Influenza D Virus in Cattle,France, 2011–2014

A new influenza virus, genus D, isolated in US pigs and cattle, has also been circulating in cattle in France. It was first identified there in 2011, and an increase was detected in 2014. The virus genome in France is 94%–99% identical to its US counterpart, which suggests intercontinental spillover.     

EQ-5D in Central and Eastern Europe: 2000–2015

Objective

Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries.

Methods

An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets.

Results

We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set.

Conclusions

Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.

     

Nathaniel (Neil) McConaghy, M.D., D.Sc. (1927–2005)

In Memoriam

Nathaniel (Neil) McConaghy, M.D., D.Sc. (1927–2005)     

The Impact of Differences in EQ-5D and SF-6D Utility Scores on the Acceptability of Cost–Utility Ratios: Results across Five Trial-Based Cost–Utility Studies

ObjectiveThis article investigates whether differences in utility scores based on the EQ-5D and the SF-6D have impact on the incremental cost–utility ratios in five distinct patient groups.MethodsWe used five empirical data sets of trial-based cost–utility studies that included patients with different disease conditions and severity (musculoskeletal disease, cardiovascular pulmonary disease, and psychological disorders) to calculate differences in quality-adjusted life-years (QALYs) based on EQ-5D and SF-6D utility scores. We compared incremental QALYs, incremental cost–utility ratios, and the probability that the incremental cost–utility ratio was acceptable within and across the data sets.ResultsWe observed small differences in incremental QALYs, but large differences in the incremental cost–utility ratios and in the probability that these ratios were acceptable at a given threshold, in the majority of the presented cost–utility analyses. More specifically, in the patient groups with relatively mild health conditions the probability of acceptance of the incremental cost–utility ratio was considerably larger when using the EQ-5D to estimate utility. While in the patient groups with worse health conditions the probability of acceptance of the incremental cost–utility ratio was considerably larger when using the SF-6D to estimate utility.ConclusionsMuch of the appeal in using QALYs as measure of effectiveness in economic evaluations is in the comparability across conditions and interventions. The incomparability of the results of cost–utility analyses using different instruments to estimate a single index value for health severely undermines this aspect and reduces the credibility of the use of incremental cost–utility ratios for decision-making.     

Vitamin D Intake and Status in 12-Month-Old Infants at 63–66° N

The objective was to assess the vitamin D status in healthy 12-month-old infants in relation to quantity and sources of dietary vitamin D, breastfeeding and seasons. Subjects were 76 12-month-old infants. Serum levels of 25-hydroxyvitamin D (25(OH)D) ≥ 50 nmol/L were considered indicative of vitamin D sufficiency and 25(OH)D < 27.5 nmol/L as being indicative of increased risk for rickets. Additionally, 25(OH)D > 125 nmol/L was considered possibly adversely high. Total vitamin D at 9–12 months (eight data collection days) included intake from diet and supplements. The mean ± SD of vitamin D intake was 8.8 ± 5.2 μg/day and serum 25(OH)D 98.1 ± 32.2 nmol/L (range 39.3–165.5). Ninety-two percent of infants were vitamin D sufficient and none at increased risk for rickets. The 26% infants using fortified products and supplements never/irregularly or in small amounts had lower 25(OH)D (76.8 ± 27.1 nmol/L) than the 22% using fortified products (100.0 ± 31.4 nmol/L), 18% using supplements (104.6 ± 37.0 nmol/L) and 33% using both (110.3 ± 26.6 nmol/L). Five of six infants with 25(OH)D < 50 nmol/L had no intake of supplements or fortified products from 0 to 12 months. Supplement use increased the odds of 25(OH)D > 125 nmol/L. Breastfeeding and season did not affect vitamin D status. The majority of infants were vitamin D sufficient. Our findings highlight the need for vitamin D supplements or fortified products all year round, regardless of breastfeeding.     

