Effects of 12-week supplementation of <Emphasis Type="Italic">Citrus bergamia</Emphasis> extracts-based formulation CitriCholess on cholesterol and body weight in older adults with dyslipidemia: a randomized,double-blind,placebo-controlled trial

Backgrounds

Recent experiments suggest that Citrus bergamia extracts could benefit people with dyslipidemia and obesity but this needs to be further validated.

Methods

A total of 98 people age-matched older adults (65 years) with elevated blood lipids were enrolled to receive 12-week supplementation of a Citrus bergamia extracts-based formulation (CitriCholess)(n?=?48) and placebo (n?=?50).

Results

No group differences were found in baseline bodyweight, body mass index (BMI), blood cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and glucose levels. CitriCholess supplementation resulted in lower levels than placebo in TG (1.83?±?0.92 vs. 1.95?±?1.34 mmol/L, P?=?0.612), TC (5.14?±?0.98 vs. 5.44?±?0.77 mmol/L, P?=?0.097), and LDL-C (3.13?±?0.74 vs. 3.43?±?0.62 mmol/L, P?=?0.032). Compared to placebo, CitriCholess also resulted in greater reductions in body weight (?0.604?±?0.939 vs. 0.06?±?0.74 kg, P?<?0.01), waist circumferences (?0.60?±?1.349 cm vs. -0.16?±?1.503 cm, P?<?0.01) and BMI (?0.207?±?0.357 vs. 0.025?±?0.274, P?<?0.01). Additionally, females had a significantly higher level of HDL-C than males. TC was significantly correlated with LDL-C, and to a less degree, with TG. TG was inversely correlated with HDL-C. Body weight and waist circumference were negatively correlated with HDL-C and positively correlated with glucose.

Conclusion

12-week supplementation of CitriCholess could benefit lipid metabolism and weight management in old adults with dyslipidemia.

     

Decreased lipogenesis-promoting factors in adipose tissue in postmenopausal women with overweight on a Paleolithic-type diet

Purpose

We studied effects of diet-induced postmenopausal weight loss on gene expression and activity of proteins involved in lipogenesis and lipolysis in adipose tissue.

Methods

Fifty-eight postmenopausal women with overweight (BMI 32.5?±?5.5) were randomized to eat an ad libitum Paleolithic-type diet (PD) aiming for a high intake of protein and unsaturated fatty acids or a prudent control diet (CD) for 24 months. Anthropometry, plasma adipokines, gene expression of proteins involved in fat metabolism in subcutaneous adipose tissue (SAT) and lipoprotein lipase (LPL) activity and mass in SAT were measured at baseline and after 6 months. LPL mass and activity were also measured after 24 months.

Results

The PD led to improved insulin sensitivity (P?<?0.01) and decreased circulating triglycerides (P?<?0.001), lipogenesis-related factors, including LPL mRNA (P?<?0.05), mass (P?<?0.01), and activity (P?<?0.001); as well as gene expressions of CD36 (P?<?0.05), fatty acid synthase, FAS (P?<?0.001) and diglyceride acyltransferase 2, DGAT2 (P?<?0.001). The LPL activity (P?<?0.05) and gene expression of DGAT2 (P?<?0.05) and FAS (P?<?0.05) were significantly lowered in the PD group versus the CD group at 6 months and the LPL activity (P?<?0.05) remained significantly lowered in the PD group compared to the CD group at 24 months.

Conclusions

Compared to the CD, the PD led to a more pronounced reduction of lipogenesis-promoting factors in SAT among postmenopausal women with overweight. This could have mediated the favorable metabolic effects of the PD on triglyceride levels and insulin sensitivity.

     

Changes of the perceived quality of care for older patients with hypertension by community health centers in shanghai

Background

Monitoring and evaluating changes of quality of primary care for older adult hypertensive patients is part of effective delivery of primary care. This study aimed to investigate changes of older adult hypertensive patients’ perceived quality of primary care over time in Shanghai.

Methods

Two rounds of cross-sectional questionnaire surveys were conducted in Shanghai in November 2011 and June 2013. A total of 437 patients participated in the first Round survey and 443 in the second. Primary care attributes were collected from Community Health Center users through on-site face-to-face interview surveys using the validated Primary Care Assessment Tool. Multiple linear regressions were used to determine whether there was any difference in primary quality of care scores between 2011 and 2013 surveys.

