Identifying the ‘if’ for ‘if-then’ plans: Combining implementation intentions with cue-monitoring targeting unhealthy snacking behaviour
Verhoeven, A.A.C. ; Adriaanse, M.A. ; Vet, E. de; Fennis, B.M. ; Ridder, D.T.D. de - \ 2014
Psychology and Health 29 (2014)12. - ISSN 0887-0446 - p. 1476 - 1492.
habit strength - interventions - metaanalysis - breaking - enhance - weight - trial - power
Implementation intentions aimed at changing unwanted habits require the identification of personally relevant cues triggering the habitual response in order to be effective. To facilitate successful implementation intention formation, in the present study, planning was combined with cue-monitoring, a novel way to gain insight into triggers for unhealthy snacking. It was tested whether keeping a cue-monitoring diary and tailoring implementation intentions accordingly improves plan effectiveness. A 2 Monitoring (cue-monitoring, control)¿×¿2 Planning (implementation intention, goal intention) between subjects design was adopted. Participants (N = 161) monitored their unhealthy snacking behaviour for a week using either a cue-monitoring or a control diary. Participants then formulated a goal intention or an implementation intention tailored to their personal cue. Snacking frequency and caloric intake from unhealthy snacks were examined using a seven-day snack diary. The results did not indicate an interaction but yielded a main effect of Monitoring. Cue-monitoring either or not combined with implementation intentions reduced unhealthy snacking behaviour compared with control. Findings emphasise the effectiveness of cue-monitoring, suggesting that on the short term, cue-monitoring suffices to decrease unhealthy snacking, without additional benefit from planning. Future research should examine whether supplementing cue-monitoring with implementation intentions is required to establish long-term behaviour change maintenance.
Predicting individual responses to pravastatin using a physiologically based kinetic model for plasma cholesterol levels
Pas, N.C.A. van de; Rullmann, J. ; Woutersen, R.A. ; Ommen, B. van; Rietjens, I. ; Graaf, A.A. de - \ 2014
Journal of Pharmacokinetics and Pharmacodynamics 41 (2014)4. - ISSN 1567-567X - p. 351 - 362.
coa reductase inhibitors - statin therapy - lowering-therapy - ldl cholesterol - hepg2 cells - atorvastatin - simvastatin - absorption - metabolism - trial
We used a previously developed physiologically based kinetic (PBK) model to analyze the effect of individual variations in metabolism and transport of cholesterol on pravastatin response. The PBK model is based on kinetic expressions for 21 reactions that interconnect eight different body cholesterol pools including plasma HDL and non-HDL cholesterol. A pravastatin pharmacokinetic model was constructed and the simulated hepatic pravastatin concentration was used to modulate the reaction rate constant of hepatic free cholesterol synthesis in the PBK model. The integrated model was then used to predict plasma cholesterol concentrations as a function of pravastatin dose. Predicted versus observed values at 40 mg/d pravastatin were 15 versus 22 % reduction of total plasma cholesterol, and 10 versus 5.6 % increase of HDL cholesterol. A population of 7,609 virtual subjects was generated using a Monte Carlo approach, and the response to a 40 mg/d pravastatin dose was simulated for each subject. Linear regression analysis of the pravastatin response in this virtual population showed that hepatic and peripheral cholesterol synthesis had the largest regression coefficients for the non-HDL-C response. However, the modeling also showed that these processes alone did not suffice to predict non-HDL-C response to pravastatin, contradicting the hypothesis that people with high cholesterol synthesis rates are good statin responders. In conclusion, we have developed a PBK model that is able to accurately describe the effect of pravastatin treatment on plasma cholesterol concentrations and can be used to provide insight in the mechanisms behind individual variation in statin response.
Salmonella subtypes with increased MICs for Azithromycin in travelers returned to the Netherlands.
