Current and historical individual data about exposure of workers in the rayon industry to carbon disulfide and their validity in calculating the cumulative dose

Introduction

The objective of the study was to investigate how exposure to carbon disulfide (CS₂) in a rayon-manufacturing plant has changed within two decades and whether it is possible to calculate valid data for the individual cumulative exposure.

Methods

The data for CS₂ concentration in air and biological exposure monitoring (2-thio-1,3-thiaxolidine-4-carboxylic acid (TTCA) in urine) from two cross-sectional studies, performed in 1992 (n = 362) and 2009 (n = 212) in a German rayon-manufacturing plant, were compared to data obtained from company-internal measurements between the studies.

Results

Using the data from the cross-sectional studies and company-internal data, cumulative external exposure and the cumulative internal exposure were calculated for each worker. External and internal CS₂ exposure of the employees decreased from 1992 (medians 4.0 ppm and 1.63 mgTTCA/g creatinine) to 2009 (medians 2.5 ppm and 0.86 mg/g). However, company-internal CS₂ data do not show a straight trend for this period. The annual medians of the company-internal measurement of external exposure to CS₂ have varied between 2.7 and 8.4 ppm, in which median values exceeded 5 ppm generally since 2000. The annual medians for the company-internal biomonitoring assessment ranged between 1.2 and 2.8 mg/g creatinine. The cumulative CS₂ exposure ranged from 8.5 to 869.5 ppm years for external exposure and between 1.30 and 176.2 mg/g creatinine years for the internal exposure. Significant correlations were found between the current air pollution and the internal exposure in 2009 but also between the cumulative external and internal CS₂ exposure.

Conclusions

Current exposure data, usually collected in cross-sectional studies, rarely allow a reliable statement on the cumulative dose, because of higher exposure in the past and of fluctuating courses of exposure. On the other hand, company-internal exposure data may be affected by non-representative measurement strategies. Some verification of the reliability of cumulative exposure data may be possible by testing the correlation between cumulative exposure data of external assessment and biological monitoring.     

Exposure assessment of potash miners at elevated CO2 levels

Purpose

In a potash mine in the center of Germany, stationary measurements 40 cm above ground level have revealed occasional increases in the carbon dioxide (CO₂) levels that exceed the 0.5 vol.% German occupational exposure limit (OEL). This study, therefore, aimed to examine the individual exposures of potash miners to CO₂ at their underground workplaces.

Methods

119 miners were equipped with personal CO₂ detectors to log the individual CO₂ exposures during underground work. We decided to use electrochemical monitors due to their compactness and minimal mass. Furthermore, generated CO₂ measurements with precipitated overshooting and false positive CO₂ values were studied using diverse CO₂ test gases and different fumigation times.

Results

The personal detectors showed short-term CO₂ peak exposures at very high concentrations in a limited number of workers. Twenty-two threshold limit value violations were observed according to the present OEL, and the personal CO₂ monitoring allowed categorization into three exposure groups, low (n = 83), moderate (n = 26) and high burdens (n = 10) of CO₂.

Conclusions

The electrochemical sensors used have numerous properties that can potentially influence the assessment of exposures. The current findings suggest that assessing similar exposure scenarios, with respect to elevated and strongly fluctuating CO₂ concentrations, the behavior of electrochemical sensors should be taken into consideration.     

Indoor allergens in settled dust from kindergartens in city of Łódź, Poland

Objectives

The main objective of the study was to determine the levels of house dust mite (Der p1), dog (Can f1), cat (Fel d1) and cockroach (Bla g2) allergens in kindergartens localized in an urban agglomeration.

Material and Methods

A quantitative analysis of allergens was carried out in settled dust samples collected by vacuuming the floor surface in three kindergartens (N = 84) and children’s clothing (N = 36). The samples were collected in spring-summer and autumn-winter periods as well as at the beginning and end of the week. The allergen dust concentration was determined by enzyme-linked immunoenzymatic assay (ELISA).