Results

Compared with those in the first Round, participants in the second Round reported higher scores in total primary care quality (28.73 vs. 27.75, P?<?0.001), as well as primary care attributes including first-contact utilization (2.81 vs. 2.60, P?<?0.001) and accessibility (2.48 vs. 2.44, P?<?0.05), continuity of care (3.38 vs. 3.27, P?<?0.001), coordination of information (3.82 vs. 3.67, P?<?0.001), comprehensiveness of service availability (3.51 vs. 3.39, P?<?0.001) and provision (2.69 vs. 2.43, P?<?0.001), and cultural competence (2.67 vs. 2.49, P?<?0.05), but a lower score in coordination of services (2.45 vs. 2.55, P?<?0.05).

Conclusion

Older adult hypertensive patients perceived better primary care quality from 2011 to 2013 in Shanghai. This may be associated with the general practitioner team service in Shanghai where hypertensive patients were targeted.

     

Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study

Purpose

To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D).

Methods

This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n?=?279). Participants underwent one of two conditions: LTMEX (n?=?241) trained three times per week; and unchanged lifestyle—the control group (CO; n?=?38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO₂ peak).

Results

LTMEX improves HRQoL, specifically physical functioning (P?<?0.001), general health (P?<?0.05), vitality (P?<?0.001), mental health (MH; P?<?0.05), physical component score (P?<?0.001), mental component score (P?<?0.001), and total SF-36 (P?<?0.001). LTMEX group also decreased body weight (BW; P?<?0.005), waist circumference (WC; P?<?0.001), waist-to-hip ratio (WHR; P?<?0.001), and systolic blood pressure (SBP; P?<?0.001), and increased VO₂ peak (P?<?0.001). CO group increased WC (P?=?0.012), BMI (P?=?0.024), waist-to-hip ratio (WHR; P?=?0.003) and SBP (P?<?0.001), and decreased vitality (P?<?0.001) and MH (P?<?0.05).

Conclusions

A LTMEX intervention improves physical and mental HRQoL in older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

     

Maximal tachycardia and high cardiac strain during night shifts of emergency physicians

Purpose

To compare tachycardia and cardiac strain between 24-hour shifts (24hS) and 14-hour night shifts (14hS) in emergency physicians (EPs), and to investigate key factors influencing tachycardia and cardiac strain.

Methods

We monitored heart rate (HR) with Holter-ECG in a shift-randomized trial comparing a 24hS, a 14hS, and a control day, within a potential for 19 EPs. We also measured 24-h HR the third day (D3) after both shifts. We measured perceived stress by visual analog scale and the number of life-and-death emergencies.

Results

The 17 EPs completing the whole protocol reached maximal HR (180.9?±?6.9 bpm) during both shifts. Minutes of tachycardia?>100 bpm were higher in 24hS (208.3?±?63.8) than in any other days (14hS: 142.3?±?36.9; D3/14hS: 64.8?±?31.4; D3/24hS: 57.6?±?19.1; control day: 39.2?±?11.6 min, p?<?.05). Shifts induced a cardiac strain twice higher than in days not involving patients contact. Each life-and-death emergency enhanced 26 min of tachycardia?≥100 bpm (p?<?.001), 7 min?≥?110 bpm (p?<?.001), 2 min?≥?120 bpm (p?<?.001) and 19 min of cardiac strain?≥30% (p?=?.014). Stress was associated with greater duration of tachycardia?≥100, 110 and 120 bpm, and of cardiac strain?≥30% (p?<?.001).

Conclusion

We demonstrated several incidences of maximal HR during shifts combined with a high cardiac strain. Duration of tachycardia were the highest in 24hS and lasted several hours. Such values are comparable to those of workers exposed to high physical demanding tasks or heat. Therefore, we suggest that EPs limit their exposure to 24hS. We, furthermore, demonstrated benefits of HR monitoring for identifying stressful events. ClinicalTrials.gov identifier: NCT01874704.

     

Concentrations of nicotine,nitrosamines, and humectants in legal and illegal cigarettes in Mexico

Background

Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers.

Methods

Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests.

Results

Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05?±?1.89 mg/g vs 12.09?±?2.69 mg/g; p?<?0001), glycerol (12.98?±?8.03 vs 2.93?±?1.96 mg/g; p?<?0.001), and N-nitrosanatabine (NAT) (1087.5?±?127.0 vs 738.5?±?338 ng/g; p?=?0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations.

Conclusion

Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry.

     

Predictors of vitamin D supplementation amongst infants in Ireland throughout the first year of life

Aim

To investigate predictors of compliance with the recommendation that all infants in Ireland are supplemented daily from birth to 12 months of age with 5 μg of vitamin D.