Hassing, R.J. ; Goessens, W.H. ; Pelt, W. van; Mevius, D.J. ; Stricker, B.H. ; Molhoek, W.M.L. ; Verbon, A. ; Genderen, P.J. - \ 2014
Emerging Infectious Diseases 20 (2014)4. - ISSN 1080-6040 - p. 705 - 708.
uncomplicated typhoid-fever - in-vitro activity - enteric fever - multidrug-resistant - ciprofloxacin - trial - susceptibility - ofloxacin - paratyphi - india
Antimicrobial susceptibility was analyzed for 354 typhoidal Salmonella isolates collected during 1999-2012 in the Netherlands. In 16.1% of all isolates and in 23.8% of all isolates that showed increased MICs for ciprofloxacin, the MIC for azithromycin was increased. This resistance may complicate empirical treatment of enteric fever.
Simulation of the effect of maize porridge fortified with grain amaranth or micronutrient powder containing NaFeEDTA on iron intake and status in Kenyan children
Macharia-Mutie, C.W. ; Omusundi, A.M. ; Mwai, J.M. ; Mwangi, A.M. ; Brouwer, I.D. - \ 2013
Public Health Nutrition 16 (2013)9. - ISSN 1368-9800 - p. 1605 - 1613.
preschool-children - body iron - deficiency - absorption - anemia - women - trial - foods - biofortification - bioavailability
Objective: Simulating the probable impact of grain amaranth and highly absorbable, low-Fe micronutrient powder (MNP) on Fe status in a potential target population is an essential step in choosing and developing an appropriate actual intervention. Design: We simulated the potential effect of fortifying maize porridge with grain amaranth or MNP on the prevalence of inadequate Fe intake and Fe deficiency using data from two cross-sectional surveys. In the first survey (2008), dietary intake data were collected by two 24 h recalls (n 197). Biochemical data (n 70) were collected in the second survey (2010). A simulation with daily consumption for 80 d of non-fortified maize porridge (60 g of maize flour), amaranth-enriched porridge (80 g of grain amaranth-maize flour, 70: 30 ratio) or maize porridge fortified with MNP (2.5 mg Fe as NaFeEDTA) was done. Setting: Mwingi District, Kenya. Subjects: Pre-school children aged 12-23 months. Results: Prevalence of anaemia, Fe deficiency and Fe-deficiency anaemia was 49%, 46% and 24%, respectively. Consumption of non-fortified, amaranth-enriched and MNP-fortified maize porridge was estimated to provide a median daily Fe intake of 8.6 mg, 17.5 mg and 11.1 mg, respectively. The prevalence of inadequate Fe intake was reduced to 35% in the amaranth-enriched porridge group and 45% in the MNP-fortified porridge group, while ferritin concentration was increased in both (by 1.82 (95% CI 1.42, 2.34) mu g/l and 1.80 (95% CI 1.40, 2.31) mu g/l, respectively; P
Importance of weight loss maintenance and risk prediction in the prevention of type 2 Diabetes: analysis of European Diabetes Prevention Study RCT
Penn, L. ; White, M. ; Lindström, J. ; Boer, A.Th. den; Blaak, E.E. ; Eriksson, J.G. ; Feskens, E.J.M. ; Ilanne-Parikka, P. ; Keinanen-Kiukaanniemi, S.M. ; Walker, M. ; Mathers, J.C. ; Uusitupa, M. ; Tuomilehto, J. - \ 2013
PLoS ONE 8 (2013)2. - ISSN 1932-6203 - 11 p.
