Search

Gender gaps in health outcomes are frequently observed. Mental health disorders also display gender differences in various countries. This paper explores gender differences in mental health outcomes of individuals in Turkey. It aims to deliver additional evidence on associations between gender, income and mental health status by providing an empirical analysis from a developing country, Turkey. This study employs a nationally representative data set from Turkish Health Survey of 2016. It constructs an index for mental health at individual level by using polychoric principal component analysis. Conditional mixed process models are estimated for quantification of associations between gender, income and mental health measures. Empirical findings indicate that there is endogenous and positive relationship between household income level and mental health status of individuals in Turkey. Turkish females report lower mental health statuses than Turkish males. Furthermore, females are more likely to use mental health services in Turkey. Gender gaps in both mental health status and mental health service use are present in the Turkish case. Results of this study imply that mental health policies should avoid applying one-fit-all approaches.

Background Hookah smoking is an emerging global health issue, especially in Eastern Mediterranean region; and accordingly, women are at the center of this issue as they have a more positive attitude towards hookah smoking. Also, the rate of hookah smoking is increasing at a faster rate among women compared to men. The aim of the present study will be systematically designing and implementing an educational intervention program for hookah smoking cessation among 15 years old women and older in the Iranian southern city of Bandar Abbas. Methods We will use intervention mapping methodology for designing the study. Due to the breadth of factors affecting hookah smoking and the complexity of hookah cessation, we will initially conceptualize hookah smoking cessation program as a set of purposeful activities designed to stop the hookah smoking. In the first step (need assessment), the environmental and behavioral factors related to hookah smoking/cessation and the determinants of these factors will be determined by systematic review and local qualitative study. Then, based on the results of the first step, the behavioral and environmental goals of hookah smoking cessation will be identified. In the second step, the practical goals will be determined for each of the behavioral and environmental outcomes; and then, the logic and matrix of change objectives will be designed using the determinants extracted from the previous step. The products of the second step will be the intervention goals. In the third step, theoretical and practical methods affecting each of the intervention goals will be identified. In the fourth step, contents of educational program for hookah cessation will be produced. The fifth step will be about planning to implement the program. In the sixth step, the effectiveness of designed program will be evaluated in a quasi-experimental intervention. Discussion Appropriate development and successful implementation of a hookah cessation intervention requires a systematic and theory-based approach. We believe that using Intervention Mapping (IM) as the guiding methodology will make it possible to address complexities of developing an intervention program. Also, reflections on the quasi-experimental research and describing the context and executed methods of implementation would contribute to the development of IM and the knowledge needed for the implementation of program. Trial registration IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129.

Background and aims: High sodium (Na) and low potassium (K) intake are associated with hypertension and CVD risk. This study explored the associations of health literacy (HL), food literacy (FL), and salt awareness with salt intake, K intake, and Na/K ratio in a workplace intervention trial in Switzerland. Methods and results: The study acquired baseline data from 141 individuals, mean age 44.6 years. Na and K intake were estimated from a single 24-h urine collection. We applied validated instruments to assess HL and FL, and salt awareness. Multiple linear regression was used to investigate the association of explanatory variables with salt intake, K intake, and Na/K. Mean daily salt intake was 8.9 g, K 3.1 g, and Na/K 1.18. Salt intake was associated with sex (p

The accommodating volume-constant age-dependent optical (AVOCADO) model of the crystalline lens is used to explore the age-related changes in ocular power and spherical aberration. The additional parameter m in the GRIN lens model allows decoupling of the axial and radial GRIN profiles, and is used to stabilise the age-related change in ocular power. Data for age-related changes in ocular geometry and lens parameter P in the axial GRIN profile were taken from published experimental data. In our age-dependent eye model, the ocular refractive power shows behaviour similar to the previously unexplained “lens paradox”. Furthermore, ocular spherical aberration agrees with the data average, in contrast to the proposed “spherical aberration paradox”. The additional flexibility afforded by parameter m, which controls the ratio of the axial and radial GRIN profile exponents, has allowed us to study the restructuring of the lens GRIN medium with age, resulting in a new interpretation of the origin of the power and spherical aberration paradoxes. Our findings also contradict the conceptual idea that the ageing eye is similar to the accommodating eye.

