EFFECT OF ACUTE AND CHRONIC ETHANOL ADMINISTRATION ON THE TRANSPORT OF THIAMINE FROM PLASMA TO DIFFERENT BRAIN REGIONS OF THE RAT

The effect of ethanol (4.7 g/kg body wt intragastrically asa single dose or once daily for 35 days) on the transport ofthiamine from plasma to four brain regions (cerebellum, cerebralcortex, pons and medulla) was studied in albino rats. Animalswere given an intravenous injection of labelled thiamine witha sampling procedure which allowed the determination of regionalblood flow and tissue thiamine uptake. Regional blood flow wasfound to be enhanced after acute, but non chronic, ethanol administration.The magnitude of increase ranged from 13 to 35% depending onthe brain region being considered. Thiamine was transferredfrom plasma to cerebral tissue by a saturable process with anon-saturable component prevailing at thiamine concentrationsabove 10–15 µM. Three main modifications in thethiamine transport were found as a result of ethanol treatment:a reduction in affinity for the carrier (K_m increased), an increasein maximal transport rate (J_max and an increase in non-saturablediffusion (K_D constant increased). The effects were more pronouncedafter acute ethanol administration. As a consequence of thesemodifications both acute and chronic ethanol treatment causedan increase in thiamine transport rate at high plasma concentrations.On the contrary, at low (physiological) plasma concentrations,thiamine transport was little increased by acute ethanol administrationand virtually unaffected by chronic ethanol intoxication.     

International Co-operation in Health. Martin McKee, Paul Garner and Robin Stott, eds.

International Co-operation in Health Martin McKee, Paul Garner and Robin Stott, eds Published in 2001 by Oxford University Press, Oxford, UK. ISBN 0 19 263198 5 (hardback); Price £39.50. The book International Co-operation in Health represents animportant contribution to a growing but scant literature onthe subject of globalization and its effects on health and healthcare. More specifically, the book seeks to inform and educate(public) health professionals about diverse threats to healthon a global scale. These include risk factors that have traditionallybeen studied by epidemiologists (e.g. infectious diseases, tobacco,and diet) as well as other global phenomena that affect healthbut have not been traditionally studied in this context (e.g.climate change and migration). As the editors point out, current epidemiological methods thatdominate public health research are     

Declining maternal smoking prevalence did not change low birthweight prevalence in Massachusetts from 1989 to 2004

Background: Maternal smoking is associated with low birthweight(LBW). LBW prevalence is increasing in the US. However, it isunclear whether a fall in maternal smoking has any impact onthe LBW prevalence in Massachusetts, a state with a comprehensivetobacco control program since 1993. Methods: Temporal patternsin prenatal maternal smoking and in LBW prevalence were quantifiedbetween 1989 and 2004, using Massachusetts Community HealthInformation Profile database. Yearly population-attributable-risk(PAR %) of singleton LBW live-births among pregnant smokingmothers were estimated based on a summary relative risk. Theexpected number of LBW babies attributable to reductions inmaternal smoking in 2004 relative to 1989 was compared to theactual number of LBW babies in 2004. Results: Of 88 929 and74 554 singleton live-births, 4297 and 4004 LBW births occurredin 1989 and 2004, respectively. Between 1989 and 2004, maternalsmoking prevalence significantly declined yearly by 6% (from19.9% to 6.8%) but overall LBW prevalence increased yearly by<1% (from 4.8% to 5.4%), with a significant yearly increase(<1%) in moderately LBW (1500–2499 g) prevalence. YearlyPAR % declined from 20.3% (n = 872) to 8.0% (n = 320), withan expected total of 3745 [4297 – (872 – 320)] LBWbabies in 2004 relative to 1989. However, actual LBW babiesnumbered 4004 in 2004. The 259 above predicted (4004 –3745) LBW babies born in 2004 being attributed to factors otherthan prenatal maternal smoking. Conclusions: Massachusetts experienceda decline in prenatal maternal smoking prevalence, but an increasein moderately LBW prevalence has offset the potential gainsapparently achieved due to reductions in maternal smoking prevalence.     