life-style intervention - impaired glucose-tolerance - follow-up - program - trial - mellitus - behavior - fin-d2d - obesity - adults
Background Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors. Methods We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm-2) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss=5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c. Results Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P
Next Generation Inactivated Polio Vaccine Manufacturing to Support Post Polio-Eradication Biosafety Goals
Thomassen, Y.E. ; Oever, A.G. van 't; Oijen, M.G.C.T. van; Wijffels, R.H. ; Pol, L.A. van der; Bakker, W.A.M. - \ 2013
PLoS ONE 8 (2013)12. - ISSN 1932-6203
sabin strains - technology-transfer - antigen - ipv - immunogenicity - culture - growth - safety - trial - cells
Worldwide efforts to eradicate polio caused a tipping point in polio vaccination strategies. A switch from the oral polio vaccine, which can cause circulating and virulent vaccine derived polioviruses, to inactivated polio vaccines (IPV) is scheduled. Moreover, a manufacturing process, using attenuated virus strains instead of wild-type polioviruses, is demanded to enhance worldwide production of IPV, especially in low- and middle income countries. Therefore, development of an IPV from attenuated (Sabin) poliovirus strains (sIPV) was pursued. Starting from the current IPV production process based on wild type Salk strains, adaptations, such as lower virus cultivation temperature, were implemented. sIPV was produced at industrial scale followed by formulation of both plain and aluminium adjuvanted sIPV. The final products met the quality criteria, were immunogenic in rats, showed no toxicity in rabbits and could be released for testing in the clinic. Concluding, sIPV was developed to manufacturing scale. The technology can be transferred worldwide to support post polio-eradication biosafety goals.
Twenty-four hour urinary urea excretion and 9-year risk of hypertension: the PREVEND study
Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Baak, M.A. van; Engberink, M.F. ; Brink, E.J. ; Jong, P.E. ; Gansevoort, R.T. ; Bakker, S.J.A. - \ 2013
Journal of Hypertension 31 (2013)8. - ISSN 0263-6352 - p. 1564 - 1569.
blood-pressure - protein-intake - association - nutrients - nitrogen - cohort - trial - life - men
OBJECTIVES:: It is not yet clear whether dietary protein could help maintaining a healthy blood pressure (BP). We investigated the association between total protein intake, estimated from 24-h urinary urea excretion, and incident hypertension in Dutch men and women. METHODS:: We analyzed data of 3997 men and women (aged 28-75 years) who participated in the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, a prospective cohort study. Urea excretion was assessed in two consecutive 24-h urine collections at baseline and approximately 4 years later, from which total protein intake was estimated using the Maroni method. Participants were followed for 9 years for hypertension incidence, defined as BP at least 140/90¿mmHg or initiation of antihypertensive medication. Hazard ratios (HR) were obtained in sex-specific quintiles of protein intake using time-dependent Cox regression, adjusted for age, sex, BMI, smoking, alcohol use, and 24-h urinary excretions of sodium and potassium. RESULTS:: Baseline BP was on average 119/70¿mmHg and 976 participants developed hypertension during follow-up. Mean protein intake (in g/kg ideal body weight) was 1.18¿±¿0.26 for men and 1.12¿±¿0.25 for women. Estimated protein intake was nonlinearly inversely associated with incident hypertension in the fully adjusted model, with nonsignificant HR of 0.77, 0.75, 0.82, and 0.83 in consecutive quintiles compared with the lowest quintile (P-trend: 0.52). CONCLUSION:: Protein intake, as assessed by urinary urea excretion, was not significantly associated with 9-year hypertension incidence in Dutch men and women.
Dietary amino acids and the risk of hypertension in a Dutch older population: the Rotterdam Study
Altorf-van der Kuil, W. ; Engberink, M.F. ; Neve, M. De; Rooij, F.J.A. van; Hofman, M.K. ; Veer, P. van 't; Witteman, J.C.M. ; Franco, O.H. ; Geleijnse, J.M. - \ 2013
American Journal of Clinical Nutrition 97 (2013)2. - ISSN 0002-9165 - p. 403 - 410.