Results

The mean geometric concentrations (±geometric standard deviations) of allergens Der p1, Can f1, Fel d1 and Bla g2 determined in kindergartens were: 0.02±3.21 μg/g of dust; 0.97±4.49 μg/g of dust; 0.30±4.43 μg/g of dust and 0.01±3.08 μg/g of dust, respectively. Younger classrooms (children aged from 3 to 4 years) were characterized by almost twice higher mean concentration of allergen Fel d1, as compared to older classrooms (children aged from 5 to 6 years) (p < 0.05). A significant impact of seasonality on the level of dog allergen Can f1 was found (p < 0.05). No significant weekly variation was found in average concentrations of the allergens. Children who had a dog and/or cat at home were characterized by high concentrations of allergens Can f1 and Fel d1 on their clothes (59.2±5.39 μg Can f1/g of dust; 3.63±1.47 μg Fel d1/g of dust), significantly higher than concentrations of allergens in children who did not have any pets (p < 0.001).

Conclusions

Special attention should be paid to keeping the kindergarten rooms tidy and clean and to an appropriate choice of furnishings and fittings which would prevent the proliferation of the house dust mite and accumulation of allergens.     

Children’s residential exposure to selected allergens and microbial indicators: endotoxins and (1→3)-β-D-glucans

Objectives

The study was aimed at assessment of exposure to endotoxins, (1→3)-β-D-glucans and mite, cockroach, cat, dog allergens present in settled dust in premises of children as agents which may be significantly correlated with the occurrence of allergic symptoms and diseases in children.

Materials and Methods

The study covered 50 homes of one-or two-year-old children in Poland. Samples of settled dust were taken from the floor and the child’s bed. The levels of (1→3)-β-D-glucans (floor), endotoxins (floor) and allergens of mite, cat, dog and cockroach (floor and bed) were analyzed.

Results

Average geometric concentrations (geometric standard deviation) of endotoxins, (1→3)-β-D-glucans, Der p1, Fel d1, Can f1 and Bla g1 in children homes were on the floor 42 166.0 EU/g (3.2), 20 478.4 ng/g (2.38), 93.9 ng/g (6.58), 119.8 ng/g (13.0), 288.9 ng/g (3.4), 0.72 U/g (4.4) and in their beds (only allergens) 597.8 ng/g (14.2), 54.1 ng/g (4.4), 158.6 ng/g (3.1) 0.6 U/g (2.9), respectively. When the floor was covered with the carpet, higher concentrations of endotoxins, (1→3)-β-D-glucans and allergens (each type) were found in the settled dust (p < 0.05). The trend was opposite in case of allergens (except dog) analyzed from bed dust and significantly higher concentrations were found in the rooms with smooth floor (p < 0.05).

Conclusions

Among the analyzed factors only the type of floor significantly modified both the level of biological indicators and allergens. The results of this study could be the base for verifying a hypothesis that carpeting may have a protective role against high levels of cockroach, dog and cat allergens.     

Modeled Effectiveness of Ventilation with Contaminant Control Devices on Indoor Air Quality in a Swine Farrowing Facility

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5°C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m³ s^?1 (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced (Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5°C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m³ s^?1 (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO₂) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO₂ concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO₂ to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures.

[Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: detailed simulation results, including room concentration and operation cost for all simulations performed in this study.]     

The use of household cleaning products during pregnancy and lower respiratory tract infections and wheezing during early life

Objective

To evaluate the effects of household use of cleaning products during pregnancy on infant wheezing and lower respiratory tract infections (LRTI).

Methods

In four prospective Spanish birth cohorts (n = 2,292), pregnant women reported the use of household cleaning products. When infants were 12–18 months old, current cleaning product use and infant’s wheezing and LRTI were reported. Cohort-specific associations between the use of specific products and respiratory outcomes were evaluated using multivariable regression analyses and estimates were combined using random-effects meta-analyses.