AGE-RELATED DIFFERENCES IN BLOOD ETHANOL PARAMETERS AND SUBJECTIVE FEELINGS OF INTOXICATION IN HEALTHY MEN

Healthy men within 4 age groups, 20–29, 30–39, 40–49and 50–59 years (N = 12 per group), drank 0.68 g/kg ethanolas neat whisky after fasting overnight. The drink was finishedwithin 20 min and the concentrations of ethanol in capillaryblood were determined at 30/60 min intervals for 7 hr. At thetime of blood sampling, the men were asked to estimate theirfeelings of intoxication according to an arbitrary scale onwhich the score 10 indicated ‘tipsy’ or a ‘Littlehigh’. The time course of blood ethanol concentrationwas similar in all 4 groups with the curve for 50–59-year-oldmen on the highest level and 20–29-year-old men lowest.Subjective intoxication scores were significantly less in theyoungest age group and the maximum score for each subject wascorrelated with age (r = 0.45, P << 0.01). Total bodywater (TBW) was not correlated with age directly (r = 0.17,P > 0.05) but when it was expressed as percent of body weighta strong negative correlation was found (r = –0.77, P> 0.001). The mean total body water estimated from ethanoldilution was 46.7 ± 4.11. (+ SD, N = 48) and this correspondsto 58% of mean body weight of the men. The distribution volumeof ethanol/kg body weight (V_d) decreased with ageing (r = –0.59,P < 0.001) being 0.72, 0.71, 0.68 and 0.66 l/kg on averagein the 20–29, 30–39, 40–49 and 50–59-year-oldage groups respectively. The reduction of V_d corresponds toan age-related decrease in the percentage of body water andan increase in the percentage of body fat. This results in elevatedblood ethanol concentrations in older individuals for a constantdose/kg body weight. The absorption of ethanol from the gutand its rate of disappearance from blood were not markedly influencedby age. The lower subjective feelings of intoxication reportedby younger men may indicate that age-related differences inacute functional tolerance to ethanol or different thresholdvalues of blood ethanol may exist before an effect is felt.     

ASSESSMENT OF ZINC NUTRITIONAL STATUS OF PELLAGRA PATIENTS

The objective of the present study was to assess zinc nutritionalstatus in alcoholic patients with pellagra using plasma, hair,urine and nail zinc levels, as well as the zinc tolerance test.The study was conducted on 81 patients, 73 males and eight females.Zinc parameters were compared with those of 84 individuals withno apparent disease aged 23–45 years. Plasma zinc levelswere lower in patients with pellagra than in the controls (P< 0.01). The results of the zinc tolerance test showed that:(1) basal zinc levels were 69.7 ± 16.8 µg/100 mlin pellagrins and 82.3 ± 34.0 µg/100 ml in thecontrols (P < 0.01); (2) after 1 h the increase in plasmalevels was similar in the pellagrin and control groups; (3)during the second hour the increase was more marked in the controls(P < 0.01), and the same was observed during the third andfourth hours (P < 0.05). Urinary zinc excretion (mg/24 h)was higher in pellagrins (P < 0.01). Zinc concentration inhair and toenails did not differ between pellagrins and controls.We conclude that pellagrins present zinc deficiency as demonstratedby plasma and urine zinc levels and by their abnormal responseto the zinc tolerance test. We suggest that hair and nail zinclevels should not be used to assess zinc nutritional statusin patients with pellagra.     

