Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project

Objectives

To analyse how psychosocial determinants of lifestyle changes targeted in the Greater Green Triangle Diabetes Prevention Project conducted in Southeast Australia in 2004-2006 predict changes in dietary behaviour and clinical risk factors.

Methods

A longitudinal pre-test and post-test study design was used. The group program was completed by 237 people at high risk of type 2 diabetes. Associations between changes in the variables were examined by structural equation modelling using a path model in which changes in psychological determinants for lifestyle predicted changes in dietary behaviours (fat and fibre intake), which subsequently predicted changes in waist circumference and other clinical outcomes. Standardised regression weights are presented, with β = ± 0.1 and β = ± 0.3 representing small and medium associations, respectively.

Results

Improvements in coping self-efficacy and planning predicted improvements in fat (β = − 0.15, p < 0.05 and β = − 0.32, p < 0.001, respectively) and fibre intake (β = 0.15, p < 0.05 and β = 0.23, p < 0.001, respectively) which in turn predicted improvements in waist circumference (β = 0.18, p < 0.01 and β = − 0.16, p < 0.05, respectively). Improvements in waist circumference predicted improvements in diastolic blood pressure (β = 0.13, p < 0.05), HDL (β = − 0.16, p < 0.05), triglycerides (β = 0.17, p < 0.01), and fasting glucose (β = 0.15, p < 0.05).

Conclusions

Psychological changes predicted behaviour changes, resulting in 12-month biophysical changes. The findings support the theoretical basis of the interventions.     

Coste-efectividad de un programa de actividad física de tiempo libre para prevenir el sobrepeso y la obesidad en niños de 9-10 años

Objective

To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children.

Methods

Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group.

Results

The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (−1.25 mm, 95% CI: −1.82 to −0.67; P < .001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (−0.59%; 95% CI: −1.03 to −0.67; P < .001), and those with a BMI > P75 showed a decrease in triceps skinfold thickness (−1.87 mm; 95%CI: −3.43 to −0.32; P < .001), and percentage of body fat (−0.67%; 95%CI: −1.32 to −0.01; P < .05).

Conclusions

This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.     

Dose-response relationship between walking and the attenuation of inherited weight

Objective

Genetic factors account for 40%-70% of the variation in body mass index (BMI). We sought to test whether moderate intensity physical activity affected parent-offspring relationships for body mass index and regional adiposity in 26,587 female and 6428 male walkers surveyed in the United States in 2000.

Methods

Survey questionnaires provided self-reported usual walking distance, height, weight, and waist circumference, and mother's and father's adiposity (1 = lean, 2 = normal, 3 = overweight, and 4 = very overweight). Regression analyses were used to test whether the contribution of parental adiposities to the walkers' body mass indexes and waist circumferences diminished with walking.

Results

In the most sedentary group (walking < 1.5 km/d), average parental adiposity was a significant determinant of the walkers' body mass indexes and waist circumferences (female: P < 10⁻¹⁵; male: P < 10⁻¹³). Greater walking distance significantly diminished the effect of average parents' adiposity on the walkers' body mass indexes (female: P < 10⁻¹⁰; male P = 0.003) and waist circumferences (female: P < 10⁻⁶; male P = 0.01). Compared to the most sedentary female walkers, the effect of parental adiposity was reduced 36% for body mass indexes and 41% for waist circumferences (corresponding reductions in men were 36% and 46%, respectively).

Conclusion

These results suggest that moderate intensity physical activity attenuates inheritance of both total and regional adiposity in a dose-dependent manner.     

Dietary intake in a randomized-controlled pilot of NOURISH: A parent intervention for overweight children

Objective

NOURISH is a community-based treatment program for parents of overweight and obese children (ages 6-11, BMI ≥ 85th percentile). This study examined the impact of Nourishing Our Understanding of Role modeling to Improve Support and Health on child and parent dietary intake, secondary trial outcomes.

Methods

In Virginia from 2008 to 2009, this randomized controlled pilot was implemented and dietary assessment of parents and children conducted at baseline, post-test, and 6-month follow-up. Parents (85% female, 62% African American, mean BMI = 34.1 ± 9.1) were randomized into intervention (n = 46) or control (n = 50) groups. Children's (mean age = 8.6 ± 1.5) mean Body Mass Index percentile was 98.1 ± 2.6. Parents completed 24-hour dietary records for themselves and their child(ren). Repeated measures analyses assessed treatment effects over time. T-tests evaluated within-group changes from baseline to post-test and to follow-up, using a modified intent-to-treat approach.