food frequency questionnaire - blood-pressure - arginine intake - protein-intake - disease - trial - men - supplementation - association - intermap
Background: Inverse associations between dietary protein and hypertension have been reported, which may be attributed to specific amino acids. Objective: We examined whether the intake of glutamic acid, arginine, cysteine, lysine, or tyrosine was associated with blood pressure (BP) levels (n = 3086) and incident hypertension (n = 1810) in the Rotterdam Study. Design: We calculated BP levels in quartiles of amino acid intake as a percentage of total protein intake (% of protein) with adjustment for age, sex, BMI, smoking, alcohol intake, education, and dietary factors. Subsequently, we used Cox proportional models that included the same confounders to evaluate the associations between specific amino acid intake and hypertension incidence. Results: Glutamic acid contributed most to protein intake (21% of protein), whereas lysine provided 7%, arginine 5%, tyrosine 4%, and cysteine 1.5%. A higher intake of tyrosine (~0.3% of protein) was significantly related to a 2.4 mm Hg lower systolic BP (P-trend = 0.05) but not to diastolic BP (P = 0.35). The other amino acids were not significantly associated with BP levels in a cross-sectional analysis. During 6 y of follow-up (7292 person-years), 873 cases of hypertension developed. None of the amino acids were significantly associated with incident hypertension (HR: 0.81–1.18; P-trend > 0.2). Conclusion: Our data do not suggest a major role for glutamic acid, arginine, lysine, tyrosine, or cysteine intake (as % of of protein intake) in determining population BP or risk of hypertension.
The Effects of Demand Characteristics on Research Participant Behaviours in Non-Laboratory Settings: A Systematic Review
McCambridge, J. ; Bruin, M. de; Witton, J. - \ 2012
PLoS ONE 7 (2012)6. - ISSN 1932-6203
self-report - validity - artifact - trial - bias
Background The concept of demand characteristics, which involves research participants being aware of what the researcher is investigating, is well known and widely used within psychology, particularly in laboratory-based studies. Studies of this phenomenon may make a useful contribution to broader consideration of the effects of taking part in research on participant behaviour. This systematic review seeks to summarise data from studies of the effects of demand characteristics on participant behaviours in non-laboratory settings. Methodology/Principal Findings Electronic databases were searched to identify eligible studies. These had to be purposely designed to evaluate possible effects of demand characteristics on at least one behavioural outcome under the autonomous control of the participants and use longitudinal study designs. Only 7 studies were included, 6 providing observational data and 1 experimental study, with 5 studies involving examination of possible effects on health behaviours. Although studies provided some evidence of effects of demand characteristics on participant behaviour, heterogeneous operationalisation of the construct, the limited number of studies and poor quality of study designs made synthesis and interpretation of study findings challenging. Conclusions/Significance Although widely accepted as important in psychology, there have been few dedicated studies of the effects of demand characteristics on research participant behaviours outside laboratory settings. This body of literature does not currently contribute to the wider study of research participation effects. A systematic review of data from laboratory-based studies is needed, as are high-quality primary studies in non-laboratory settings. We suggest that unqualified use of the term demand characteristics should be abandoned
Levels and trends in cardiovascular risk factors and drug treatment in 4837 eldery Dutch myocardial infarction patients between 2002 and 2006
Soedamah-Muthu, S.S. ; Geleijnse, J.M. ; Giltay, E.J. ; Goede, J. de; Oude Griep, L.M. ; Waterham, E. ; Teitsma-Jansen, A.M. ; Mulder, B.J.M. ; Boer, M.J. de; Deckers, J.W. ; Zock, P.L. ; Kromhout, D. - \ 2012
Netherlands Heart Journal 20 (2012)3. - ISSN 1568-5888 - p. 102 - 109.