Associations of serum perfluoroalkyl substance and vitamin D biomarker concentrations in NHANES, 2003–2010

Perfluoroalkyl substances (PFAS) are persistent endocrine disrupting chemicals found in industrial and commercial products. Previous research has shown that other endocrine disrupting chemicals such as phthalates and bisphenol A may alter circulating levels of vitamin D; however, no research has examined associations between PFAS and vitamin D biomarkers. We conducted a cross-sectional analysis of 7040 individuals aged 12 years and older participating in the 2003–2010 cycles of the United States National Health and Nutrition Examination Survey (NHANES). Concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and total 25-hydroxyvitamin D [25(OH)D] were measured in serum samples. We used multivariable linear regression to estimate covariate-adjusted differences in total 25(OH)D or prevalence odds of vitamin D deficiency per log₂ change in PFAS concentrations. We also assessed potential effect measure modification by gender, age, and race/ethnicity. PFAS were detected in over 98% of the samples. In adjusted models, each 2-fold increase in PFOS was associated with 0.9?nmol/L (95% CI: 0.2, 1.5) lower total 25(OH)D concentrations, with associations significantly stronger among whites (β: ?1.7; 95% CI: ?2.6, ?0.7) and individuals older than 60 years of age (β: ?1.7; 95% CI: ?2.9, ?0.5). Each 2-fold increase in PFHxS was associated with 0.8?nmol/L (95% CI: 0.3, 1.3) higher total 25(OH)D, and this association was not modified by age, gender, and race/ethnicity. PFOA and PFNA were not associated with total 25(OH)D. When assessing prevalence odds of vitamin D deficiency, we observed similar patterns of association with PFAS concentrations. Our results suggest that some PFAS may be associated with altered vitamin D levels in the United States population, and associations may vary by chemical, age, and race/ethnicity. Prospective epidemiological studies are needed to confirm our findings and determine their implications for vitamin D-associated health outcomes in children and adults.     

Vitamin D Status and Risk of Breast Cancer in Iranian Women: A Case–Control Study

Objective: Considering the rising incidence of breast cancer and high prevalence of vitamin D deficiency in Iran, this case–control study aimed to investigate the relationship between serum concentration and intake of vitamin D and risk of breast cancer.

Methods: A total of 135 incident breast cancer cases at the Cancer Research Center of Shahid Beheshti University of Medical Sciences were matched with 135 controls by age and menopausal status. A validated and reliable 168-item food frequency questionnaire was completed by participant interviews. To determine the vitamin D content of foods we used the U.S. Department of Agriculture (USDA) nutrient database. To analyze the food frequency questionnaires we used the data collected in the Iranian Household Food Pattern Study, conducted by the National Nutrition and Food Technology Research Institute and the Iranian Ministry of Agriculture. Five-milliliter blood samples were collected to measure serum 25-hydroxyvitamin D (25(OH)D) using an enzyme-linked immunosorbent assay method.

Results: Women in the fourth quartile of serum 25(OH)D level had 3 times lower risk of developing breast cancer compared to those in the first quartile. In the adjusted model the inverse relationship remained significant (odds ratio [OR] = 0.269; 95% confidence interval [CI], 0.122–0.593). In the stratified model by menopausal status the inverse association was only seen in premenopausal women (OR = 0.25; 95% CI, 0.094–0.687).

Dietary intake of vitamin D was inversely associated with risk of breast cancer (OR fourth quartile [Q4] vs first quartile [Q1] = 0.39; 95% CI, 0.196–0.784; p = 0.008). After adjusting for the confounding factors, this inverse association remained significant.

Conclusion: Results from this case–control study support the protective effect of higher serum concentration of 25(OH)D against breast cancer. Moreover, dietary but not total intake of vitamin D was associated with decreased risk of breast cancer.     

维生素D受体及维生素D作用进展

维生素D受体(vitamin D receptor,VDR)基因上存在多个多态性位点,与许多疾病的发生发展密切相关.维生素D在骨代谢、免疫性疾病、肿瘤、糖尿病等疾病中作用被进一步发现,并在治疗许多疾病中得到应用.本文对维生素D受体及维生素D作用的进展进行综述.     

冻融周期中D 5、D 5加D 6、D 6期囊胚移植妊娠结局比较

目的比较分析冻融囊胚移植(frozen-thawed embryo transfer,FET)周期移植第5 d(D 5)双囊胚、第5 d+第6 d(D 5+D 6)混合双囊胚、第6 d(D 6)双囊胚的临床妊娠结局。方法回顾性分析2014年1月至2018年6月在邢台不孕不育专科医院接受FET且移植2枚囊胚的1 578个周期的临床结局,根据移植囊胚的发育天数分为3组:D 5组为解冻第5 d双囊胚移植组(821个周期);D 5+D 6组为解冻第5 d加第6 d各1枚囊胚移植组(226个周期);D 6组为解冻第6 d双囊胚移植组(531个周期)。结果 3组患者平均年龄、不孕年限、内膜厚度、基础卵泡刺激素等基础数值比较,差异无统计学意义(P0.05);D 5+D 6组的临床种植率(57.74%)、妊娠率(76.55%)高于D 5组(51.88%、69.06%)和D 6组(37.00%、56.12%)(P0.05);D 5组高于D 6组(P0.05)。结论 FET周期中移植D 5+D 6囊胚比单纯移植D 5或D 6囊胚有更好的妊娠结局,D 5囊胚比D 6囊胚有更好的妊娠结局。     