Context: Recent studies have suggested that a subgroup of obese individuals is not at increased risk of obesity-related complications. This subgroup has been referred to as metabolically healthy obese.Objective: To investigate whether obesity is a risk factor for development of ischemic heart disease (IHD) irrespective of metabolic health.Design: In all, 6238 men and women from the Danish prospective Inter99 study were followed during 10.6 (standard deviation = 1.7) years.Setting: General community.Participants: Participants were classified according to body mass index and four metabolic risk factors (low high-density lipoprotein cholesterol, elevated blood pressure, triglycerides, and fasting plasma glucose). Metabolically healthy individuals were defined as having no metabolic risk factors, and metabolically unhealthy individuals were defined as having a minimum of one.Main Outcome Measures: IHD.Results: During follow-up, 323 participants developed IHD. Metabolically healthy obese men had increased risk of IHD compared with metabolically healthy normal-weight men [hazard ratio (HR), 3.1; 95% confidence interval (CI), 1.1 to 8.2)]. The corresponding results for women were less pronounced (HR, 1.8; 95% CI, 0.7 to 4.8). Being metabolically healthy but overweight was not associated with higher risk of IHD in men (HR, 1.1; 95% CI, 0.5 to 2.4), and in women the risk was only slightly increased and insignificant (HR, 1.5; 95% CI, 0.8 to 3.0). A substantial proportion of metabolically healthy individuals became metabolically unhealthy after 5 years of follow-up. When these changes in exposure status were taken into account, slightly higher risk estimates were found.Conclusions: Being obese is associated with higher incidence of IHD irrespective of metabolic status, and we question the feasibility of denoting a subgroup of obese individuals asmetabolically healthy.

Statistical models are key for estimating fish distributions based on environmental variables, and validation is generally advocated as indispensable but seldom applied. Generalized Linear Models were applied to distributions of juvenile Solea solea, Solea senegalensis, Platichthys flesus and Dicentrarchus labrax in response to environmental variables throughout Portuguese estuaries. Species-specific Delta models with two sub-models were used: Binomial (presence/absence); Gamma (density when present). Models were fitted and tested on separate data sets to estimate the accuracy and robustness of predictions. Temperature, salinity and mud content in sediment were included in most models for presence/absence; salinity and depth in most models for density (when present). In Binomial models (presence/absence), goodness-of-fit, accuracy and robustness varied concurrently among species, and fair to high accuracy and robustness were attained for all species, in models with poor to high goodness-of-fit. But in Gamma models (density when present), goodness-of-fit was not indicative of accuracy and robustness. Only for Platichthys flesus were Gamma and also coupled Delta models (density) accurate and robust, despite some moderate bias and inconsistency in predicted density. The accuracy and robustness of final density estimations were defined by the accuracy and robustness of the estimations of presence/absence and density (when present) provided by the sub-models. The mismatches between goodness-of-fit, accuracy and robustness of positive density models, as well as the difference in performance of presence/absence and density models demonstrated the importance of validation procedures in the evaluation of the value of habitat suitability models as predictive tools. (C) 2013 Elsevier Ltd. All rights reserved.

Contains fulltext : 171270.pdf (Publisher’s version ) (Open Access) Good syndrome (GS) or thymoma-associated immunodeficiency, is a rare condition that has only been studied in retrospective case series. General consensus was that GS has a worse prognosis than other humoral immunodeficiencies. In this study, physicians of GS patients completed two questionnaires with a two year interval with data on 47 patients, 499 patient years in total. Results on epidemiology, disease characteristics, and outcome are presented. Mean age at diagnosis was 60years and median follow-up from onset of symptoms was 9years. There was a high frequency of respiratory tract infections due to encapsulated bacteria. Median survival was 14years. Survival was reduced compared to age-matched population controls (5-year survival: 82% versus 95%, p=0.008). In this cohort survival was not associated with gender (HR 0.9, 95% CI 0.3-3.0), autoimmune diseases (HR 2.9, 95% CI 0.8-10.1) or immunosuppressive use (HR 0.3, 95% CI: 0.1-1.2).