Advanced glycation end-products in patients with chronic alcohol misuse

Aims: The aim of our study was to determine serum levels ofadvanced glycation end-products (AGE) in patients with chronicalcohol misuse and to examine their relationship to markersof nutrition and inflammation. Methods: The study group consistedof 23 heavy alcohol drinkers treated for chronic alcohol misuseand 22 healthy controls. Studied parameters included AGE (fluorescence,CML – carboxymethyllysine and pentosidine), lipids, glucose,albumin, leptin, prealbumin, C-reactive protein (CRP) and pregnancy-associatedplasma protein A (PAPP-A). Results: AGE fluorescence was significantlyhigher in chronic alcoholic patients than in healthy subjects(4.3 ± 0.7 x 10³ vs 3.7 ± 0.5 x 10³ AU/g protein,P < 0.005), while CML was only slightly but not significantlyelevated (569.1 ± 106.6 vs 545.5 ± 85.8 µg/l)and pentosidine levels did not differ (105.4 ± 29 vs102.2 ± 23 nmol/l). In alcoholics, AGE correlate significantlynegatively with leptin (r = –0.46, P < 0.05) and pentosidinewith prealbumin (r = –0.43, P < 0.05), otherwise therewas no relationship between AGE and other biochemical parameters(glucose, cholesterol, albumin, CRP, PAPP-A). Conclusion: Ourfindings suggest a more complex relationship among advancedglycation, oxidative stress and metabolism of ethanol and theirlink to nutrition and nutrition-associated parameters. AGE asa result of oxidative stress might be similarly linked to increasedcardiovascular risk of heavy alcohol drinkers, as are malnutritionand inflammation; however, further studies are needed to confirmthis hypothesis.     

Six Month Follow-up of Fourteen Victims with Short-term Exposure to Chlorine Gas

Fourteen cases, 5 with pre-existing COAD, exposed to up to 30p.p.m. chlorine gas in an accidental leakage, were followedup clinically, radiologically and by spirometry at 2 weeks,4 weeks, 8 weeks and 6 months. All the patients were asymptomaticby 2 weeks and did not reveal any radiological abnormality.The FVC, FEV₁ and FVC observed/predicted improved at 4 weeks(p <0·05, p <0·05, p <0·01) andthe improvement in FEF_{0·25–0·75} reachedstatistical significance (p <0·05) at 6 months. Themean improvement in FVC was 0·841 and FEV₁ was 0·61at 4 weeks. The 5 patients with pre-existing COAD did not showany evidence of additional lung damage. The observations havebeen consistent with acute tracheobronchitis with trends towardscomplete recovery. Requests for reprints should be addressed to: Professor A. C. Shah, Department of Respiratory Diseases, L. T. M. G. Hospital, Sion, Bombay 400022, India     

WHEN ALCOHOLICS DRINK AFTERSHAVE: A STUDY OF NONBEVERAGE ALCOHOL CONSUMERS

A one-year prospective study was conducted to describe nonbeveragealcohol (NBA) consumption (the use of substitutes for traditionalforms of ethanol) among alcoholics. It was found that 11% ofinpatient alcoholics at a veterans' hospital and 8.6% of alcoholicsat a community hospital had consumed NBA. Substances consumedranged from toiletries to organic solvents, often in quantitiesexceeding the theoretical lethal dose. ‘Ready availability’was cited as the primary reason for consumption. Social, demographicand psychiatric parameters were then compared between 48 VAalcoholics who used NBA and 48 nonusing alcoholics. No socialor demographic differences were found, but NBA drinkers drankmore alcohol (P < 0.0001), had higher global alcoholic severityscores (P < 0.0001), more severe withdrawal symptoms (P <0.0001), and a higher frequency of antisocial personality disorder(P = 0.009) and drug abuse (P = 0.005). When NBA drinkers weresubdivided by quantity of NBA consumption and recency of latestingestion, no social or psychological differences were foundbetween groups, except for more frequent and heavier illicitdrug use among ‘heavy’ NBA consumers (P < 0.0001).     

