Weight-reducing diets: Are there any differences?

This paper compares the efficacy of two widely used weight-loss diets differing in macronutrient composition – a low-carbohydrate diet versus a low-fat diet. Although a calorie is a calorie under the controlled conditions of a metabolic unit (i.e., only the level of calorie intake matters and not the source of calories), we conclude that these interrelationships are far more complex in the free-living situation. The different diet-related factors that condition energy balance, including total energy intake, satiety and hunger sensory triggers, and palatability, must be considered when assessing the efficacy of weight-reducing diets of different macronutrient composition.     

Evaluation of interns by senior residents and faculty: is there any difference?

INTRODUCTION: Both senior residents and faculty members evaluate family practice interns (PGY-1) on the inpatient family medicine service at the University of Missouri-Columbia. The purpose of this study was to investigate the content and nature of narrative comments on a clinical evaluation sheet. METHODS: Objective 1. The authors placed the subjective comments made by faculty and senior residents in their evaluations of PGY-1 residents into 12 distinctive categories. Objective 2. Comments were coded with a positive or negative valence. Objective 3. The genders of the evaluator and learner were recorded. RESULTS: All evaluations made between 1996 and 1999 were analysed. A total of 1341 individual comments were reviewed. Objective 1. Categories used most often were generic comments (20.2%), personal attributes (18%), and clinical competence (14.1%). There was no difference in category use based on the experience level of the evaluator (P = 0.17). Objective 2. The majority of the comments (81.9%) were positive in nature. Senior faculty members were significantly less likely to make negative comments than were junior faculty members or senior residents (P = 0.004). Objective 3. There were no differences in category use based on the gender of the evaluator (P = 0.13). CONCLUSIONS: Objective 1. Narrative evaluation comments may be placed into 12 distinctive categories. Most comments are generic and do not help to inform learning. Objective 2. A total of 82% of comments were positive. Residents were more likely to make negative comments than senior faculty members. Objective 3. There was no demonstrable gender bias in writing negative comments.     

Childhood allergies in Reunion Island: is there any difference with metropolitan France?

BACKGROUND: The present study had three aims: to estimate for the first time with standardized methodology allowing international comparisons the prevalence and the severity of childhood allergies in Reunion Island, to determine their risk factors and to make a comparison with metropolitan France. METHODS: The same standardized protocol (ISAAC) was used in population-based samples of adolescents recruited in metropolitan France between 1993 and 1994 (n=18555) and in Reunion Island in 2000 (n=2 362). RESULTS: Compared to metropolitans, the adolescents living in Reunion Island suffered significantly more from asthma in the past Year and in life (22 vs 13% and 19 vs 13% respectively). The trend was less clear for allergic rhinitis and eczema since in the case of these manifestations the adolescents reported more symptoms (27 vs 16% et 14 vs 10%, respectively) whereas the metropolitans reported more lifetime diagnostic labels (14 vs 17% et 18 vs 23%, respectively). In Reunion Island, allergies were slightly more severe (1.1 vs 0.8% for severe asthma and 15 vs 2% for eczema). Furthermore, 68% of asthmatics who had severe asthma attacks in the past Year and more than a third of adolescents with severe asthma did not take any asthma medication, which is different from the metropolitan situation. Risk factors for allergies were the same in Reunion Island and in metropolitan France, except the ownership of a pet in the first Year of life, which was not protective against the development of allergies as recently shown in some western countries but was a risk factor. CONCLUSIONS: Asthma and allied diseases are less frequent in metropolitan France than in Reunion Island where management appears to be insufficient. Improvement in prevention and management plans are required in Reunion Island.     

The efficient use of pharmaceuticals: does Europe have any lessons for a Medicare drug benefit?

Managing drug use in a way that maximizes the value obtained from total health care spending faces obstacles; hence, payers and policymakers tend to look at pharmaceutical expenditures in isolation from the rest of health care spending. Currently there are both regulatory and putative market-based approaches to containing pharmaceutical spending worldwide. But evidence suggests that regulatory efforts in Europe and elsewhere have not proved effective in containing costs or improving efficiency or access, and supposedly market-based solutions now in vogue, such as reference pricing, pose their own set of challenges and may in practice violate market principles. In the end, silo-based budgeting is short-sighted; the emphasis in Europe and in the United States should be on measures that achieve efficient health care rather than the containment of drug spending.     

The tricarboxylic acid cycle in human skeletal muscle: is there a role for nutritional intervention?