coronary-heart-disease - life-style - prevention - mortality - guidelines - trial
Background It is important to gain insight into opportunities for secondary prevention of cardiovascular disease. Our aim was to investigate levels and trends in cardiovascular risk factors and drug treatment in Dutch post-myocardial infarction (MI) patients between 2002 and 2006 and to make comparisons with the EUROASPIRE surveys (1999–2007). Methods We analysed data from 4837 post-MI patients (aged 69 years, 78% men) from 32 Dutch hospitals, using baseline cross-sectional data from the Alpha Omega Trial. Results Between 2002 and 2006, significant declines were found in the prevalence of smoking (23% to 16%, p¿
The Long Term Effect of Current and New Interventions on the New Case Detection of Leprosy: A Modeling Study
Fischer, E.A.J. ; Vlas, S.J. de; Habbema, J.D.F. ; Richardus, J.H. - \ 2011
PLoS Neglected Tropical Diseases 5 (2011)9. - ISSN 1935-2727
mycobacterium-leprae - contacts - chemoprophylaxis - epidemiology - metaanalysis - protection - bangladesh - trial - bcg
Background: Although the number of newly detected leprosy cases has decreased globally, a quarter of a million new cases are detected annually and eradication remains far away. Current options for leprosy prevention are contact tracing and BCG vaccination of infants. Future options may include chemoprophylaxis and early diagnosis of subclinical infections. This study compared the predicted trends in leprosy case detection of future intervention strategies. Methods: Seven leprosy intervention scenarios were investigated with a microsimulation model (SIMCOLEP) to predict future leprosy trends. The baseline scenario consisted of passive case detection, multidrug therapy, contact tracing, and BCG vaccination of infants. The other six scenarios were modifications of the baseline, as follows: no contact tracing; with chemoprophylaxis; with early diagnosis of subclinical infections; replacement of the BCG vaccine with a new tuberculosis vaccine ineffective against Mycobacterium leprae ("no BCG"); no BCG with chemoprophylaxis; and no BCG with early diagnosis. Findings: Without contact tracing, the model predicted an initial drop in the new case detection rate due to a delay in detecting clinical cases among contacts. Eventually, this scenario would lead to new case detection rates higher than the baseline program. Both chemoprophylaxis and early diagnosis would prevent new cases due to a reduction of the infectious period of subclinical cases by detection and cure of these cases. Also, replacing BCG would increase the new case detection rate of leprosy, but this effect could be offset with either chemoprophylaxis or early diagnosis. Conclusions: This study showed that the leprosy incidence would be reduced substantially by good BCG vaccine coverage and the combined strategies of contact tracing, early diagnosis, and treatment of infection and/or chemoprophylaxis among household contacts. To effectively interrupt the transmission of M. leprae, it is crucial to continue developing immuno-and chemoprophylaxis strategies and an effective test for diagnosing subclinical infections.
To die with of from heart failure: a difference that counts: is heart failure underrepresented in national mortality statistics?
Engelfriet, P.M. ; Hoogenveen, R.T. ; Boshuizen, H.C. ; Baal, P.H. van - \ 2011
European Journal of Heart Failure 13 (2011)4. - ISSN 1388-9842 - p. 377 - 383.
death certification - lifetime risk - trends - disease - epidemiology - population - admissions - trial - mode - care
Aims Mortality attributed to a disease is an important public health measure of the ‘burden’ of that disease. A discrepancy has been noted between the high mortality rates associated with heart failure (HF) and the share of deaths ascribed to HF in official mortality statistics. It was our main aim to estimate excess mortality associated with HF and use the estimates to better understand the burden of HF. Methods and results Excess mortality was defined as the difference in mortality rates between individuals with and those without HF. An epidemiological model was formulated that allowed deriving age-specific excess mortality rates in HF patients from HF incidence and prevalence. Incidence and prevalence were estimated from yearly collected cross-sectional data from four nationally representative General Practice registries in the Netherlands. The year 2007 was chosen as a reference. Next, excess mortality rates were used to calculate numbers of deaths among HF patients and compare the figures with national cause-of-death statistics. The latter were found to be more than three times smaller than the former (roughly 6000 vs. 21 000). Further, by applying HF prevalence and mortality rates to a life table of the Dutch population, average numbers of life years lost due to HF were calculated to be 6.9 years. Conclusion National mortality statistics strongly underestimate the number of deaths associated with HF. Moreover, the high mortality rate in HF patients amounts to a remarkably large number of life years lost given the advanced age of disease onset.
How should we define health?