Results

Both groups reported significant dietary changes, with few treatment effects found. For parents in NOURISH, significant improvements were found in intakes of total kilocalories/day, grams/day of carbohydrates and sugar, and percent calories from protein (p < 0.05). Among control group children, significant improvements in total kilocalories/day and grams/day of carbohydrates and sugar were found (p < 0.05).

Conclusions

Among parents who self-select into a childhood obesity program, minimal intervention can elicit short-term dietary changes comparable to those of a structured intervention.     

The Alberta Physical Activity and Breast Cancer Prevention Trial: quality of life outcomes

Objective

Interventions for disease prevention should also be evaluated for quality of life (QoL) effects. Few exercise trials have examined QoL in the context of primary disease prevention. Here, we report the QoL outcomes from the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial.

Methods

The ALPHA trial was a randomized controlled trial in Calgary and Edmonton, Canada between May 2003 and July 2007 that compared an exercise intervention to a sedentary lifestyle among 320 sedentary, postmenopausal women. The exercise group was asked to perform moderate-to-vigorous intensity aerobic exercise 45 min/day, 5 days/week for 1 year. QoL was assessed by the short form-36 health survey.

Results

Compared to the control group, the exercise group maintained significantly better physical functioning (p < 0.001), general health (p < 0.001), vitality (p = 0.002), and bodily pain (p = 0.020) by 4-5 points which exceeds the 3.0 minimally important difference for these scales. Changes in body composition partially mediated the intervention effects. Antidepressant use and the presence of comorbidities moderated some intervention effects.

Conclusions

A 1-year moderate-to-vigorous aerobic exercise program prevents declines in the physical aspects of QoL in postmenopausal women. Exercise may have a potentially important advantage for breast cancer prevention compared to other lifestyle or biomedical interventions.     

Sub-optimal prevalence of mumps antibodies in a population based study of young adults in Israel after 20 years of two dose universal vaccination policy

Background

A recent mumps outbreak in Israel despite an ongoing national program of a 2-dose universal childhood vaccination policy since 1988, raised questions regarding population immunity among young adults.

Objective

To assess the seroprevalence of mumps antibodies among young Israeli adults born after 1987 in order to determine evidence based vaccination policy.

Methods

We conducted a seroprevalence study of mumps IgG antibodies among 441 Israeli adults born in 1988-9, based on a representative sample of sera collected upon recruitment to mandatory military service in 2007.

Results

The overall seroprevalence of IgG antibody to mumps virus among 1988-9 born was 83.7%, 82.1% among males and 85.7% among females. Seroprevalence among 2007 recruits was similar to 1999 recruits (83.3%, P = 0.89) and significantly lower than 1987 recruits (94.1%, P < 0.0001). The absolute decrease between 2007 and 1987 for males was 13.1% (P < 0.0001) and for females 7.0% (P = 0.02). Seroprevalence was not significantly higher among native Israelis (84.9%) than among young adults born in the Commonwealth of Independent States (81.1%, P = 0.46) and significantly higher compared to young adults born in Western Europe or North America (68.2%, P = 0.045).

Conclusions

Our findings indicate sub-optimal population seroprevalence despite a 2-dose universal childhood vaccination policy. This study allows better understanding of current mumps outbreaks in Israel and elsewhere following periods of low circulation of wild virus. These findings support mumps vaccination, even for populations and individuals that received two doses during childhood, as means for outbreak containment among young adults, especially in crowded settings, and serve as a reminder to the need for dynamic vaccination policy, supported by health promotion activities.     

The SQUASH was a more valid tool than the OBiN for categorizing adults according to the Dutch physical activity and the combined guideline

Objective

To examine whether the “Short QUestionnaire to ASsess Health-enhancing physical activity” (SQUASH) and the “Injuries and Physical Activity in the Netherlands” questionnaire (“Ongevallen en Bewegen in Nederland,” OBiN) were valid in assessing adherence to physical activity (PA) guidelines.

Study Design and Setting

Participants (N = 187) aged 20-69 years were categorized as “inactive,” “semiactive,” or “norm-active” according to the Dutch PA, the American College of Sports Medicine (ACSM), and the combined guideline (adhering to either or both of two other guidelines) by the questionnaires and a combined heart rate monitor and accelerometer (Actiheart). Percentage of exact agreement and maximum disagreement (difference of two categories) for the categorization between questionnaires and Actiheart was calculated.