The tricarboxylic acid (TCA) cycle is essential for oxidative energy production. The expansion (anaplerosis) of the intermediates of the TCA cycle is achieved via a number of pathways, and is known to be influenced by metabolic status and nutritional and pharmacological interventions. Contraction is associated with anaplerosis in skeletal muscle, and some authors have suggested that the rate of anaplerosis can limit oxidative energy delivery. The results of more recent studies, however, are consistent with the idea that expansion of the muscle TCA intermediate pool is principally a reflection of muscle pyruvate availability, and is of little functional importance to TCA cycle flux, thereby indicating that any intervention aimed at increasing TCA intermediates expansion will be of little practical value.     

Monoamine oxidase-B activity in alcohol withdrawal of smokers: is there any relationship with aggressiveness?

There is a considerable inconsistency in terms of the association between alcoholism and alterations in monoamine oxidase (MAO) activity. The main objectives of this study were to investigate the changes in platelet MAO-B activity throughout the alcohol withdrawal period and whether or not MAO-B activity differed between patients with high- and low-aggression tendency. We assayed platelet MAO-B levels spectrophotometrically in 22 male inpatients with alcohol dependence in their first and fourth weeks of withdrawal and in 20 healthy controls. Patients were divided into two high- and low-aggression subgroups according to scores obtained in a Brown-Goodwin Assessment for Life History of Aggression. Our data revealed that the significantly lower platelet MAO-B activity observed during the first week of alcohol withdrawal in patients, compared to controls, did not continue in the fourth week, and that there was no relationship between aggressiveness and MAO activity. These results suggest that low platelet MAO activity may be a state marker of alcohol withdrawal period or a result of high alcohol consumption rather than a trait marker of alcoholism.     

HDL cholesterol and bone mineral density in normal-weight postmenopausal women: is there any possible association?

AIM: Epidemiological investigation of the association between lipid profile, atherosclerosis and bone mass has produced conflicting RESULTS: The present paper reports the assessment of the lipid profile, bone mineral density (BMD) and turnover in a cohort of Italian women. METHODS: In this cross sectional study we enrolled 173 women in menopause (101 osteoporotic and 72 normal). In each subject the authors evaluated BMD, bone turnover, lipid profile (total cholesterol, high density lipoprotein [HDL], low density lipoprotein [LDL] and triglycerides), and risk factors for osteoporosis, cardiovascular diseases and eating habits using a questionnaire. RESULTS: HDL was significantly higher in osteoporotic patients than in controls and the risk of osteoporosis was significantly higher in women with higher level of HDL. The authors suggest that the level of HDL could be used as screening for postmenopausal osteoporosis: the cut-off points recommended are HDL >61 mg/dL to detect women with a high risk (sensitivity 74%) and <45 mg/dL to detect those with a low risk (specificity 83%). CONCLUSION: This study provides evidences of the relation between HDL, but not total cholesterol or LDL levels with BMD in a cohort of normal-weight women and equally distributed cardiovascular risks. It also suggests that a proatherogenic lipid profile is associated with higher bone mineral density, and that HDL can be used in deciding whether a patient's BMD should be measured.     

Dichotomising dementia: is there another way?

This article discusses the reduction of the complex experience of dementia to a dichotomised ‘tragedy’ or ‘living well’ discourse in contemporary Western society. We explore both discourses, placing them in the context of a successful ageing paradigm, highlighting the complex nature of dementia and the risks associated with the emergence of these arguably competing discourses. Specifically, we explore this dichotomy in the context of societal understandings and responses to dementia. We argue for an acceptance of the fluid nature of the dementia experience, and the importance of an understanding that recognises the multiple realities of dementia necessary for social inclusion to occur. Such an acceptance requires that, rather than defend one position over another, the current discourse on dementia is challenged and problematised so that a more nuanced understanding of dementia may emerge; one that fully accepts the paradoxical nature of this complex condition.     

Neurodevelopment and neurodegeneration: are there critical stages for nutritional intervention?

Rather than being an inevitable consequence of age, cognitive decline can occur with marked variation among individuals. In this context, nutrition is one factor that is believed to be influential. When considering the potential role of diet, two factors need to be considered. First, cognitive or brain reserve is said to decrease the incidence of dementia; that is, it has been suggested that those with larger brains and better intellectual functioning have a greater capacity to resist the effects of the biological changes that define dementia. As such, the adequacy of nutrition before birth and in the early formative years may have long-term consequences. Second, shrinkage of the brain begins in young adulthood, suggesting that any insidious influence of diet will take place from that time onward over a period of many decades. The marked decline in the weight of the brain associated with advanced dementia suggests it will be easier to slow that decline than to repair the brain. If this model is accurate, diet is influential throughout the entire lifespan, and this has substantial methodological implications for the study of the topic.