International audience; Simulating fish larval drift helps assess the sensitivity of recruitment variability to early life history. An individual based model (IBM) coupled to a hydrodynamic model was used to simulate common sole larval supply from spawning areas to coastal and estuarine nursery grounds at the meta-population scale (4 assessed stocks), from the southern North Sea to the Bay of Biscay (Western Europe) on a 26-yr time series, from 1982 to 2007. The IBM allowed each particle released to be transported by currents, to grow depending on temperature, to migrate vertically depending on development stage, to die along pelagic stages or to settle on a nursery, representing the life history from spawning to metamorphosis. The model outputs were analysed to explore interannual patterns in the amounts of settled sole larvae at the population scale; they suggested; (i) a low connectivity between populations at the larval stage, (ii) a moderate influence of interannual variation in the spawning biomass, (iii) dramatic consequences of life history on the abundance of settling larvae and (iv) the effects of climate variability on the interannual variability of the larvae settlement success. (C) 2015 Elsevier B.V. All rights reserved.

Background: Chemotherapy can affect taste and smell function. This may contribute to the high prevalence of overweight and metabolic syndrome in testicular cancer survivors (TCS). Aims of the study were to evaluate taste and smell function and possible consequences for dietary intake, food preference, and body composition in TCS treated with cisplatin-based chemotherapy.Methods: Fifty TCS, 1-7 years post-chemotherapy, and 50 age-matched healthy men participated. Taste and smell function were measured using taste strips and 'Sniffin' Sticks', respectively. Dietary intake was investigated using a food frequency questionnaire. Food preference was assessed using food pictures varying in taste (sweet/savoury) and fat or protein content. Dual-Energy X-ray Absorptiometry was performed to measure body composition. Presence of metabolic syndrome and hypogonadism were assessed.Results: TCS had a lower total taste function, a higher bitter taste threshold, higher Body Mass Index (BMI), and more (abdominal) fat than controls (p Conclusion: Although taste function was impaired in TCS, this was not related to a different dietary intake compared to controls. Lower testosterone levels were associated with a higher BMI, fat mass, and abdominal fat distribution in TCS. (C) 2016 Elsevier Ltd. All rights reserved.

Aims To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe. Methods and Results Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients’ 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE 5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE 10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels ( 2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as 1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72%and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin 40 mg/day or rosuvastatin 20 mg/day). Among veryhigh- risk patients, this figure was 8.4%. Conclusions There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe, Writing support was provided by Oxford PharmaGenesis Ltd, Oxford, UK, and was funded by AstraZeneca

BACKGROUND: Adverse health-related behaviours (HRBs) have been shown to co-occur in adolescents. Evidence lacks on factors associated with these co-occurring HRBs. The Theory of Triadic Influence (TTI) offers a route to categorize these determinants according to type (social, cultural and intrapersonal) and distance in the causal pathway (ultimate or distal). Our aims were to identify cultural, social and intrapersonal factors associated with co-occurring HRBs and to assess the relative importance of ultimate and distal factors for each cluster of co-occurring HRBs.METHODS: Respondents concerned a random sample of 898 adolescents aged 12-18 years, stratified by age, sex and educational level of head of household. Data were collected via face-to-face computer-assisted interviewing and internet questionnaires. Analyses were performed for young (12-15 years) and late (16-18 years) adolescents regarding two and three clusters of HRB, respectively.RESULTS: For each cluster of HRBs (e.g. smoking, delinquency), associated factors were found. These accounted for 27 to 57% of the total variance per cluster. Factors came in particular from the intrapersonal stream of the TTI at the ultimate level and the social stream at the distal level. Associations were strongest for parenting practices, risk behaviours of friends and parents and self-control.CONCLUSION: Results of this study confirm that it is possible to identify a selection of cultural, social and intrapersonal factors associated with co-occurring HRBs among adolescents.