Subjects and methods

A prospective observational study was conducted. Self-complete questionnaires recorded socio-demographic characteristics, health behaviours and supplementation practices for 158 mother-infant dyads at 4, 9 and 12 months post-partum. A 2-day food diary was also obtained on 12-month-old infants to examine the contribution of diet to vitamin D intakes.

Results

At 4, 9 and 12 months of age, 57.6% (n = 91), 34.2% (n = 54) and 23.4% (n = 37) of infants, respectively, were supplemented as recommended. In multivariate analyses, receiving supplementation advice from health professionals in the early post-partum period was the most significant predictor of correctly supplementing 4-month-old [p?<?0.01; odds ratio, OR: 61.94 (95% confidence interval, CI: 11.53–332.83)], 9-month-old [p?<?0.01, OR: 10.30 (95% CI: 2.29–46.27)] and 12-month-old [p?=?0.04, OR: 3.85 (95% CI: 1.05–14.08)] infants. Amongst 12 month olds, mean intakes from diet and supplementation combined (7.6?±?4.7 μg/day) were suboptimal.

Conclusion

Suboptimal vitamin D supplementation practices were evident throughout infancy. Dietary intakes of vitamin D did not compensate for suboptimal supplementation practices. Supplementation practices may improve if health professionals advocate safe supplementation during routine infant health checks.

     

Correlates of health-related quality of life in young-old and old–old community-dwelling older adults

Purpose

This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old–old).

Methods

This cross-sectional study included 802 older adults aged 60–79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires.

Results

A multiple regression analysis showed that BMI (β = ?0.15, p?=?0.001), body strength (β =?0.21, p?<?0.001), aerobic endurance (β =?0.29, p?<?0.001), physical activity (β =?0.11, p?=?0.007), depressive symptoms (β = ?0.19, p?<?0.001), falls (β = ?0.19, p?<?0.001), and living alone (β = ?0.16, p?<?0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old–old compared to young-old adults.

Conclusion

This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.

     

Association between habitual dietary and lifestyle behaviours and skin autofluorescence (SAF), a marker of tissue accumulation of advanced glycation endproducts (AGEs), in healthy adults

Purpose

Advanced glycation endproducts (AGEs) are produced endogenously and also enter the body during the consumption of AGEs present in heat-processed food. It is unknown whether AGEs of dietary origin accumulate within the body of healthy individuals. AGEs can deposit within skin tissue long-term by crosslinking extracellular matrix proteins. The fluorescent nature of many AGEs enables their detection within the skin by non-invasively measuring skin autofluorescence (SAF). This study aimed to identify habitual dietary and lifestyle behaviours cross-sectionally associated with SAF in an adult population sample.

Methods

251 Healthy adult volunteers completed validated food frequency and physical activity questionnaires. Waist circumference, BMI, blood pressure and blood glucose was also measured. SAF was measured using an AGE Reader.

Results

Significant positive correlations were found between SAF and chronological age (r = 0.63, P < 0.001), waist circumference (r = 0.28, P < 0.01), body weight (r = 0.24, P < 0.05), BMI (r = 0.23, P < 0.05) and consumption of meat and meat products (r = 0.22, P < 0.05). A negative correlation was found between SAF and cereal consumption (r = ?0.21, P < 0.05). Cigarette smokers also had a significantly higher SAF than non-smokers (2.4 vs 2.0 U, P < 0.05). Regression analysis identified age, cigarette smoking, waist circumference and intake of meat products as significant predictors of SAF. The regression model explained 48% of the variation in SAF.

Conclusions

Age, cigarette smoking, waist circumference and dietary consumption of meat/meat products were positively associated with SAF in this sample. Further research is required to determine whether frequent consumption of foods containing large quantities of dietary AGEs contribute to pathological disease processes in healthy individuals.

     

The effects of coenzyme Q10 administration on glucose homeostasis parameters,lipid profiles,biomarkers of inflammation and oxidative stress in patients with metabolic syndrome

Background

Limited data are available indicating the effects of coenzyme Q10 (CoQ10) supplementation on metabolic status of patients with metabolic syndrome (MetS).

Purpose

The present study was conducted to determine the effects of CoQ10 administration on glucose homeostasis parameters, lipid profiles, biomarkers of inflammation and oxidative stress among patients with MetS.