Results

The SQUASH had a significant higher agreement than the OBiN for the Dutch PA (SQUASH: 78%, OBiN: 46%; P < 0.01) and combined guideline (SQUASH: 84%, OBiN: 55%; P < 0.01). Both questionnaires had a low agreement regarding the ACSM guideline (SQUASH: 37%, OBiN: 34%; P = 0.45). The SQUASH had a significant higher maximum disagreement than the OBiN for this guideline (SQUASH: 19.8%, OBiN 8%; P < 0.01).

Conclusion

The SQUASH was a more valid measure than the OBiN for categorizing adults according to the Dutch PA and the combined guideline. Both questionnaires failed to correctly categorize adults according to the ACSM guideline.     

Participation and cardiovascular risk reduction in a voluntary worksite nutrition and physical activity program

Objective

In a cohort of employees participating in a worksite nutrition and physical activity program, we compared program completion and changes in cardiovascular risk factors by baseline body mass index.

Methods

In 2007, 774 employees enrolled in a 10 week program at a hospital in Boston, Massachusetts. Program completion and change in weight, cholesterol, and blood pressure were compared between obese (body mass index ≥ 30), overweight (body mass index = 25-29.9), and normal weight (body mass index < 25) participants.

Results

At baseline, 63% were obese or overweight and had higher blood pressure and cholesterol compared to normal weight participants. Program completion was 82% and did not differ by body mass index. Mean weight loss was 1.9 kg at end of program (p < 0.001) and 0.4 kg at 1 year (p = 0.002). At end of program, participants with body mass index ≥ 30 lost 3.0% body weight vs. 2.7% for body mass index = 25-29.9 and 1.7% for body mass index < 25 (p < 0.001), but weight loss at 1 year did not differ by body mass index. Mean cholesterol and blood pressure were lower at end of program and 1 year (all, p < 0.005) but did not differ by body mass index.

Conclusions

Worksite programs can successfully initiate cardiovascular risk reduction among employees, but more intensive interventions are needed to make significant improvements in the health of higher risk obese employees.     

Pharmacist-led Tdap vaccination of close contacts of neonates in a women's hospital

Background

Pertussis can cause severe illness and death in infants. Immunization of family members with the tetanus toxoid, reduced diphtheria toxoids, and acellular pertussis (Tdap) vaccine can decrease risk of pertussis infection among infants. A community pharmacy on a women's hospital campus implemented a Tdap vaccination pilot program.

Objective

To investigate the rate of Tdap vaccination among close contacts of neonates in a women's hospital pharmacy and to assess the impact of a coordinated pharmacy and hospital Tdap vaccination program.

Methods

The intervention entailed education from hospital staff who explained the risks of pertussis, advocated the benefits of vaccination, and encouraged family members to be vaccinated. In the on-site clinic or in the pharmacy, pharmacists administered vaccine to eligible patients. Rates of Tdap vaccinations in the intervention pharmacy with in-hospital vaccination were compared to comparison pharmacies without Tdap interventions.

Results

In the pre-study period (December 2008–November 2010), there were 31 Tdap vaccinations administered at the intervention pharmacy (mean = 1.3/month); during the study period (December 2010–November 2012), 2045 Tdap vaccinations were administered (mean = 85.2/month). In four comparison hospital-campus pharmacies, there were 77 vaccinations (mean = 0.8/month) during the pre-study period and 817 vaccinations (mean = 8.5/month) during the study period. There were 155 vaccinations administered in 44 area-community pharmacies (mean = 0.1/month) during the pre-study period and 2930 (mean = 2.8/month) during the study period. The intervention pharmacy had the highest average monthly rate of change in Tdap volume from pre-study to study period (83.9), compared to comparison hospital-campus pharmacies (7.7, p < .001) and area-community pharmacies (2.7, p < .001). During the study period, the estimated Tdap vaccination coverage per live births was 8.1% in the intervention pharmacy versus 5.5% in the comparison hospital-campus pharmacies (p < .001).

Conclusions

Tdap vaccination rates increased after implementation of the intervention program. This project illustrates how health systems and community pharmacists can collaborate to improve patient care.     