Objective: Multiple studies have identified clusters of co-occurring health-related behaviours. Little is known, however, about factors associated with such clusters. This study aims to identify these factors and to assess whether their effects are in accordance with the Theory of Triadic Influence (TTI).Design: A cross-sectional study using a representative sample (N = 3497) of the Dutch population aged 19-40.Main Outcome Measures: Our data concerned 18 health-related behaviours combined in three clusters (Health, Alcohol and Delinquency) and 30 non-behaviour-specific (i.e. ultimate or distal) cultural, social and intrapersonal factors. The three clusters were used as outcomes in regression analyses.Results: Descriptive Norms of Friends and Gender were associated with all three behaviour clusters. Furthermore, Having Parents who Smoke or Consume Alcohol was associated with, respectively, the Health and Alcohol clusters. Self-Control and past Parental Monitoring were associated with the Health and Delinquency clusters. Effect sizes were moderate to large (r(2): 0.05 to 0.22).Conclusion: Factors with a moderate to large association with several behaviour clusters were identified. These factors were located within the social and intrapersonal stream of the TTI, not within the cultural stream.

In this study we analysed the value of measuring diurnal peak Bow variability (DPV) in general practice for diagnosing asthma or chronic obstructive pulmonary disease (COPD), One hundred and eighty-two subjects, aged 18-75 yrs, with undiagnosed asthma or COPD, presenting with a persistent cough recorded a peak flow diary twice daily for 2 weeks. A diagnosis of asthma or COPD was based on the recurrence of airway symptoms in the past year accompanied by spirometric measurements and a provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second. DPV was expressed as amplitude percentage highest of the day. Cut-off values of 15% and 20% (DPV15%, DPV20%) were employed and the number of days that these values were reached, was assessed. The influence of age, sex and pack-years smoking on DPV was analysed by logistic regression. The a priori probability to have asthma (n=69) or COPD (n=12) was 45% (81/182) and increased to >70% with a DPV20% for at least 3, and a DPV15% for at least 4 days. Scoring formulas for asthma (DPV15% (number of days present) + 4 (if female sex)) and for asthma and COPD combined (8x DPV15% (number of days present) + 24 (if female sex) + pack-years smoking) predicted which subjects were at risk for having asthma (or COPD), Simple formulas based on the number of days with diurnal peak flow variability at 15%, female sex and pack-years can predict which patients with persistent cough are likely to have asthma or chronic obstructive pulmonary disease.

The aims of this study are: (1) to evaluate whether the estimates of the association of risk factors with bronchial hyperresponsiveness (BHR) depends on the accumulated dose administered in challenge tests; and (2) to verify whether a model developed for survival studies (Weibull regression) is suited to analyze methacholine dose-response curves. For these purposes, 863 challenge tests, from EC Respiratory Health Survey in Italy, up to a cumulative dose of 6 mg methacholine, were analyzed by Weibull regression and by traditional methods (logistic model and linear model), both before and after truncation of the curves at 2 mg. With all methods the main risk factors for BHR were respiratory symptoms and atopy while age and airway caliber exerted a protective action. Our results confirmed that in epidemiological surveys 2 mg methacholine is enough to fully appreciate the effect of risk factors on BHR and showed chat the Weibull model explains the observed variability better than linear and logistic regressions. (C) 1998 Elsevier Science Inc.

Background and objective Analysis of inflammatory biomarkers in saliva could offer an attractive opportunity for the diagnosis of different systemic conditions specifically in epidemiological surveys. The aim of this study was to investigate if certain salivary biomarkers could be used for detection of common systemic diseases. Materials and methods A randomly selected sample of 1000 adults living in Skane, a county in the southern part of Sweden, was invited to participate in a clinical study of oral health. 451 individuals were enrolled in this investigation, 51% women. All participants were asked to fill out a questionnaire, history was taken, a clinical examination was made and stimulated saliva samples were collected. Salivary concentrations of IL-1β, -6, -8, TNF-α, lysozyme, MMP-8 and TIMP-1 were determined using ELISA, IFMA or Luminex assays. Results Salivary IL-8 concentration was found to be twice as high in subjects who had experience of tumour diseases. In addition, IL-8 levels were also elevated in patients with bowel disease. MMP-8 levels were elevated in saliva from patients after cardiac surgery or suffering from diabetes, and muscle and joint diseases. The levels of IL-1β, IL-8 and MMP-8, as well as the MMP-8/TIMP-1 ratio were higher in subjects with muscle and joint diseases. Conclusion Biomarkers in saliva have the potential to be used for screening purposes in epidemiological studies. The relatively unspecific inflammatory markers used in this study can not be used for diagnosis of specific diseases but can be seen as markers for increased systemic inflammation.

