved motility over time regardless of temperature of incubation upon thawing. Overall, incubation at room temperature preserved motility better than incubation at 37�C. Methods A-C yielded satisfactory post-thaw recovery of progressively motile spermatozoa despite the various differences among their protocols. For long-term use of each sample, however, it would be beneficial to incubate spermatozoa at room temperature after using Method C. This technique appears to be more appropriate for gene banking rhesus semen, and applying this protocol would allow more efficient usage of each semen sample, potentially providing for multiple IVF cases over a 24-h period. This work was supported by NIH Grant RR15395.

Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate

OBJECTIVE

To compare longitudinal changes in bone mineral density (BMD) among first-time depot medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and evaluate user characteristics associated with that BMD change.

DESIGN

Prospective longitudinal study.

SETTING

Healthy volunteers in an academic research environment.

PATIENT(S)

Women, aged 18 to 35, choosing DMPA for contraception (n = 178) and women using no hormonal contraception (n = 145).

MAIN OUTCOME MEASURE(S)

Hip and spine BMD measured, at three-month intervals for 24 months, by dual energy x-ray absorptiometry.

RESULT(S)

Mean hip BMD declined 2.8% (SE = 0.034) 12 months following DMPA initiation and 5.8% (SE = 0.096) after 24 months. Mean spine (L1-L3) BMD declined 3.5% (SE = 0.022) and 5.7% (SE = 0.034), respectively, after one and two years of DMPA use. Mean hip and spine BMD of control participants changed less than 0.9% over the same period. Among DMPA users, body mass index (BMI) change was inversely associated with BMD change at the hip, but not at the spine. Calcium intake, physical activity, and smoking did not influence BMD change in either group.

CONCLUSION(S)

Hip and spine BMD declined after one DMPA injection and this decline continued with each subsequent injection for 24 months. With the exception of increasing BMI among DMPA users, no user characteristics offered protection against DMPA-related BMD loss.

Bone mineral density and fractures among alcohol-dependent women in treatment and in recovery

Women are at higher risk for osteoporosis, but most of the literature examining the effect of alcohol abuse on bone mineral density (BMD) has been in men. The aim of this study was to determine differences in BMD and fracture prevalence among women in treatment for alcohol abuse, in recovery and non-alcohol-dependent women. This cross-sectional study was completed at two residential substance abuse centers in Iowa (USA). The patients were Caucasian women, aged 18-70 years, in treatment for alcohol abuse and dependence ( n=228); in recovery and abstaining from alcohol ( n=156); and women with no history of alcohol abuse ( n=447). The main outcome measures were femoral neck and lumbar spine BMD measured by dual-energy X-ray absorptiometry (DXA); self-reported lifetime fracture prevalence. After adjusting for age and menopausal status, women in treatment had BMDs that were 7.7% ( p<0.01) and 6.3% ( p<0.01) lower at the femoral neck and lumbar spine, respectively, than non-alcohol-abusing women, and 4.8% lower at both bone sites ( p<0.01) than women in recovery. Femoral neck BMD of women in recovery was 3.1% lower ( p<0.01) than in non-alcohol-dependent women; however, the difference was not significant following multivariate analysis. Women in treatment and recovery reported more fractures during childhood and early adolescence than non-alcohol-dependent women ( p<0.01). Women in recovery also reported significantly greater numbers of fractures following sobriety than their paired non-alcohol-dependent counterparts. Alcohol abuse and dependence was associated with lower femoral neck and lumbar spine BMD. Women with histories of alcohol dependence had a higher lifetime prevalence of fractures, including time periods before the onset of problem drinking and following abstinence, suggesting that factors other than acute intoxication contributed to the greater fracture prevalence.

Socio-demographic and health system factors in relation to exclusive breast-feeding in Tobago

To determine the prevalence and significant correlates of exclusive breast-feeding among nursing mothers, we conducted a survey among nursing mothers attending the Wellness Baby Clinic in Tobago from July 1 to December 1, 1998. A random sample of 151 mothers had face-to-face interviews with a standardized pretested questionnaire. Our results suggest that 48.3% and 20.8% of infants were exclusively breast-fed at two and four months respectively. Univariate logistic regression analyses showed that exclusive breast-feeding at two months was significantly positively associated with years of schooling completed by the mother, frequency of prenatal visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding, and occupation of the child's father. Exclusive breast-feeding at four months was significantly positively associated with mother's age, years of schooling completed by the mother, frequency of prenatal visits, mother's knowledge of the recommended duration of breast-feeding, years of schooling completed by the child's father and occupation of the child's father. In multivariate logistic analyses, adjusting simultaneously for all relevant explanatory variables, exclusive breast-feeding at two months was significantly positively associated with frequency of prenatal clinic visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding and occupation of the child's father. In addition, exclusive breast-feeding at four months was significantly positively associated with frequency of prenatal clinic visits, length of hospital stay, mother's knowledge of recommended duration of breast-feeding, years of schooling completed by the child's father, family structure and inversely associated with mother's age. In this sample, parental socio-demographic characteristics and health system factors were associated with subsequent infant feeding practices.