Methods

This randomized, double-blind, placebo-controlled trial was performed among 60 overweight or obese and type 2 diabetes mellitus patients with coronary heart disease aged 40–85 years old. Participants were randomly allocated into two groups. Group A (n = 30) received 100 mg CoQ10 supplements and group B (n = 30) received placebo for 8 weeks. Fasting blood samples were taken at the beginning of the study and after 8-week intervention to quantify glucose homeostasis parameters, lipid profiles and biomarkers of inflammation and oxidative stress.

Results

Compared with the placebo, CoQ10 supplementation resulted in a significant reduction in serum insulin levels (?2.1 ± 7.1 vs. +4.1 ± 7.8 µIU/mL, P = 0.002) and homeostasis model of assessment-insulin resistance (?0.7 ± 2.1 vs. +1.0 ± 2.0, P = 0.002) and homeostatic model assessment-beta cell function (?5.9 ± 22.2 vs. +15.9 ± 34.0, P = 0.005). In addition, patients who received CoQ10 supplements had a significant increase in plasma total antioxidant capacity (TAC) concentrations (+26.0 ± 105.0 vs. ?162.2 ± 361.8 mmol/L, P = 0.008) compared with the placebo group. However, after adjustment for the baseline levels, age and baseline BMI, the effect on TAC levels (P = 0.08) disappeared. Additionally, compared with the placebo group, a significant positive trends in plasma glutathione (P = 0.06) and a significant reduction in malondialdehyde (P = 0.08) were seen among patients who received CoQ10 supplement. We did not observe any significant changes in fasting plasma glucose, lipid concentrations and inflammatory markers.

Conclusions

Overall, daily intake of 100 mg CoQ10 supplements among patients with MetS for 8 weeks had beneficial effects on serum insulin levels, HOMA-IR, HOMA-B and plasma TAC concentrations.

Clinical trial registration number

www.irct.ir: IRCT201502245623N35.

     

Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus

Purpose

We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).

Methods

A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group’s five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.

Results

The mean EQ-5D-5L index scores were 0.971?±?0.082 among individuals with unilateral DR and 0.970?±?0.145 among those with bilateral DR, which were lower compared with those without DR (0.986?±?0.045, P?=?0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR]?=?0.16, P?=?0.02, comparing participants with unilateral vs. no DR; OR?=?0.11; P?=?0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P?>?0.05).

Conclusion

Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities.

     

Analysis of the diagnostic value of CD138 for chronic endometritis,the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study

Background

To investigate the role of CD138 immunohistochemistry in the diagnosis of chronic endometritis (CE) and the risk factors for assisted conception patients having CE complications.

Methods

Ninety-three patients, with normal uterine shape confirmed by examination and who were planning to undergo assisted conception treatments, were selected as research subjects. Endometrial tissue was isolated for routine hematoxylin and eosin (HE) and CD138 immunohistochemical staining. Additionally, the disease histories of patients were collected, and the reproductive prognosis was followed up.

Results

① CE detection rate: The rate of CD138 immunohistochemical staining was greater than that of HE staining (27.96 % vs. 26.89 %, P <0.05); ② Pregnancy rate: the pregnancy rate of CD138-positive patients (7.7 %) was lower than the pregnancy rate of CD138-negative patients (31.3 %) (p?=?0.017?<?0.05); ③ The results from univariate analysis showed that a previous history of prolonged menstrual bleeding episodes, an abortion history, and complications of fallopian tube obstruction were associated with CE (P <0.05). The results of logistic regression analysis confirmed that prolonged menstrual bleeding episodes (P?=?0.014, OR?=?5.394, 95 % CI 1.405-20.699), a previous abortion history (P?=?0.029, OR?=?3.194, 95 % CI 1.125-9.073), and fallopian tube obstruction (P?=?0.028, OR?=?3.274, 95 % CI 1.139-9.415) were independent risk factors for positive CD138 results.

Conclusions

CD138 immunohistochemistry can improve the CE diagnosis rate. A previous history of prolonged menstrual bleeding episodes, an abortion history, and a history of fallopian tube obstruction are risk factors for chronic endometritis, and a CD138 immunohistochemical examination should be advised among them.

     

Effect of probiotics and synbiotics consumption on serum concentrations of liver function test enzymes: a systematic review and meta-analysis

Purpose

The gut–liver interaction suggests that modification of gut bacterial flora using probiotics and synbiotics may improve liver function. This systematic review and meta-analysis aimed to clarify the effect of probiotics and synbiotics consumption on the serum concentration of liver function enzymes.

Methods

PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library (Central) were searched from 1980 to August 2017 for studies where adults consumed probiotics and/or synbiotics in controlled trials and changes in liver function enzymes were examined.