Herz–Kreislauf–Risiken des Sports

Zusammenfassung Herz-Kreislauf-Erkrankungen sind für fast 50% der Gesamt mortalität in Deutschland verantwortlich. Eine regelmäßige körperliche Aktivität ist länger fristig mit einer deutlichen Reduktion kardiovaskulärer Morbidität und Mortalität sowohl in der Primär- als auch in der Sekundärprävention bei bereits bestehender Erkrankung assoziiert. Prospektive epidemiologische Studien haben gezeigt, dass sich sowohl moderate als auch intensive körperliche Aktivität länger fristig positiv auf das Herz-Kreislauf-Risiko auswirken. Auch die Aufnahme einer moderaten körperlichen Aktivität erst in einem mittleren oder höheren Lebensalter ist mit einer Risikoreduktion für Herz-Kreislauf-Erkrankungen verbunden. Allerdings ist akute Anstrengung mit einem erhöhten Risiko assoziiert, ein koronares Ereignis auszulösen, vor allem bei untrainierten Patienten mit bestehender koronarer Herzkrankheit. Auch bei körperlich sehr aktiven Menschen ist das Risiko während und nach einer akuten Anstrengung signifikant erhöht. Menschen, die regelmäßig körperlich aktiv sind, haben allerdings während der akuten Anstrengung ein deutlich geringeres Risiko für einen plötzlichen Herztod oder einen akuten Myokardinfarkt als Menschen, die sich selten körperlich betätigen. Trotz des erhöhten Risikos während der akuten Anstrengung ist die regelmäßige körperliche Aktivität länger fristig ein wesentlicher Bestandteil der Prävention kardiovaskulärer und weiterer Erkrankungen. Daher empfehlen aktuelle Leitlinien einheitlich die regelmäßige körperliche Aktivität zur Prävention von Herz-Kreislauf-Erkrankungen.     

维生素D和维生素D缺乏性佝偻病的研究

进入21世纪,维生素D缺乏性佝偻病又出现了上升趋势.该文探讨了其病因:纯母乳喂养时间过长而未添加维生素D,尤其是那些摄入母亲自身是维生素D缺乏者乳汁的婴儿;由于各种原因造成婴儿日照时间减少,从而使得婴儿体内由皮肤转化的内源性维生素D的量大大减少;在很多温带地区移民人群中佝偻病的高发病率.因此,维生素D缺乏可能是一项国际妇幼保健问题,需再次强调对儿童及孕妇额外补充维生素D及日照的重要性.     

维生素D中毒

McCollum从维生素A中分离出维生素D(V_D),能防治大鼠佝偻病。Agduhr用富含鱼肝油的饲料喂小鼠,引起了心脏和其它器官的严重损害。Hess用活化麦角固醇防治婴儿佝偻病及手足抽搦,出现高钙血症,X线照片显示骨骺过度钙化及其它部位的钙化。到目前为止,V_D中毒的研究主要集中于临床表现和治疗以及主动脉、     

维生素D新知

我们都知道,维生素D对骨骼健康至关重要。它在肠道促进钙吸收,在骨骼促进钙的利用,在肾脏促进钙的重吸收,全面调节钙的代谢,对骨骼健康有决定性影响。近年的研究证实,除了肠、骨和肾有维生素D受体外。其他二十余种组织也有维生素D的受体,包括脂肪、平滑肌、软骨、骨髓、肺、胃、脑、视网膜、子宫、卵巢、睾丸、乳腺、腮腺以及几乎所有的内分泌腺体。     

维生素D缺乏及维生素D缺乏性佝偻病防治建议

<正>在我国,维生素D缺乏性佝偻病目前仍是婴幼儿的常见病,因维生素D缺乏引起体内钙、磷代谢失常,导致长骨干骺端和骨组织矿化不全,以致骨骼发生病变。维生素D缺乏还可影响神经、肌肉、造血、免疫等组织器官的功能,对小儿的健康危害较大。因此,积极预防维生素D缺乏及维生素D缺乏性佝偻病,是儿科医疗保健工作者的重要任务。维生素D缺乏性佝偻病的发生与日光照射、季节、气候、地理、喂养方式、出生情况、生活习惯、环境