Electronic reminders did not improve postal questionnaire response rates or response times: a randomized controlled trial

Objective

We aim to evaluate the effectiveness of electronic reminders (ERs) to improve the response rates and time to response of postal questionnaires in a health research setting.

Study Design and Setting

This pragmatic randomized controlled trial (RCT) was nested within a multicenter RCT of yoga for lower back pain. Participants who provided an electronic mail address and/or mobile phone number were randomized to receive an ER or no reminder (controls) on the day they were due to receive a follow-up questionnaire.

Results

One hundred twenty-five participants (32 males and 93 females) mean age 46 (standard deviation: 11, range: 20-65) were randomized to ER (n = 62) or controls (n = 63). Overall 85.6% of participants returned postal questionnaires (87.1% ER group and 84.1% from controls). No significant differences were found between the two groups for response rate (difference between groups = 3.0%, 95% confidence interval [CI] = −10, 16; P = 0.64) or time to response after adjusting for age, gender, and treatment allocation (χ² _[3df] = 7.10; P = 0.07).

Conclusion

In the present RCT, we found little evidence for the effectiveness of ERs to increase response rates or time to respond for the return of questionnaires in this study population group.     

Evaluating the Ozioma cancer news service: a community randomized trial in 24 U.S. cities

Objective

This community randomized trial evaluated effects of the Ozioma News Service on the amount and quality of cancer coverage in Black weekly newspapers in 24 U.S. cities.

Method

We created and operated Ozioma, the first cancer information news service specifically for Black newspapers. Over 21 months, Ozioma developed community- and race-specific cancer news releases for each of 12 Black weekly newspapers in intervention communities. Cancer coverage in these papers was tracked before and during the intervention and compared to 12 Black newspapers in control communities.

Results

From 2004 to 2007, we coded 9257 health and cancer stories from 3178 newspaper issues. Intervention newspapers published approximately 4 times the expected number of cancer stories compared to control newspapers (p_12,21mo < .01), and also saw an increase in graphics (p_12,21mo < .01), local relevance (p_12mo = .01), and personal mobilization (p_12mo < .10). However, this increased coverage supplanted other health topics and had smaller graphics (NS), had less community mobilization (p_21mo = .01), and is less likely to be from a local source (NS).

Conclusion

Providing news releases with localized and race-specific features to minority-serving media outlets can increase the quantity of cancer coverage. Results are mixed for the journalistic and public health quality of this increased cancer coverage in Black newspapers.     

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls

Objective

Anorexia nervosa (‘AN’) is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program (‘PriMa’) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls.

Method

Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.

Results

After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d = .24) and body self esteem (d = .29), but not for eating behavior.

Conclusion

The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.     

Effect of a contraceptive pill containing estradiol valerate and dienogest (E2V/DNG) in women with menstrually-related migraine (MRM)

Background

Combined hormonal contraception might worsen migraine in sensitive women, especially during the free-hormone interval, and raise concerns about the vascular risk. The characteristics of a contraceptive pill containing estradiol valerate/dienogest (E2V/DNG) might be of potential benefit in women with menstrually related migraine (MRM) who choose to use oral contraception for birth control.

Study design

This was a prospective diary-based pilot study. Thirty-two women (age > 35 years) [n= 18 who had never used combined oral contraceptives (COCs) and n= 14 who had previously used COCs] diagnosed with MRMs according to the International Headache Society criteria were included. During the observational period, women filled in a diary with the clinical characteristics of migraine attacks. After a three-cycle run-in period, each subject received a COC containing E2V/DNG (Qlaira®/Natazia®; Bayer HealthCare, Berlin, Germany) administered using an estrogen step-down and progestogen step-up approach. Follow-up evaluations were scheduled at the last cycle of run-in and at the third and sixth cycles of treatment.

Results

The number of migraine attacks was significantly reduced at the third (p<.001) and sixth cycles (p<.001) in comparison with the run-in period. A similar result was evident for the duration (p<.001 at the third and p<.001 at the sixth cycle) as well as for the severity of head pain (p<.001 at the third and p<.001 at the sixth month). Indeed, a significantly lower number of analgesics were used at the third cycle (p<.001) in comparison with baseline, and a further decrease was evident at the sixth cycle (p<.001) in comparison with the third cycle of E2V/DNG use. Interestingly, duration and severity of head pain were significantly correlated with the number of days of dysmenorrhea at the third cycle (r= .89, p=.000 and r= .67, p=.02; respectively) and at the sixth cycle (r= .76, p=.000 and r= .62, p=.04; respectively) in women without complete remission of menstrual cramps during the study period.