Results

A total of 17 studies (19 trials) were included in the meta-analysis. Random effects meta-analyses were applied. Probiotics and synbiotics significantly reduced serum alanine aminotransferase [? 8.05 IU/L, 95% confidence interval (CI) ? 13.07 to ? 3.04; p?=?0.002]; aspartate aminotransferase (? 7.79 IU/L, 95% CI: ? 13.93 to ? 1.65; p?=?0.02) and gamma-glutamyl transpeptidase (? 8.40 IU/L, 95% CI ? 12.61 to ? 4.20; p?<?0.001). Changes in the serum concentration of alkaline phosphatase and albumin did not reach a statistically significant level. Changes to bilirubin levels were in favour of the control group (0.95 μmol/L, 95% CI 0.48–1.42; p?<?0.001). Subgroup analysis suggested the existence of liver disease at baseline, synbiotics supplementation and duration of supplementation?≥?8 weeks resulted in more pronounced improvement in liver function enzymes than their counterparts.

Conclusions

Probiotics and synbiotics may be suggested as supplements to improve serum concentration of liver enzymes, especially when synbiotics administered for a period?≥?8 weeks and in individuals with liver disease.

     

Lifestyle health risk factors and multiple non-communicable diseases among the adult population in India: a cross-sectional study

Aim

This article investigated the relationship between lifestyle factors and the co-occurrence of multiple chronic non-communicable diseases (NCDs).

Subjects and methods

Cross-sectional analysis of results from the World Health Organization Study on Global Ageing and Adult Health (WHO SAGE) was conducted in India in 2007. Subjects were aged 18 years and older. Multiple NCD morbidity was measured by a simple count of self-reported chronic NCDs from a list of nine. Five lifestyle risk factors were evaluated: (1) tobacco use, (2) alcohol consumption, (3) fruit and vegetable consumption, (4) physical activity, and (5) body mass index (BMI). Each lifestyle risk factor was given a score of 1 (unhealthy) if the recommended behavioral targets were not achieved and 0 otherwise. The combined effect of unhealthy lifestyle was evaluated using the total sum of scores.

Results

The overall mean number ± SD of unhealthy lifestyle factors in the study population was 2.3?±?1.14. Individually, the likelihood of reporting multiple chronic NCDs was greater among adults with low or high BMI (1.35, p?<?0.05), alcohol consumption (1.36, p?<?0.10), low intake of fruits and vegetables (1.05, p?<?0.10), and tobacco users (1.62, p?<?0.01). When combined, the risk of reporting multiple NCDs increased significantly with the increased exposure to the number of unhealthy lifestyle factors.

Conclusion

The present study provides support to the association of lifestyle factors and multiple NCD morbidity. Accumulation of a greater number of unhealthy lifestyle factors progressively increased the likelihood of suffering from multiple NCDs among adults in India.

     

Sedentary time among primary school children in south-west Germany: amounts and correlates

Background

Sedentary behaviour in children is related to different health consequences such as overweight and cardio-metabolic diseases that can track into adulthood. Previous studies have shown that children spend hours being sedentary, but no data of sedentary time (ST) among German children has been available, yet. Therefore, this study investigated objectively measured amounts and correlates of ST in a sample of German primary school children.

Methods

Children’s physical activity (PA) was objectively assessed for 6 days using a multi-sensor device (Actiheart®; CamNtech, Cambridge, UK). Activity levels were categorized on the basis of energy expenditure (MET) into sedentary, light PA (LPA), and moderate to vigorous PA (MVPA). ST excluding sleeping hours was assessed for 231 children (7.1 ± 0.6 years, male: 45.9%) and analysed for independent groups. Examined factors (parental education, household income, and migration background) were assessed by parental questionnaire. Children’s weight, height and gender were collected in schools. Weight status was calculated on the basis of BMI percentiles.

Results

On average, children spent 3.5 ± 1.5 h daily being sedentary, excluding sleeping hours. Significantly higher ST was found in girls (t = ?4.6; p < 0.01), in children with migration background (t = ?6.9; p < 0.01), at the weekend (t = ?2.8; p < 0.01), and among inactive children (t = 6.8; p < 0.01). Additionally, significant correlations with ST in this sample were identified for MVPA (B = ?0.99; [?1.09;-0.88], p < 0.01), LPA (B = ?0.89; [?0.97;-0.82], p < 0.01), migration background (B = ?17.64; [5.24;30.04], p < 0.01), gender (B = ?13.48; [?25.94;-1.01], p < 0.05) and household income (B = ?4.80; [?9.07; ?0.53], p < 0.05).