Comprehensive evaluation of patients with haematuria on multi-slice computed tomography scanner: protocol design and preliminary observations

An imaging protocol with a multi-slice CT scanner that allows comprehensive assessment of patients with haematuria is described. This protocol allows evaluation of the kidneys, ureters and bladder in a single examination using CT. This approach should streamline the diagnostic work-up of patients with haematuria.

Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network

BACKGROUND

The optimal approach for diagnosing primary HIV-1 infection has not been defined.

OBJECTIVE

To determine the usefulness of symptoms and virologic tests for diagnosing primary HIV-1 infection.

DESIGN

Prospective cohort study.

SETTING

A teaching hospital in Los Angeles and a university research center in San Diego, California.

PATIENTS

436 patients who had symptoms consistent with primary HIV infection.

MEASUREMENTS

Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen.

RESULTS

Primary infection was diagnosed in 54 patients (12.4%). The sensitivity and specificity of the p24 antigen assay were 88.7% (95% CI, 77.0% to 95.7%) and 100% (CI, 99.3% to 100%), respectively. For the HIV RNA assay, sensitivity was 100% and specificity was 97.4% (CI, 94.9% to 98.9%). Fever, myalgia, rash, night sweats, and arthralgia occurred more frequently in patients with primary infection (P < 0.05).

CONCLUSIONS

No sign or symptom allows targeted screening for primary infection. Although assays for HIV RNA are more sensitive than those for p24 antigen in diagnosing primary infection, they are more expensive and are more likely to yield false-positive results.

HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: results from the Hemophilia Growth and Development Study

OBJECTIVE

To assess changes in adaptive, emotional, and behavioral functioning over four years in children and adolescents with hemophilia and with or without HIV infection and to evaluate the relationship of these changes to immune status.

METHODS

Participants were 277 HIV-seropositive and 126 HIV-seronegative boys with hemophilia. Participants with HIV infection were divided into three groups based on trajectory of immune functioning (CD4+ cell counts) over the course of the study. Caregivers completed the Vineland Adaptive Behavior Scales and Pediatric Behavior Scale (PBS).

RESULTS

Results showed declining Vineland Communication scores for participants with consistently poor immune functioning. These participants also started with more PBS Attention Deficit and Deviation symptoms, which then decreased more sharply than for other groups. Low CD4+ counts were consistently associated with more Health and Depression-Anxiety symptoms on the PBS. However, with few exceptions, group means remained within normal limits.

CONCLUSIONS

According to their caregivers, boys with hemophilia and HIV infection showed considerable resilience with regard to adaptive behavior and emotional and behavioral problems. However, over time changes occurred in these areas that appear to be related to immune functioning.

A proposed aquatic plant community biotic index for wisconsin lakes

The Aquatic Macrophyte Community Index (AMCI) is a multipurpose tool developed to assess the biological quality of aquatic plant communities in lakes. It can be used to specifically analyze aquatic plant communities or as part of a multimetric system to assess overall lake quality for regulatory, planning, management, educational, or research purposes. The components of the index are maximum depth of plant growth; percentage of the littoral zone vegetated; Simpson's diversity index; the relative frequencies of submersed, sensitive, and exotic species; and taxa number. Each parameter was scaled based on data distributions from a statewide database, and scaled values were totaled for the AMCI value. AMCI values were grouped and tested by ecoregion and lake type (natural lakes and impoundments) to define quality on a regional basis. This analysis suggested that aquatic plant communities are divided into four groups: (1) Northern Lakes and Forests lakes and impoundments, (2) North-Central Hardwood Forests lakes and impoundments, (3) Southeastern Wisconsin Till Plains lakes, and (4) Southeastern Wisconsin Till Plains impoundments, Driftless Area Lakes, and Mississippi River Backwater lakes. AMCI values decline from group 1 to group 4 and reflect general water quality and human use trends in Wisconsin. The upper quartile of AMCI values in any region are the highest quality or benchmark plant communities. The interquartile range consists of normally impacted communities for the region and the lower quartile contains severely impacted or degraded plant communities. When AMCI values were applied to case studies, the values reflected known impacts to the lakes. However, quality criteria cannot be used uncritically, especially in lakes that initially have low nutrient levels.