This paper proposes a hierarchical Bayesian framework for modeling the life cycle of marine exploited fish with a spatial perspective. The application was developed for a nursery-dependent fish species, the common sole (Solea solea), on the Eastern Channel population (Western Europe). The approach combined processes of different natures and various sources of observations within an integrated framework for life-cycle modeling: (1) outputs of an individual-based model for larval drift and survival that provided yearly estimates of the dispersion and mortality of eggs and larvae, from spawning grounds to settlement in several coastal nurseries; (2) a habitat suitability model, based on juvenile trawl surveys coupled with a geographic information system, to estimate juvenile densities and surface areas of suitable juvenile habitat in each nursery sector; (3) a statistical catch-at-age model for the estimation of the numbers-at-age and the fishing mortality on subadults and adults. The approach provided estimates of hidden variables and parameters of key biological significance. A simulation approach provided insight to the robustness of the approach when only weak data are available. Estimates of spawning biomass, fishing mortality, and recruitment were close to the estimations derived from stock-assessment working groups. In addition, the model quantified mortality along the life cycle, and estimated site-specific density-dependent mortalities between settled larvae and age-0 juveniles in each nursery ground. This provided a better understanding of the productivity and the specific contribution of each nursery ground toward recruitment and population renewal. Perspectives include further development of the modeling framework on the common sole and applications to other fish species to disentangle the effects of multiple interacting stress factors (e.g., estuarine and coastal nursery habitat degradation, fishing pressure) on population renewal and to develop risk analysis in the context of marine spatial planning for sustainable management of fish resources.

For many marine fish species, recruitment is strongly related to larval survival and dispersal to nursery areas. Simulating larval drift should help assessing the sensitivity of recruitment variability to early life history. An individual-based model (IBM) coupled to a hydrodynamic model was used to simulate common sole larval supply from spawning areas to coastal and estuarine nursery grounds at the population scale in the eastern Channel on a 14-yr time series, from 1991 to 2004. The IBM allowed each particle released to be transported by currents from the hydrodynamic model, to grow with temperature, to migrate vertically giving stage development, and possibly to die according to drift duration, representing the life history from spawning to metamorphosis. Despite sensitivity to the larval mortality rate, the model provided realistic simulations of cohort decline and spatio-temporal variability of larval supply. The model outputs were analysed to explore the effects of hydrodynamics and life history on the interannual variability of settled sole larvae in coastal nurseries. Different hypotheses of the spawning spatial distribution were also tested, comparing homogeneous egg distribution to observation and potential larval survival (PLS) maps. The sensitivity analyses demonstrated that larval supply is more sensitive to the life history along larval drift than to the phenology and volume of spawning, providing explanations for the lack of significant stock–recruitment relationship. Nevertheless, larval supply is sensitive to spawning distribution. Results also suggested a very low connectivity between supposed different sub-populations in the eastern Channel.