Conclusion

Girls, children with migration background, and inactive children were identified as potential risk groups. A higher income was associated with less ST. In general, ST was higher at the weekend. Furthermore, as PA was found to be negatively correlated to ST, these activities may replace each other. Therefore, these findings should be considered in future health interventions.

Trial registration

German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494 DATE: 25/08/2010.

     

Can single disease payment system based on clinical pathway reduce hospitalization costs in rural area? A case study of uterine leiomyoma in Anhui,China

Background

Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example.

Methods

The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years.

Results

The total hospitalization expenditure (per-time) dropped from 919.08?±?274.92 USD to 834.91?±?225.29 USD and length of hospital stay reduced from 9.96?±?2.39?days to 8.83?±?1.95?days(P?<?0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P?<?0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (??0.360); while the CV of materials expense increased the most (0.186).

Conclusion

There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.

     

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors

Purpose

Lower quality of life, especially in the physical domain (Physical-QOL), is common in patients after hematopoietic stem cell transplantation (HSCT). However, few studies explore changes in the Physical-QOL, i.e., physical symptoms, in everyday life of patients following HSCT. The present study addresses this gap by examining patient daily physical symptoms and their predictors in terms of demographic and clinical characteristics.

Methods

Physical symptoms were reported by 188 patients (56.9% men; aged 47.6?±?13.4 years) for 28 consecutive days after post-HSCT hospital discharge. Multilevel modeling was used to investigate fixed and random effects for physical symptom changes over time.

Results

The results indicated that the initial level of physical symptoms (immediately after hospital discharge) systematically decreased over 28 days. Treatment toxicity (WHO scale; β?=?0.09, p?<?.01) and baseline depressive symptoms (CES-D scale; β?=?0.06, p?<?.01) were associated with the initial level of physical symptoms. Patients with more depressive symptoms before HSCT and with more adverse treatment effects presented with more physical symptoms immediately after hospital discharge. The type of transplant, diagnosis, and conditioning regimen differentiated the course of physical symptoms. Patients with leukemias and other myeloid neoplasms (β?=?0.05, p?<?.01), after allogeneic HSCT (β?=??0.06, p?<?.01), and with non-myeloablative conditioning (β?=??0.09, p?<?.01) showed a significant lower decrease in symptoms over time. Patients with multiple myeloma presented with the most rapid improvement (β?=??.03, p?<?.05).

Conclusions

The findings suggest a heterogeneous and rather positive response to HSCT. Treatment-related conditions occurred to be a significant predictor of the intensity of change in physical functioning after HSCT.

     

Season,dietary factors,and physical activity modify 25-hydroxyvitamin D concentration during pregnancy

Purpose

The objectives of this cross-sectional study were to define maternal and umbilical cord blood (UCB) 25-hydroxyvitamin D (25(OH)D) to characterize maternal factors modifying 25(OH)D during pregnancy and predict UCB 25(OH)D in two subgroups with Declined [Δ25(OH)D?<0 nmol/l] and Increased [Δ25(OH)D?>0 nmol/l] 25(OH)D concentration.

Methods

A complete dataset was available from 584 women. 25(OH)D was determined at gestational weeks 6–13 and in UCB. Baseline characteristics were collected retrospectively using questionnaires. Δ25(OH)D was calculated as UCB 25(OH)D?early pregnancy 25(OH)D. Dietary patterns were generated with principal component analysis. Multivariate regression models were applied.

Results

Vitamin D deficiency was scarce, since only 1% had 25(OH)D concentration?<50 nmol/l both in early pregnancy and in UCB. Shared positive predictors of UCB 25(OH)D in the subgroups of Declined and Increased, were early pregnancy 25(OH)D (P?<?0.001) and supplemental vitamin D intake (P?<?0.04). For the Increased subgroup summer season at delivery (P?=?0.001) and “sandwich and dairy” dietary pattern characterized with frequent consumption of vitamin D fortified margarine and milk products (P?=?0.009) were positive predictors of UCB 25(OH)D. Physical activity (P?=?0.041) and maternal education (P?=?0.004) were additional positive predictors in the Declined group

Conclusions

Maternal and newborn vitamin D status was sufficient, thus public health policies in Finland have been successful. The key modifiable maternal determinants for 25(OH)D during pregnancy, and of the newborn, were supplemental vitamin D intake, frequent consumption of vitamin D fortified foods, and physical activity.