Huber, M. ; Knottnerus, J.A. ; Green, L. ; Horst, H. van der; Jadad, A.R. ; Kromhout, D. ; Leonard, B. ; Lorig, K. ; Loureiro, M.I. ; Meer, J.W.M. van der; Schnabel, P. ; Smith, R. ; Weel, C. van; Smid, H. - \ 2011
BMJ: British Medical Journal 343 (2011). - ISSN 0959-8138 - 3 p.
disease self-management - trial
The current WHO definition of health, formulated in 1948, describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” At that time this formulation was groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying, and as populations age and the pattern of illnesses changes the definition may even be counterproductive. The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands
Teff (Eragrostis tef) production constraints on Vertisols in Ethiopia: farmers' perceptions and evaluation of low soil zinc as yield-limiting factor.
Haileselassie, B. ; Stomph, T.J. ; Hoffland, E. - \ 2011
Soil Science and Plant Nutrition 57 (2011)4. - ISSN 0038-0768 - p. 587 - 596.
iron - supplementation - manganese - infants - copper - trial
Teff (Eragrostis tef (Zucc.) Trotter) is a major food crop in Ethiopia and Eritrea. It is well adapted to Vertisols. Yields are low (around 1000¿kg ha-1) despite fertilization with urea and diammonium phosphate. The objectives of this study were to understand farmers’ perception on teff production constraints and to evaluate on-farm yield response of teff to zinc (Zn) fertilization. We conducted a farm survey and a participatory fertilization experiment in three teff-based sites (peasant associations) on Vertisols in the mid highland and lowland agroecological zones in Ethiopia. Per site 10 farmers participated in the survey and on-farm experiment. Poor soil fertility in the mid highland and moisture deficit in the lowland agroecological zones were mentioned by farmers as major teff production constraints, respectively. On-farm application of Zn fertilizer at a rate of 8¿kg Zn ha-1 increased teff grain and straw yields by 14% and 15% on average, respectively, which could be economically profitable. Not all plots showed a positive response, however, indicating the necessity for enhanced insight in indicators for soil Zn bioavailability as a yield-limiting factor. Our study indicates the importance of Zn in teff production on Vertisols. We propose further research on management options to prepare for effective interventions based on the farm survey and on-farm experiment.
The process of setting micronutrient recommendations: a cross-European comparison of nutrition-related scientific advisory bodies
Timotijevic, L. ; Barnett, J. ; Brown, K. ; Shepherd, R. ; Fernandez-Celemin, L. ; Domolki, L. ; Ruprich, J. ; Dhonukshe-Rutten, R.A.M. ; Sonne, A.M. ; Hermoso, M. ; Koletzko, B. ; Frost-Andersen, L. ; Timmer, A. ; Raats, M.M. - \ 2011
Public Health Nutrition 14 (2011)4. - ISSN 1368-9800 - p. 716 - 728.
folic-acid - health-policy - risk - science - perspectives - expertise - politics - context - trial
Objective - To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. Design - Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. Setting - Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. Results - Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. Conclusions - Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake
Gynaecomastia linked to the intake of a herbal supplement fortified with diethylstilbestrol
Toorians, A.W.F.T. ; Bovee, T.F.H. ; Rooy, J. De; Stolker, L.A.A.M. ; Hoogenboom, L.A.P. - \ 2010
Food Additives & Contaminants. Pt. A, Chemistry, Analysis, Control, Exposure & Risk Assessment 27 (2010)7. - ISSN 1944-0049 - p. 917 - 925.
benign prostatic hyperplasia - breast-cancer - phase-ii - pc-spes - trial - multicenter - bioassay - receptor - beta - bph
This study reports the findings of a supplement marketed on the Internet for prostate problems. The supplement was orally taken by a 60-year-old man with divergent hormonal levels and who was surgically treated for gynaecomastia: development of abnormally large mammary glands in males. The supplement showed a strong effect in a yeast oestrogen bioassay, expressing a yeast-enhanced green fluorescent protein (yEGFP) upon exposure to oestrogens. Using both nuclear magnetic resonance (NMR) and a gradient liquid chromatographic time-of-flight mass spectrometric (LC/TOF-MS) method, the response was shown to be caused by very high levels of diethylstilbestrol, known for causing gynaecomastia. The gynaecomastia was most probably caused by this orally taken 'natural' herbal supplement, as the patient's hormonal levels also returned to normal again when stopping the use of it. This case demonstrates that physicians need to be aware of the use of supplements with illegal components that may be responsible for unwanted side-effects.
