Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

Aims/hypothesis The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS).Methods In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n=163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity.Results During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups.Conclusions/interpretation In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.     

The impact of the 1918 Spanish flu epidemic on economic performance in Sweden: An investigation into the consequences of an extraordinary mortality shock

We study the impact of the 1918 influenza pandemic on short- and medium-term economic performance in Sweden. The pandemic was one of the severest and deadliest pandemics in human history, but it has hitherto received only scant attention in the economic literature – despite representing an unparalleled labour supply shock. In this paper, we exploit seemingly exogenous variation in incidence rates between Swedish regions to estimate the impact of the pandemic. The pandemic led to a significant increase in poorhouse rates. There is also evidence that capital returns were negatively affected by the pandemic. However, contrary to predictions, we find no discernible effect on earnings.     

Landscape and children’s health: Old natures and new challenges for the preventorium

Preventoria were established in the early part of the twentieth century at fresh air sites away from cities for the purposes of rest cures for children, usually for those who were at risk of contracting tuberculosis. This paper discusses preventoria in relation to their general landscapes, and outlines the types of landscapes in which preventoria are found, namely woods and forests, ocean, rivers and lakes, and agricultural settings. The preventorium movement is placed in historical landscape context, with urban planning, national parks, and other nineteenth century trends. Fresh air was the driving force of both treatment and locations of preventoria and sanatoria. Current movements in child health to combat obesity and ‘nature-deficit-disorder’ also call for greater engagement with fresh air, and stress the therapeutic value of natural landscape.Australia’s oldest preventorium is examined as a case study of preventoria and the challenges which old preventoria are facing today to re-invent themselves in predominantly rural landscapes.     

未婚青年性病预防和治疗咨询需要和实现状况

全球15~24岁青年性传播疾病(STI)报告率最高[1]。目前各国缺乏未婚性活跃青年STI发病率和流行率的有效数据[2]。国内学者推断中国未婚育龄人群中性病的感染率高于已婚育龄人群[3]。     

The effect of macular pigment on heterochromatic luminance contrast

Macular pigment (MP) selectively filters short-wave light and may improve visual performance via this mechanism. This study was designed to test the hypothesis that MP alters contrast between an object and its background, and thus alters the object’s detectability. In order to test this hypothesis, participants of a variety of ages were recruited into two groups. Group 1 consisted of 50 healthy elderly subjects (M = 72.7, SD = 7.3 years). Group 2 consisted of 28 healthy younger subjects (M = 22.7, SD = 3.6 years). For all subjects, contrast thresholds were assessed in Maxwellian-view. For subjects in Group 1, a circular grating target (600 nm, 1°; not absorbed by MP) was surrounded by a 10°, 460 nm field (strongly absorbed by MP). Subjects in Group 2 were measured using identical conditions with the exception that the surround was changed to 425 nm in one condition and to a broad-band (xenon) white in another. All subjects adjusted the intensity of the surround until the target was no longer visible. Finally, for a sub-sample of subjects in Group 2, a 1° bipartite field was used and wavelength was varied on one side to minimize the appearance of the border with the 460 nm reference side, foveally and parafoveally between 420–540 nm, with 20 nm steps, using the minimally distinct border (MDB) technique. MP density was assessed psychophysically. MP density was related to the amount of energy in the surround (at 425 and 460 nm, and for broad-band white) needed to lose sight of the central target. When the MDB technique was used to measure spectral sensitivity, the differences in the two curves yielded a spectrum that closely matched MP’s ex vivo spectrum. Our data suggest that MP modifies an object’s contrast against a short-wave background via simple filtration.     

Serum antibody response to Moraxella catarrhalis proteins in stringently defined otitis prone children

BackgroundMoraxella catarrhalis (Mcat) is a frequent pathogen of acute otitis media (AOM) in young children. Here we prospectively assessed naturally-induced serum antibodies to four Mcat vaccine candidate proteins in stringently defined otitis prone (sOP) and non-otitis prone (NOP) children age 6–36 months old following nasopharyngeal (NP) colonization, at onset of AOM and convalescence from AOM.MethodsSerum IgG and IgM antibody against recombinant Mcat proteins, oligopeptide permease A (OppA), outer membrane protein (OMP) CD, hemagglutinin (Hag), and PilA clade 2 (PilA2), were quantitated by ELISA.ResultsDuring NP colonization by Mcat all four antigens were immunogenic in both sOP and NOP children. However, sOP children had lower antibody responses than NOP children across age 6–36 months, similar to our findings for protein vaccine candidates of Streptococcus pneumoniae (Spn) and Nontypeable Haemophilus influenzae (NTHi). sOP children displayed a later and lower peak of antibody rise than NOP children for all four antigens during NP colonization of Mcat. The age-dependent increase of antibody ranked as OppA > Hag5-9 > OMP CD > PilA2 in both sOP and NOP children. Lower serum antibody levels to the Mcat antigens were measured in sOP compared to NOP children at the onset of AOM. We did not find a consistent significant increase of antibody at the convalescence phase after an AOM event.ConclusionssOP children is a highly vulnerable population that mount lower serum antibody responses to Mcat candidate vaccine proteins compared to NOP children during asymptomatic NP carriage and at onset of AOM.     

Use of antipsychotics in elderly patients with dementia: Do atypical and conventional agents have a similar safety profile?

Pharmacological treatment of dementia addresses two main clinical features of the disease: cognitive deterioration with predominantly memory loss and behavioural and psychological symptoms (BPSD). While cholinesterase inhibitors are recommended in an attempt to delay memory loss and disability, what should be considered the most appropriate pharmacological treatment for BPSD has remained questionable. Antipsychotic medications, conventional and atypical agents, have been increasingly utilized in clinical practice but only a small number of clinical studies have investigated their relative cost–benefit ratio. This review focuses on the safety of atypical and conventional antipsychotics when used in patients with BPSD. Overall, atypical and conventional antipsychotics are associated with a similarly increased risk for all-cause mortality and cerebrovascular events. Relative to atypical agents users, patients being treated with conventional antipsychotics have an increased incidence of cardiac arrhythmias and extrapyramidal symptoms. Conversely, users of atypical antipsychotics are exposed to an increased risk of venous thromboembolism and aspiration pneumonia. Also, metabolic effects (i.e. increased risk of diabetes, weight gain) have consistently been documented in clinical studies with atypical antipsychotics, although this effect tends to be attenuated with advancing age and in elderly patients with dementia. Antipsychotics, both conventional and atypical, should be used with caution only when nonpharmacologic approaches have failed to adequately control BPSD. More effective interventions are necessary to improve postmarket drug safety in vulnerable populations.