Results

The period prevalence of LRTI was higher when sprays (combined odds ratio (OR) = 1.29; 95 % confidence interval (CI) 1.04–1.59) or air fresheners (OR = 1.29; CI 1.03–1.63) were used during pregnancy. The odds of wheezing increased with spray (OR = 1.37; CI 1.10–1.69) and solvent (OR = 1.30; CI 1.03–1.62) use. The associations between spray and air freshener use during pregnancy and both outcomes remained apparent when these products were not used after pregnancy. Nevertheless, the estimates were higher when post-natal exposure was included.

Conclusion

The use of cleaning sprays, air fresheners and solvents during pregnancy may increase the risk of wheezing and infections in the offspring.     

Pneumoproteins in sewage workers exposed to sewage dust

Purpose

The association between exposure to bacteria and endotoxins in sewage dust and the serum concentrations of pneumoproteins in sewage treatment plant workers were studied.

Methods

Forty-four workers from eight sewage treatment plants and 38 reference workers participated in the study. Microbial aerosol was collected by personal inhalable samplers. The concentrations of bacteria and endotoxins were determined by fluorescence microscopy and the Limulus assay, respectively. Pneumoproteins (Clara cell protein: CC16, and Surfactant proteins A and D: SP-A, SP-D) were determined by ELISA in blood samples collected post-shift.

Results

The exposure to dust ranged from 0.02 to 9.3 (geometric mean (GM) 0.3 mg/m³, of bacteria from 0.3 to 4,900 × 10³ (GM 27 × 10³) cells/m³ and endotoxins from 1 to 3,160 (GM 28) EU/m³. The exposed workers had lower CC16 [arithmetic mean (AM) 4.9 ng/ml] compared to the referents (AM 6.4 ng/ml, p < 0.01). No significant difference was observed for SP-D and SP-A. Exposure to bacteria was positively associated with CC16 (p < 0.05) and SP-D (p < 0.05), adjusting for possible confounders.

Conclusions

This study showed that exposed workers had lower serum concentration of CC16 as compared to the referents, which may reflect a long-term effect on secretion of these pneumoproteins. The positive association between exposure to bacteria and the serum concentrations of CC16 and SP-D may be explained by a transient increased permeability of the lung–blood barrier.     

Exposure to respirable dust and manganese and prevalence of airways symptoms,among Swedish mild steel welders in the manufacturing industry

Purpose

Welding fume consists of metal fumes, e.g., manganese (Mn) and gases, e.g., ozone. Particles in the respirable dust (RD) size range dominate. Exposure to welding fume could cause short- and long-term respiratory effects. The prevalence of work-related symptoms among mild steel welders was studied, and the occupational exposure to welding fumes was quantified by repeated measurements of RD, respirable Mn, and ozone. Also the variance components were studied.

Method

A questionnaire concerning airway symptoms and occupational history was answered by 79 % of a cohort of 484 welders. A group of welders (N = 108) were selected and surveyed by personal exposure measurements of RD and ozone three times during 1 year.

Results

The welders had a high frequency of work-related symptoms, e.g., stuffy nose (33 %), ocular symptoms (28 %), and dry cough (24 %). The geometric mean exposure to RD and respirable Mn was 1.3 mg/m³ (min–max 0.1–38.3 mg/m³) and 0.08 mg/m³ (min–max <0.01–2.13 mg/m³), respectively. More than 50 % of the Mn concentrations exceeded the Swedish occupational exposure limit (OEL). Mainly, low concentrations of ozone were measured, but 2 % of the samples exceeded the OEL. Of the total variance for RD, 30 and 33 % can be attributed to within-worker variability and between-company variability, respectively.

Conclusions

Welders had a high prevalence of work-related symptom from the airways and eyes. The welders’ exposure to Mn was unacceptably high. To reduce the exposure further, control measures in the welding workshops are needed. Correct use of general mechanical ventilation and local exhaust ventilation can, for example, efficiently reduce the exposure.     

Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

Background

The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children.

Objective

The aim of the current study was to observe the pedagogical interventions of group care workers within residential youth care and their associations with child behaviors.

Methods

Group care worker interventions and child behaviors were videotaped during structured observations. Participants included 95 children (64 % boys, M _age = 9.19) and 53 group care workers (74 % female, M _age = 33.79 years). A coding system was developed to code pedagogical interventions and child behaviors.