Different Mechanisms for Heterogeneity in Leprosy Susceptibility Can Explain Disease Clustering within Households
Fischer, E.A.J. ; Vlas, S. De; Meima, A. ; Habbema, D. ; Richardus, J. - \ 2010
PLoS ONE 5 (2010)11. - ISSN 1932-6203
risk-factors - epidemiology - population - model - indonesia - contacts - trial - bcg
The epidemiology of leprosy is characterized by heterogeneity in susceptibility and clustering of disease within households. We aim to assess the extent to which different mechanisms for heterogeneity in leprosy susceptibility can explain household clustering as observed in a large study among contacts of leprosy patients. We used a microsimulation model, parameterizing it with data from over 20,000 contacts of leprosy patients in Bangladesh. We simulated six mechanisms producing heterogeneity in susceptibility: (1) susceptibility was allocated at random to persons (i.e. no additional mechanism), (2) a household factor, (3, 4) a genetic factor (dominant or recessive), or (5, 6) half a household factor and half genetic. We further assumed that a fraction of 5%, 10%, and 20% of the population was susceptible, leading to a total of 18 scenarios to be fitted to the data. We obtained an acceptable fit for each of the six mechanisms, thereby excluding none of the possible underlying mechanisms for heterogeneity of susceptibility to leprosy. However, the distribution of leprosy among contacts did differ between mechanisms, and predicted trends in the declining leprosy case detection were dependent on the assumed mechanism, with genetic-based susceptibility showing the slowest decline. Clustering of leprosy within households is partially caused by an increased transmission within households independent of the leprosy susceptibility mechanism. Even a large and detailed data set on contacts of leprosy patients could not unequivocally reveal the mechanism most likely responsible for heterogeneity in leprosy susceptibility.
Low peripheral nerve conduction velocities and amplitudes are strongly related to diabetic microvascular complications in type 1 diabetes: the EURODIAB Prospective Complications Study
Charles, M. ; Soedamah-Muthu, S.S. ; Tesfaye, S. ; Fuller, J.H. ; Arezzo, J.C. ; Chaturvedi, N. ; Witte, D.R. - \ 2010
Diabetes Care 33 (2010)12. - ISSN 0149-5992 - p. 2648 - 2653.
risk-factors - glycemic control - anthropometric factors - iddm complications - vascular factors - neuropathy - polyneuropathy - prevalence - trial - age
Objective: Slow nerve conduction velocity and reduction in response amplitude are objective hallmarks of diabetic sensorimotor polyneuropathy. As subjective or clinical indicators of neuropathy do not always match well with the presence of abnormal nerve physiology tests, we evaluated associations to nerve conduction in patients with type 1 diabetes. Methods: Nerve conduction studies were performed in the distal sural and ulnar sensory nerves and the peroneal motor nerve in 456 individuals with type 1 diabetes who participated in the follow-up visit of the EURODIAB Prospective Complications Study (EPCS). We used multivariate regression models to describe associations to decreased nerve conduction measures. Results: In addition to an effect of duration of diabetes and HbA1c, which were both associated with low nerve conduction velocity and response amplitude, we found the presence of nephropathy, retinopathy or a clinical diagnosis of neuropathy were associated with low nerve conduction velocity and amplitude. In the case of non-proliferative retinopathy, odds ratio for being in lowest tertile were 2.30 (1.13; 4.67) for nerve conduction velocity. A similar odds ratio was found for each 2% difference in HbA1c (OR: 2.39 (1.68; 3.41). Conclusions: We show that the presence of other microvascular diabetic complications, together with diabetes duration, and HbA1c, are associated to low nerve conduction velocity and amplitude response; and that cardiovascular disease or risk factors do not seem to be associated to these measures
Dietary protein and risk of hypertension in a Dutch older population: the Rotterdam Study
Altorf-van der Kuil, W. ; Engberink, M.F. ; Rooij, F.J.A. van; Hofman, A. ; Veer, P. van 't; Witteman, J.C.M. ; Geleijnse, J.M. - \ 2010
Journal of Hypertension 28 (2010)12. - ISSN 0263-6352 - p. 2394 - 2400.