Conclusions

The present diary-based pilot study indicates that the use of a pill containing EV2/DNG for six cycles has a positive effect in women with MRM and suggests an association between dysmenorrhea with COCs use as a potential feature of refractory head pain.     

Dyslipidemic high-fat diet affects adversely bone metabolism in mice associated with impaired antioxidant capacity

Objective

The present study examined impacts of dyslipidemic high-fat diet on the bone antioxidant system and bone metabolism in growing mice. Furthermore, the relationship was studied between them.

Methods

Male C57BL/6 mice (4 wk old) were fed with normal diet, high-fat diet (HFD), or HFD supplemented with 0.1% antioxidant lipoic acid (LA). After 13-wk feeding, the markers of plasma lipids status, bone metabolism in plasma and in urine, and femora oxidative stress were measured. To provide molecular evidence for abnormal bone metabolism affected by HFD, bone cell-specific mRNA levels were tested by real-time quantitative polymerase chain reaction. Moreover, insulin-like growth factor I and tumor necrosis factor-alpha in plasma and their mRNA levels in femur were measured.

Results

The feeding dyslipidemic HFD induced both inhibitory bone formation reactions and enhancement of bone resorption reactions, accompanied by impaired bone antioxidant system, low levels of insulin-like growth factor I in plasma and in bone, and high levels of tumor necrosis factor-alpha in plasma but not in bone. In contrast, these alternatives were prevented completely or partially in mice fed LA supplement. Further, plasma propeptide of ? collagen C-propeptide as a marker of bone formation was positively correlated with both total antioxidant capacity (r = 0.683, P < 0.001) and reduced glutathione/oxidized glutathione ratio (r = 0.565, P < 0.003) of bone. Cross-linked N-telopeptides of bone type ? collagen as a marker of bone resorption was negatively correlated with both total antioxidant capacity (r = −0.753, P < 0.001) and glutathione/oxidized glutathione ratio (r = −0.786, P < 0.001).

Conclusion

Dyslipidemia induces impaired bone antioxidant system. Oxidative stress could be an important mediator of hyperlipidemia-induced bone loss.     

A randomized controlled trial of continuous activity, short bouts, and a 10,000 step guideline in inactive adults

Objective

Although several studies have examined the effect of accumulated bouts on health outcomes, the impact of recommending short bouts on activity-related behavior in health promotion efforts has received minimal investigation.

Method

During this 5-week study in 2007-2008, 43 university employees (8 male, 35 female) in the Southeastern United States were randomly assigned to a group recommended to achieve (a) 10,000 steps (10 K), (b) 30-minutes (30 min) of continuous physical activity, or (c) 30-minutes of activity in bouts of at least 10 minutes (bouts).

Results and conclusions

Repeated measures ANOVA revealed that the 10 K group showed the largest increase in step counts whereas the bouts group showed the smallest change over the intervention period, p = 0.01. Condition differences were most pronounced on days in which participants met their activity recommendation. Accelerometer results revealed that the 10 K (d = 1.1) and 30 min groups (d = 0.89) showed large increases in minutes of moderate to vigorous activity (MVPA), whereas the bouts group showed minimal change (d = 0.11). Although activity recommendations did not differentially affect self-efficacy, participants from all conditions showed decreased self-efficacy across the intervention (p = 0.02), highlighting the need to develop strategies to increase self-efficacy in activity promotion efforts.     

Étude comparative des primo-infections à Epstein-Barr virus et à cytomégalovirus chez 52 patients immunocompétents

Objective

The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005.

Patients and methods

Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi² test or Fischer's exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test.

Results

There were no significant changes over the years in the numbers of EBV (n = 32) and CMV (n = 20) primary infections. The patient's mean age was 22.7 years (14-48 years) in EBV primary infections and 38.6 years (13-66 years) in CMV primary infections (P < 0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P < 0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P < 0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P < 0.001). Thrombopenia was less frequently associated with EBV primary infection (P < 0.001).

Conclusion

Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care.     

Microbiology of facial cellulitis related to dental infection

Objective

The study objective was to identify bacteria responsible for facial cellulitis of dental origin.