Made available in DSpace on 2019-09-12T16:57:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 Objective: To estimate the prevalence of excessive daytime sleepiness (EDS) and to identify associated factors in women aged 35 to 49 years from the "Pindamonhangaba Health Project" (PROSAPIN). Methods: This was a cross-sectional observational study of 372 women aged 35 to 49 years, randomly selected from the Family Health Strategy (FHS) program of the city of Pindamonhangaba, SP, Brazil, where the "Pindamonhangaba Health Project" (PROSAPIN) is being developed. EDS was assessed through interviews using the Epworth Sleepiness Scale and the associated factors through questions that investigated sociodemographic characteristics, gynecological history, presence of comorbidities, lifestyle, sleep routine, and use of drugs capable of altering the state of alertness; anthropometric variables were also measured. The prevalence of EDS was estimated with a 95% confidence interval (95% CI) and the associated factors were identified through a multiple logistic regression model performed with the Stata software, release 10.0. Results: EDS prevalence was 18.5% (95% CI: 14.7-22.9) and the associated factors were: profession related to domestic services (OR = 2.2, 95% CI: 1.1-4.3), physical activity level above the mean of the study population (OR = 1.9, 95% CI: 1.1-3.4), and presence of features suggestive of anxiety (OR = 1.9, 95% CI: 1.1-3.4). Conclusion: The prevalence of EDS in women aged 35-49 years from PROSAPIN was high and associated with sociodemographic characteristics, presence of comorbidities, and lifestyle. [Alves Pereira, Elaine Cristina] Fundacao Univ Vida Crista FUNVIC, Sao Paulo, Brazil [Basso Schmitt, Ana Carolina] FMUSP, Dept Fisioterapia Fonoaudiol & Terapia Ocupac, Sao Paulo, Brazil [Alves Cardoso, Maria Regina; Aldrighi, Jose Mendes] Univ Sao Paulo, FSP, BR-09500900 Sao Paulo, Brazil [Paixao Pereira, Wendry Maria] Universidade de Taubaté (Unitau) UNITAU [Lorenzi-Filho, Geraldo] Inst Curacao INCOR, Lab Sono, Sao Paulo, Brazil [Blumel, Juan Enrique] Univ Chile, Fac Med, Santiago 7, Chile

Sp. Iss. SI Proceedings of the Seventh International Symposium on Flatfish Ecology, Part I; Estuaries and coastal waters are essential nursery habitats for many marine species, and especially for flatfishes. Thus, investigating how anthropogenic disturbances affect the quality of these habitats is of major importance to understand their consequences on the population renewal of marine species. The aim of the present study was to analyse the effects of estuarine habitat degradation on the population of the common sole in the Eastern Channel, a key species in the fish community and fisheries in this area. We especially focused on the drastic drop in the surface area and on the low water quality of the Seine estuary, the main river of the Eastern Channel. A geographic Information System (GIS) was used to develop quantitative maps of sole nursery habitats in the Eastern Channel by using a habitat suitability model based on bathymetry and sediment structure. This approach indicated that juvenile densities are low in the Seine estuary with regards to other nursery sectors. Then, thanks to historical maps of the Seine estuary, habitat suitability maps were built for key dates in the modifications of this estuary since 1850. This backward predictive approach suggests that habitat loss in the Seine estuary has led to a 42% decrease of its nursery capacity. As the density of juvenile sole in the Seine estuary is low in comparison to other sectors, this represents only a 3% loss at the sole population scale, in the Eastern Channel. However, when we assumed that prior to anthropogenic disturbance the juvenile density in the Seine estuary might have been equivalent to the current density of adjacent sectors with higher quality, the loss in abundance could be nearly 23% (8-36%). Results suggest that the loss in habitat surface combined with habitat degradation has led to an important loss in the contribution of the Seine estuary nursery to the whole sole population in the Eastern Channel. (C) 2009 Elsevier BM. All rights reserved.

Background: AGA IgA II and AGA IgG II have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis and monitoring CD in children with that of tTG IgA, an established CD marker.Methods: We studied a cohort of 161 CD and 129 control children in whom CD was histologically confirmed or ruled out. We followed 37 children with CD on a gluten-free diet for 12–84 months. In fasting sera, we measured AGA IgA II, AGA IgG II, and tTG IgA using ELISAs.Results: The best sensitivity (92.5%), specificity (97.6%), positive predictive value (98%), and negative predictive value (91.2%) were obtained using tTG IgA. AGA IgG II correctly identified 3 of 3 children with CD with total IgA deficiency who had negative AGA IgA II and tTG IgA results. In children Conclusions: The best available index for diagnosing CD in children was tTG IgA. In infants