Results

It showed that group care workers mainly used positive pedagogical interventions (warmth/support and positive control) and seldom used negative pedagogical interventions (permissiveness and negative control). Frustration and anger of children was associated with positive controlling interventions and permissiveness of group care workers. The hypothesis that child anxiety and nervousness is associated with warm and supportive interventions could not be confirmed.

Conclusions

Pedagogical interventions should be part of education, training, and supervision of group care workers.     

Association of pediatric asthma severity with exposure to common household dust allergens

Background

Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma.

Objective

To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children.

Methods

Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education.

Results

Der p 1 house dust mite allergen concentration of 2.0 μg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 μg/g and OR 2.55 95% CI 1.13, 5.73 for ?10.0 μg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22).

Conclusion

Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.     

Prevalence of respiratory symptoms and disorders among rice mill workers in India

Objectives

Lung function tests have become an integral part of assessment of pulmonary disease. Diseases of the respiratory system induced by occupational dusts are influenced by the duration of exposure. The aim of the study is to investigate the impairment of lung function and prevalence of respiratory symptoms among the rice mill workers.

Methods

A total of 120 rice mill workers from three districts of Karnataka were included in this study. Fifty urban dwellers from the same socio-economic level were selected as controls. The study included clinical examination, assessment of respiratory symptoms, pulmonary function test, measurement of peak expiratory flow rate, absolute eosinophil count, ESR estimation, total IgE estimation and radiographic test.

Results

The present study has shown that the rice mill workers complained of several types of respiratory disorders like phlegm (40.8 %), dyspnea (44.2 %), chest tightness (26.7 %), cough (21.7 %), and nose irritation (27.5 %). Rice mill workers exposed to dust presented significantly (p < 0.05) lower levels of FVC (3.44 ± 0.11), FEV₁ (2.73 ± 0.15) and PEFR (304.95 ± 28.79) than the controls. The rice mill workers are having significantly higher absolute eosinophil counts, total IgE and ESR than control groups. The hematological findings suggest that the harmful effects may be linked to both non-specific irritation and allergic responses to rice husk dust among rice mill workers.

Conclusion

Dust exposure in the working environment affects the lung function values and increased the respiratory symptoms among the rice mill workers.     

Exposure study to examine chemosensory effects of formaldehyde on hyposensitive and hypersensitive males

Objective

Main objective of this study was to examine the chemosensory effects of formaldehyde on hyposensitive and hypersensitive males at concentrations relevant to the workplace. Attention focused on objective effects on and subjective symptoms of the mucous membranes of the eyes, the nose, the upper respiratory tract and olfactory function.

Methods

Forty-one male volunteers were exposed for 5 days (4 h per day) in a randomised schedule to the control condition (0 ppm) and to formaldehyde concentrations of 0.5 and 0.7 ppm and to 0.3 ppm with peak exposures of 0.6 ppm, and to 0.4 ppm with peak exposures of 0.8 ppm, respectively. Peak exposures were carried out four times a day over a 15-min period of time. Subjective pain perception induced by nasal application of carbon dioxide served as indicator for sensitivity to sensory nasal irritation. The following parameters were examined before and after exposure: subjective rating of symptoms and complaints (Swedish Performance Evaluation System), conjunctival redness, eye-blinking frequency, self-reported tear film break-up time and nasal flow rates. In addition, the influence of personality factors on the volunteer’s subjective scoring was examined (Positive And Negative Affect Schedule).

Results

Formaldehyde exposures to 0.7 ppm for 4 h and to 0.4 ppm for 4 h with peaks of 0.8 ppm for 15 min caused no significant sensory irritation of the measured conjunctival and nasal parameters. No differences between hypo- and hypersensitive subjects were seen. Nevertheless, statistically significant differences were noted for olfactory symptoms, especially for the ‘perception of impure air’. These subjective complaints were more pronounced in hypersensitive subjects.