Design

Adult patients, admitted for facial cellulitis of dental origin were included. The pus sample was taken by swabbing during the surgical incision and drainage performed under general anesthesia. The bacteriological diagnosis was performed by microscopic examination and bacterial culture in aerobic and anaerobic atmosphere.

Results

Two hundred and seven bacterial species were isolated from 100 samplings, that is to say 2.07 bacterial species per sample. 19% of the samples contained only aerobic germs, 36% only anaerobic ones, and 45% contained mixed aerobic and anaerobic flora. Streptococcus (65.38%) and Capnocytophaga (11.54%) were the most frequently isolated aerobic bacteria. The anaerobic bacteria accounted for 62.32% of isolates and the most frequently isolated were Prevotella (55%) and Fusobacterium (16.28%). Bacterial species were not significantly different according to the age (P-value = 0.06) and sex (P-value = 0.584). There was a significant statistical association between aerobic or anaerobic bacteria and clinical symptoms such as cheek edema (P-value = 0.03) and pus at tooth root (P-value = 0.02). Patients previously treated by antibiotic therapy presented significantly more infections due to the same respiratory germ type (P-value = 0.009).

Conclusions

Even though the bacterial flora responsible for facial cellulitis of dental origin is polymorphic, anaerobic bacteria were predominant.     

Immune evaluation and vaccine responses in Down syndrome: evidence of immunodeficiency?

Background

Patients with Down syndrome (DS) appear to be at a greater risk for serious infections, but it is unclear whether this is due to anatomic variations or intrinsic immune defects.

Objective

We assessed a cohort of pediatric subjects with DS to determine if immunological abnormalities indeed account for the excess infections.

Methods

We performed quantitative assessment of T-independent (type 2 - pneumococcal polysaccharide vaccine) and T-dependent Ab responses (with inactivated seasonal influenza vaccine) along with numerical quantitation of lymphocyte subpopulations and thymic output in a random population sample of children with DS (cases) along with family-matched sibling or community controls.

Results

Median serum IgG levels were significantly higher in cases (1090 mg/dL) as compared with controls (808 mg/dL, P = 0.02). Cases had significantly lower median CD4 T cell counts than the controls (636 cells/μL, P = 0.01). Cases had reduced CD19 B cell counts and CD19% than the controls (P = 0.009 and 0.006 respectively). Cases also showed decreased total memory (CD19+CD27+, P = 0.002) and class-switched memory (CD19+CD27+IgM−IgD−, P = 0.004) B cells.The median CD4 recent thymic emigrant (RTE) in females and males cases was lower than controls (P = 0.007 and 0.07 respectively). Cases had a lower median T cell receptor excision circle (TREC) count of 2556 as compared to the controls count of 5216, P < 0.006 although both the cases and controls were within the established reference range. There were no differences in the percentage of cases and controls who responded to inactivated influenza vaccine, but the response to polysaccharide pneumococcal vaccine was suboptimal in cases.

Conclusions

Our study suggests that there are subtle abnormalities in both humoral and cellular arms of the immune response in children with DS as compared to the control subjects.     

Level of evidence and conflict of interest disclosure associated with higher citation rates in orthopedics

Objective

To identify the scientific and nonscientific factors associated with rates of citation in the orthopedic literature.

Study Design and Setting

All original clinical articles published in three general orthopedics journals between July 2002 and December 2003 were reviewed. Information was collected on variables plausibly related to rates of citation, including scientific and nonscientific factors. The number of citations at 5 years was ascertained and linear regression was used to identify factors associated with rates of citation.

Results

In the multivariate analysis, factors associated with increased rates of citation at 5 years were high level of evidence (22.2 citations for level I or II vs. 10.8 citations for level III or IV; P = 0.0001), large sample size (18.8 citations for sample size of 100 or more vs. 7.9 citations for sample size of 25 or fewer; P < 0.0001), multiple institutions (15.2 citations for two or more centers vs. 11.1 citations for single center; P = 0.023), self-reported conflict of interest disclosure involving a nonprofit organization (17.4 citations for nonprofit disclosure vs. 10.6 citations for no disclosure; P = 0.027), and self-reported conflict of interest disclosure involving a for-profit company (26.1 citations for for-profit disclosure vs. 10.6 citations for no disclosure; P = 0.011).

Conclusion

High level of evidence, large sample size, representation from multiple institutions, and conflict of interest disclosure are associated with higher rates of citation in orthopedics.