Erythrocyte cholinesterase activity levels in desert farm workers

In this study we have examined 532 migrant farm workers engagedmainly in the cultivation of vegetable crops, in both greenhousesand openfarms, and an equal number of controls. Erythrocyteacetylcholinesterase activity (AChE) was measured to determinethe degree of toxicity due to exposure to organophosphate andcarbamate pesticides in the farm workers employed either asforemen (41.5%) or farmers (58.5%). The mean ages of the farmworkers and controls were 35.2±7.4 (mean±SD) yearsand 34.6±7.1 years. AChE activity of the farm workersand controls was 3.89±0.64 Ul/ml (mean±SD) and4.15±0.29 Ul/ml. The haemoglobin adjusted erythrocytecholinesterase activity (HAChE) was 29.96±4.14(mean±SD)for farm workers and 32.10±2.26 for controls. AChE activitywas very highly significantly lower for the foremen (3.76±0.69)compared to farmers (3.98±0.59) (Student's t-test=4.13,p=0.0001). HAChE was also very highly significantly lower forforemen (29.24±4.37) compared to farmers (30.46±3.88)(Student's t-test=3.64, p=0.0001). The poorly controlled useof pesticides in the farms appeared to have caused sub-clinicalintoxication in the farm workers and indicated the need fortraining and implementation of hygiene practices.     

Influence of Birth Weight on White Blood Cell Count in Biracial (Black-White) Children, Adolescents, and Young Adults: The Bogalusa Heart Study

The effect of birth weight on white blood cell (WBC) count amongblacks and whites was examined in 2,080 children (aged 4–11years, 57.4% white, and 49.2% male), 892 adolescents (aged 12–17years, 57.2% white, and 50.8% male), and 1,872 adults (aged18–38 years, 68.4% white, and 41.9% male) from Bogalusa,Louisiana, in 2005. After adjustment for age, sex, race, bodymass index, and smoking status (in adolescents and adults),the WBC count decreased across quartiles of increasing birthweight specific for race, sex, and gestational age in children(P_trend = 0.0007) and adults (P_trend = 0.005). In multivariateregression analyses that included the covariates above, birthweight was inversely associated with WBC count in children (βcoefficients (unit, cells/µL per kg) = –256, –241,and –251 for whites, blacks, and the combined sample,with P = 0.003, 0.029, and <0.001, respectively) and in adults(β = –224 and –211 for whites and the combinedsample, with P = 0.015 and 0.008, respectively). These resultsshow that low birth weight is associated with increased systemicinflammation as depicted by the WBC count in childhood and adulthood,thereby potentially linking fetal growth retardation to cardiovasculardisease and diabetes. birth weight; inflammation; leukocyte count     

Who gets what: politics, evidence, and health promotion

Science journal, starting with its July 2005 issue, presentsits readers with 125 questions and problems yet to be resolvedby the scientific community. These range from the deceptivelysimple (‘what is the structure of water?’), theobvious (‘what triggers puberty?’ or ‘whatare the roots of human culture?’), to the amazingly esoteric(‘do mathematically interesting zero-value solutions ofthe Riemann zeta function all have the form of a+bi?’). More than half of these issues have     

INCREASED RATE OF ETHANOL ELIMINATION AND ELEVATED BLOOD ACETATE IN ASTHMATICS ON CORTICOSTEROID, BETA-2-SYMPATHICOMIMETIC AND THEOPHYLLINE TREATMENT

The rate of ethanol elimination and blood acetate concentrationsafter a peroral dose of alcohol were measured in eight asthmaticpatients receiving high-dose corticosteroid, sustained releasetheophylline and beta-2-sympathicomimetic treatment and in eightnonalcoholic, healthy controls. Mean ethanol elimination rate(ER) and mean blood acetate concentration (AC) were significantly(P<0.01) higher in asthmatics (ER=134.8 ± 12.9 mg/kg/hr,AC = 1.13± 0.25 mM) than in controls (ER = 100.2 ±12.3 mg/kg/hr, AC = 0.64 ± 0.10 mM). In the asthmaticsthere was a significant negative correlation between the ageand the rate of ethanol elimination (r = –0.890, P <0.01); in the control group, however, this correlation was oflower degree (r = –0.423) and did not achieve statisticalsignificance. Enhanced ethanol metabolism in asthmatics is possiblydue to the effect of drugs. Our results suggest that ethanolelimination rate is increased in asthmatics receiving medicationand that the effect is most significant in younger age groups.     