Conclusions

Formaldehyde concentrations of 0.7 ppm for 4 h and of 0.4 ppm for 4 h with peaks of 0.8 ppm for 15 min did not cause adverse effects related to irritation, and no differences between hypo- and hypersensitive subjects were observed.     

Development and psychometric properties of the Maastricht Personal Autonomy Questionnaire (MPAQ) in older adults with a chronic physical illness

Purpose

To develop and test the Maastricht Personal Autonomy Questionnaire (MPAQ), an instrument measuring personal autonomy of older adults with a chronic physical illness in accordance with their experience of autonomy. Achievement of personal autonomy is conceptualized as correspondence between the way people’s lives are actually arranged and the way people want to arrange their lives.

Methods

A field test was conducted in three waves (n = 412, n = 125 and n = 244) among a random sample of people older than 59 years with either chronic obstructive pulmonary disease or diabetes mellitus. Construct validity, reproducibility and responsiveness were evaluated.

Results

The MPAQ entailing 16 items consists of three scales: degree of (personal) autonomy, working on autonomy and dilemmas. Construct validity was largely supported by confirmatory factor analysis and correlations between the MPAQ and other instruments. Intraclass correlation coefficients ranged from 0.61 to 0.80 and SRDs_group from 0.10 to 0.13. Mean change was larger (0.54) than was SRD_group (0.11) in patients who had deteriorated, but smaller in patients who had improved (0.07).

Conclusions

The MPAQ has good content and construct validity and moderate reproducibility. Responsiveness is weak, although better for deterioration than for improvement.     

The independent effect of body mass index on health-related quality of life among racial and ethnic subgroups

Purpose

To evaluate the impact of race/ethnicity on the relationship between body mass index (BMI) and health-related quality of life (HRQOL) among blacks, Hispanics, and whites.

Methods

We used the Sinai Urban Health Institute’s Improving Community Health Survey dataset to measure physical and mental HRQOL using the Physical Component Score (PCS-12) and the Mental Component Score (MCS-12) of the Short Form-12. Multivariate linear regression models were applied to the overall sample and in models stratified by race/ethnicity to evaluate the effects of BMI on physical and mental HRQOL outcome variables while controlling for confounders.

Results

Considering physical HRQOL, increasing BMI was independently associated with worse PCS-12 (β = ?0.22, p value <0.001) in the overall sample; the magnitude was not significantly different across racial/ethnic subgroups (blacks: β = ?0.18, p value = 0.02; Hispanics: β = ?0.28, p value = 0.01; whites: β = ?0.20, p value = 0.02). Overall, Hispanic participants reported a worse PCS-12 compared to whites (β = ?3.06, p value = 0.002). Considering mental HRQOL, BMI was not significantly associated with MCS-12 in the overall sample (β = ?0.06, p value = 0.21) nor was BMI significantly associated with MCS-12 in any racial/ethnic subgroups. Overall, black participants reported better MCS-12 compared to whites (β = 2.51, p value = 0.001).

Conclusions

BMI was associated with worse physical HRQOL to a similar degree among blacks, Hispanics, and whites. This finding suggests that interventions leading to obesity reduction should be associated with substantial and equal improvements in the physical HRQOL of all race/ethnicity groups.     

Indoor particle counts during Asian dust events under everyday conditions at an apartment in Japan

Objective

Asian dust storms originating from arid regions of Mongolia and China are a well-known springtime phenomenon throughout East Asia. Evidence is increasing for the adverse health effects caused by airborne desert dust inhalation. Given that people spend approximately 90 % of their time indoors, indoor air quality is a significant concern. The present study aimed to examine the influence of outdoor particulate matter (PM) levels on indoor PM levels during Asian dust events under everyday conditions.

Methods

We simultaneously monitored counts of particles larger than 0.3, 0.5, 1, 2, and 5 μm using two direct-reading instruments (KC-01D1 airborne particle counter; Rion), one placed in an apartment room and another on the veranda, under everyday conditions before and during an Asian dust event. We also examined how indoor particle counts were affected by opening a window, crawling, and air purifier use.