food frequency questionnaire - lowers blood-pressure - carbohydrate intake - dairy-products - men - women - fiber - trial - meat - fat
AB Background: Several observational studies suggest an inverse association of protein with blood pressure (BP). However, little is known about the role of dietary protein from specific sources in BP. Method: We examined the relation between several types of dietary protein (total, plant, animal, dairy, meat, grain, fish, soy, and nut) and incident hypertension in 2241 participants from the Rotterdam Study, aged at least 55 years, who were free of hypertension at baseline. Hazard ratios, with 95% confidence intervals (CIs), for incident hypertension during 6 years of follow-up were obtained per standard deviation (SD) of energy-adjusted intake of protein. Hazard ratios were adjusted for age, sex, body mass index (BMI), baseline systolic blood pressure (SBP) smoking, educational level, alcohol, intake of carbohydrates, other nutrients, and other types of protein (if applicable). We conducted stratified analyses by age (cut-off 70 years), sex, and BMI (cut-off 25 kg/m2). Results: The risk of hypertension in the total cohort (1113 cases) was not related to intake of total protein or types of protein (all hazard ratios ~1.00 per SD). Sex and BMI did not significantly modify the associations of dietary protein with hypertension. In 559 participants aged at least 70 years, the intake of animal protein was positively related to risk of hypertension (hazard ratio 1.37 per SD, 95% CI 1.09-1.72). For participants aged below 70 years no association was found (hazard ratio 0.92, 95% CI 0.81-1.06). Conclusion: Total dietary protein or types of protein are not related to incident hypertension in this older population. In the more aged, however, high intake of animal protein may increase the risk of hypertension, which warrants further investigation
Alpha-Linolenic Acid: Is It Essential to Cardiovascular Health?
Geleijnse, J.M. ; Goede, J. de; Brouwer, I.A. - \ 2010
Current Atherosclerosis Reports 12 (2010)6. - ISSN 1523-3804 - p. 359 - 367.
coronary-heart-disease - n-3 fatty-acid - myocardial-infarction - fish-oil - secondary-prevention - national heart - reduced risk - flaxseed oil - double-blind - trial
There is a large body of scientific evidence that has been confirmed in randomized controlled trials indicating a cardioprotective effect for omega-3 fatty acids from fish. For alpha-linolenic acid (ALA), which is the omega-3 fatty acid from plants, the relation to cardiovascular health is less clear. We reviewed the recent literature on dietary ALA intake, ALA tissue concentrations, and cardiovascular health in humans. Short-term trials (6–12 weeks) in generally healthy participants mostly showed no or inconsistent effects of ALA intake (1.2–3.6 g/d) on blood lipids, low-density lipoprotein oxidation, lipoprotein(a), and apolipoproteins A-I and B. Studies of ALA in relation to inflammatory markers and glucose metabolism yielded conflicting results. With regard to clinical cardiovascular outcomes, there is observational evidence for a protective effect against nonfatal myocardial infarction. However, no protective associations were observed between ALA status and risk of heart failure, atrial fibrillation, and sudden death. Findings from long-term trials of ALA supplementation are awaited to answer the question whether food-based or higher doses of ALA could be important for cardiovascular health in cardiac patients and the general population