Prospective studies on the risk of malignant transformation in patients with monoclonal gammopathy of undetermined significance (MGUS) and factors predictive of survival are lacking. The Dutch Comprehensive Cancer Centre West, comprising 1.6 million inhabitants, initiated a prospective hospital-based cohort study on 1464 patients with newly diagnosed M-proteinaemia, median age 73 (17-103) years. M-protein related diagnoses, patients' characteristics, laboratory investigations, bone marrow examinations and skeletal X-rays were registered with a yearly follow-up. Main endpoints were death, or new diagnoses of multiple myeloma and non-Hodgkin lymphoma. Kaplan-Meier survival curves were compared with age- and gender-matched survival data from the total Dutch population. Cumulative malignant transformation was corrected for death using a competing risk model. Risk factors for transformation or death were analyzed by univariate and multivariate analyses. In 1007 MGUS-patients, malignant transformation was associated with rising M-protein levels, IgA and IgM isotype and occurred at a yearly rate of 0.4%. All MGUS patients survived less than a matched cohort of the Dutch population, even in the absence of M-protein-associated comorbidity. Serum albumin levels at entry appeared highly predictive for survival. M-proteinaemia is not an innocent symptom. Although malignant transformation occurs rarely, survival is shortened irrespective of comorbidity.

In this study we analysed the value of measuring diurnal peak Bow variability (DPV) in general practice for diagnosing asthma or chronic obstructive pulmonary disease (COPD), One hundred and eighty-two subjects, aged 18-75 yrs, with undiagnosed asthma or COPD, presenting with a persistent cough recorded a peak flow diary twice daily for 2 weeks. A diagnosis of asthma or COPD was based on the recurrence of airway symptoms in the past year accompanied by spirometric measurements and a provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second. DPV was expressed as amplitude percentage highest of the day. Cut-off values of 15% and 20% (DPV15%, DPV20%) were employed and the number of days that these values were reached, was assessed. The influence of age, sex and pack-years smoking on DPV was analysed by logistic regression. The a priori probability to have asthma (n=69) or COPD (n=12) was 45% (81/182) and increased to >70% with a DPV20% for at least 3, and a DPV15% for at least 4 days. Scoring formulas for asthma (DPV15% (number of days present) + 4 (if female sex)) and for asthma and COPD combined (8x DPV15% (number of days present) + 24 (if female sex) + pack-years smoking) predicted which subjects were at risk for having asthma (or COPD), Simple formulas based on the number of days with diurnal peak flow variability at 15%, female sex and pack-years can predict which patients with persistent cough are likely to have asthma or chronic obstructive pulmonary disease.

The aims of this study are: (1) to evaluate whether the estimates of the association of risk factors with bronchial hyperresponsiveness (BHR) depends on the accumulated dose administered in challenge tests; and (2) to verify whether a model developed for survival studies (Weibull regression) is suited to analyze methacholine dose-response curves. For these purposes, 863 challenge tests, from EC Respiratory Health Survey in Italy, up to a cumulative dose of 6 mg methacholine, were analyzed by Weibull regression and by traditional methods (logistic model and linear model), both before and after truncation of the curves at 2 mg. With all methods the main risk factors for BHR were respiratory symptoms and atopy while age and airway caliber exerted a protective action. Our results confirmed that in epidemiological surveys 2 mg methacholine is enough to fully appreciate the effect of risk factors on BHR and showed chat the Weibull model explains the observed variability better than linear and logistic regressions. (C) 1998 Elsevier Science Inc.

In general population studies of adults, the relationship of increased airway responsivenessand lowerlevelof pulmonary function is well established (1-7). The impact of responder status on level of FEV J is considerable. In a cross-sectional analysis of data of 2,156subjects who participated in the Vlagtwedde-Vlaardingen Study (5), responsiveness was assessedby challenge testing with histamine.Subjects with a pew at ~ 16mg/ml wereconsidered responders. In a linear regression analysis, the average level of FEV! for adult subjects (age> 21 yr) with increased responsiveness was 325 mllower for males and 305 mllower for females compared with nonresponsive subjects, and this difference was independent of smoking and symptom status. In this study population, on average the younger subjects (age 15-21 yr) also had a lower level of FEV. if they were responders. This difference was significant for females (214 ml) but not for males (131 ml). What can be learned from these cross-sectional data is that a difference in level between responders and nonresponders already exists in early adulthood and remains present in older subjects.