Results

An Asian dust event on 24 April 2012 caused 50- and 20-fold increases in PM counts in outdoor and indoor air, respectively. A window open for 10 min resulted in a rapid increase of indoor PM counts up to 70 % of outside levels that did not return to baseline levels after 3 h. An air purifier rapidly reduced PM counts for all particle sizes measured.

Conclusions

It is important to account for occupant behavior, such as window-opening and air purifier use, when estimating residential exposure to particulate matter.     

Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula

Background

Reducing the dietary glycaemic response has been proposed as a means of reducing the risk of diabetes.

Aim

To evaluate the effects of a new diabetes-specific formula (DSF) enriched with resistant starch type IV and fructose-free on postprandial glycaemia, insulinaemia and gastrointestinal hormones in healthy volunteers and in outpatient type 2 diabetics.

Methods

(1) Twenty-four healthy volunteers were divided into two groups: Group 1 ( n = 10) was provided 50 g of the carbohydrate (CHO) constituent of the new product and 50 g of glucose separated by 1 week; Group 2 ( n = 14) was provided 400 ml of the new DSF (T-Diet Plus^® Diabet NP) and 400 ml of a control product separated by 1 week. (2) Ten type 2 diabetic patients received 400 ml of the new DSF and two other commercially available DSF (Glucerna^® SR and Novasource^® Diabet) on three occasions separated by 1 week. Venous blood samples were drawn at time 0 and at different times until 120 min. Glucose, insulin and gastrointestinal hormones were determined. Glycaemic and insulinaemic indices and glycaemic load were calculated.

Results

The CHO constituent and the new DSF showed low glycaemic index and glycaemic load. In healthy subjects, insulin and C-peptide release were lower after administration of the CHO constituent as well as after the new DSF (P < 0.001). Ghrelin, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) production were lower after intake of the CHO constituent (P ranging from <0.001 to 0.019) compared with glucose, and GIP was lower after ingestion of the new DSF (P = 0.002) than after the control product. In type 2 diabetic patients, glucose AUC was lower after the administration of the new DSF (P = 0.037) compared with the others.

Conclusions

Our results indicate that this new product could be beneficial for diabetic patients.     

Dietary antioxidant capacity is associated with improved serum antioxidant status and decreased serum C-reactive protein and plasma homocysteine concentrations

Purpose

To investigate the associations of dietary TAC from diet and supplements with serum antioxidant concentrations and serum C-reactive protein (CRP) and plasma total homocysteine (tHcy) in US adults.

Methods

This was a cross-sectional study. Food consumption data, serum antioxidant levels, and serum CRP and Plasma tHcy concentrations of 4,391 US adults aged ≥19 years in the National Health and Nutrition Examination Survey 2001–2002 were analyzed. The USDA flavonoid and proanthocyanidin databases and dietary supplement data as well as antioxidant capacities of 43 antioxidants were also utilized.

Result

Serum CRP and plasma tHcy concentrations were higher in older adults, smokers, and those with lower non-leisure time physical activity levels (P < 0.05). Energy-adjusted daily total antioxidant capacity (TAC) from diet and supplements was positively associated with serum vitamin E and carotenoid concentrations (P < 0.05). Adjusted odds ratio (OR) for plasma tHcy >13 μmol/L significantly decreased across quartiles of TAC from diet and supplements (Q1 = 2.18 (1.56–2.77); Q2 = 1.30 (1.00–2.07); Q3 = 1.34 (0.84–2.28); Q4 = 1.00; P for linear trend <0.001). A negative trend across quartiles of TAC from diet and supplements was also observed in OR for serum CRP ≥3 mg/L (Q1 = 1.26 (0.97–1.70); Q2 = 1.21 (0.91–1.66); Q3 = 0.97 (0.80–1.24); Q4 = 1.00; P for linear trend <0.05).

Conclusions

These findings indicated that dietary TAC provided an integrated conceptual tool in assessing serum antioxidants and investigating the associations between antioxidant intake and CVD risk. The implicated applicability of dietary TAC needs further validation in prospective cohort studies.     

Changing values, changing outcomes: the influence of reprioritization response shift on outcome assessment after spine surgery

Background

When patients experience a substantial health state change, they may undergo changes in the underlying meaning of their self-report to standardized outcome measures. These response shifts can reflect changes in the patient’s internal standards, values or conceptualization of quality of life. We investigated the presence of changing values (reprioritization response shift) in a longitudinal cohort of spine surgery patients.

Methods

Spinal decompression surgery patients (mean age 52 years; 39 % female, 36 % working) provided visual analogue scale (VAS) back and leg pain items, the Short-Form-36 (SF-36v1), and the Oswestry Disability Index (ODI) data pre- and post-surgery (n _pre = 169; n _6weeks = 102; n _3months = 106; n _6months = 68). Improved and No-Effect patient groups were compared using the VAS minimally important difference (±15 points) as a cutoff. Reprioritization response shift detection was based on change in the relative importance of the SF-36 domains for group discrimination pre- and post-surgery.

Results

The Improved group evidenced significant post-surgery differences from the No-Effect group on bodily pain, general health, physical functioning, social functioning, vitality, and the ODI. The relative importance analysis showed a differential effect with bodily pain (p < 0.01) and physical functioning (p < 0.05) becoming more important, and role physical (p < 0.01) becoming less important post-surgery in distinguishing the Improved group as compared to the No-Effect group. The Improved patients also evidenced stronger associations between bodily pain and physical functioning, vitality and general health (p < 0.05). The No-Effect group evidenced increased inter-correlations of bodily pain with social functioning, mental health, and general health (p < 0.05).

Conclusions

Patients who report clinically significant change in leg and back pain post-surgery using VAS pain scores are also distinguished by increased importance of bodily pain and physical functioning, and decreased importance of role physical. Bodily pain is primarily reflective of physical item response post-surgery among Improved patients, but reflects physical, social, and emotional item response among No-Effect patients. These changes in values may reflect a “moving goal post” in outcome assessment that complicates the interpretation of mean differences over time on standard spine outcome measures.     

Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women

Purpose

This study aimed to determine whether there is a relationship between iron status and bone metabolism, and to compare the effects of the consumption, as part of the usual diet, of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women.

Methods

Young healthy iron-deficient or iron-sufficient women (serum ferritin ≤30 ng/mL or >30 ng/mL, respectively) were recruited. Iron-deficient women were assigned to a nutritional intervention consisting of a randomised, controlled, double-blind, parallel design trial of 16 weeks during winter. They consumed, as part of their usual diet, an iron (Fe group, n = 54) or iron and vitamin D-fortified (Fe+D group, n = 55) flavoured skimmed milk (iron, 15 mg/day; vitamin D₃, 5 μg/day, 200 IU). The iron-sufficient women followed their usual diet without supplementation (R group, n = 56). Dietary intake, body weight, iron biomarkers, 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), procollagen-type 1 N-terminal propeptide (P1NP), and aminoterminal telopeptide of collagen I (NTx) were determined.

Results

Negative correlations were found between baseline log-ferritin and log-NTx (p < 0.001), and between transferrin and P1NP (p = 0.002). Serum 25OHD increased (from 62 ± 21 to 71 ± 21 nmol/L, mean ± SD, p < 0.001) while P1NP and NTx decreased in Fe+D during the assay (p = 0.004 and p < 0.001, respectively). NTx was lower in Fe+D compared to Fe at week 8 (p < 0.05) and was higher in Fe and Fe+D compared to R throughout the assay (p < 0.01). PTH did not show changes.

Conclusions

Iron deficiency is related with higher bone resorption in young women. Consumption of a dairy product that supplies 5 μg/day of vitamin D₃ reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status, defined as 25OHD over 75 nmol/L.     

Environmental cadmium exposure and osteoporosis: a review

Objectives

To review the published literature investigating the association between cadmium exposure and osteoporosis.

Methods

A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models.

Results

The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I ² = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I ² = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels.

Conclusions

This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.