An increased level of airway responsiveness has been proposed as a risk factor associated with the onset and prognosis of chronic airway obstruction. To determine this, longitudinal studies are necessary, with measurement of both the level of airway responsiveness and of additional risk factors, such as cigarette smoking, made before measurement of pulmonary function decline. The association of airways responsiveness with decline in FEV(1) has been prospectively studied in a random sample of the Dutch population. Longitudinal data from 921 males, providing 2,376 paired observations, and 698 females, providing 1,682 paired observations, were used for analysis. Differences between responders and nonresponders (PC10 less than or equal to 16 mg/ml of histamine) were estimated from linear regression analyses stratified by gender and smoking status, with adjustment for age, residential area, the presence of respiratory symptoms, indicators for each interval, and residuals of FEV(1) at the beginning of the interval. Responders had a greater mean yearly decline in FEV(1), and the differences between responders and nonresponders were similar for all gender and smoking subgroups. In an overall regression model, subjects with airway hyperresponsiveness had a significantly steeper decline in FEV(1), independent of the other variables (males: beta = -12.5 ml/yr, SEM = 3.22, p

Background : Restless leg syndrome (RLS) has negative effects on the quality of life of the patients. Epidemiological studies on RLS are limited. Aim : To determine the prevalence of RLS among people aged 40 years and above in Orhangazi district of Bursa, Turkey. Materials and Methods : The study was carried out between 2004 and 2005. This population-based study was conducted in two phases. In the phase 1, residents conducted door-to-door interviews using a short questionnaire to determine the possible cases of RLS. In the phase 2, physicians ascertained the suspected cases of RLS. Diagnosis of RLS was made using the criteria proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and also the rating scale for RLS. Results : Out of 1, 256 subjects screened in phase 1, 1,124 (89.6%) were included in the study. Also, 161 cases with suspected symptoms of RLS were detected in phase 1, 49 of the suspected cases could not be evaluated in phase 2. A diagnosis of RLS was also made in 60 cases during phase 2. Conclusions : We defined the prevalence of RLS as 9.71% among 40 years of age and older population. The prevalence of RLS did not differ by age and was 2.6 times more in women. None of the patients were diagnosed as RLS sought medical care for the symptoms, possibly due to lack of knowledge of patients and physicians about RLS. Prevalence studies help to provide knowledge on morbidity, which is essential for diagnosis and early treatment.

Objectives Studies on the co-occurrence, 'clustering' of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults.Methods A representative sample (N = 2,982; response 71%) of the Dutch population aged 19-40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch.Results Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rule-breaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity.Conclusions This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people.

The therapeutic paradigm in psoriasis includes antitumor necrosis alpha agents that have been proved effective and safe as long-term therapy. Recently, it has been described a correlation between the use of biologic agents and the occurrence of monoclonal gammopathies, which are haematological conditions characterized by clonal plasma cells proliferation producing a monoclonal immunoglobulin that accumulates in the blood.The aim of this study is to detect electrophoretic abnormalities in psoriatic patients undergoing treatment with infliximab.A retrospective study evaluating all charts from the clinic database of all patients treated with infliximab. The evaluation of serum protein profile is routinely performed in the clinical setting during biologic therapies. We reported the occurrence MGUS in infliximab-treated patients.The study analysis included 141 charts. Overall, 23 patients showed a MGUS in their electrophoretic profile, though in 6 cases MGUS was detected at the baseline. Thereby, 17 cases (12.06% of the study population) developed MGUS during infliximab therapy.Serum protein electrophoresis test represents a useful tool to detect and monitor any potentially harmful condition that could occur during treatment with a biologic agent. Particularly, it could be crucial for the detection of MGUS, which does not affect clinical response, and it does not represent a criteria to withdraw the treatment.