Use of condoms: intention and behaviour of adolescents living in juvenile rehabilitation centres

The aim of the present study was to identify the psychosocialfactors explaining intention and behaviour regarding condomuse among a sample of 152 adolescents (44 F; 108 M) living injuvenile rehabilitation centres. At baseline, the variablesderived from psychosocial theories were assessed by questionnaire.The self-report of condom use was obtained 3 months later. Thevariability in intention (R² = 0.76; P < 0.001) was explainedby personal principles guiding adoption of the behaviour (ß= 0.44, P < 0.001), perceived control in adopting the behaviour(ß = 0.36, P < 0.001) and habit of using condomsin the previous 3 months (ß = 0.15, P < 0.01).Prediction of condom use yielded an R² of 0.49 (P < 0.001),the interaction terms formed by intention and perceived behaviouralcontrol (P < 0.01) and habit of using condoms by perceivedbehavioural control (P < 0.001) being the significant predictors.MANOVA analyses revealed important differences between highand low intenders on each of the items of the personal principlescale and the perceived control sub-scales. The results suggestthat the promotion of condom use among adolescents experiencingsocial adaptation difficulties should focus on developing thepersonal social responsibility that each individual has regardingthe adoption of a responsible sexual behaviour, as well as developingthe personal skills and resources necessary to overcome thepsychological and physical barriers of using condoms.     

ERRATUM

The Journal of the Society of Occupational Medicine, 27, 53,second column, contains eight lines of text which should haveappeared on 70–71. 53, second column. The section Complaints in General shouldhave ended (second paragraph, lines 8–9) with the sentence:‘This pattern is present in the experiences of both "old"and "new" employees.’ The text should then continue withthe section Complaints about Slow Work, appearing on 55. 70–71. The final paragraph of the section Finance on 70(bottomof second column) should have been completed by matter appearingat the end of the section Complaints in General on 53 (secondparagraph, lines 9–12) so as to read: ‘Staff salariesare related to the appropriate scales recommended by the BritishMedical Association and the Royal College of Nursing. Despitethe distances involved, transport costs are not unduly high(total of 5.5 per cent)’. The Finance section should befollowed by the section The Future, the heading and first paragraphof which appear at the bottom of 53, second column; this sectioncontinues on 71, first column, paragraph beginning: Furtheremphasis is given by the actions of government and by decisionsin court and settlements out of it'.The headline on 71 shouldread: ‘East of Scotland OHS’. The publishers much regret these errors, which have been correctedon the reprints of the articles concerned.     

Salivary acetylcholinesterase as a biomarker for organophosphate exposure

Background Workers exposed to organophosphate (OP) pesticidesare required to undergo periodic statutory medical surveillancein several countries. Aim To study the relationship between serum, erythrocyte andsaliva acetylcholinesterase (AChE) levels and to explore theuse of salivary AChE as potential biomarker for OP exposure. Methods A cross-sectional study was conducted on 19 healthyadult male lead-exposed workers who were undergoing six monthlystatutory medical examination. Passive drool saliva sampleswere collected from each worker. Each blood sample was testedfor serum and erythrocyte AChE, and each saliva sample was testedfor AChE. Results Among the 19 subjects, the mean (±standard deviation)of salivary, erythrocyte and serum AChE/cholinesterase were22.7 (±17.4), 17171 (±1467), 8861 (±1876)U/l, respectively. There was a moderate correlation betweensalivary and erythrocyte AChE (r = 0.42, P = 0.071), but notsalivary and serum AChE (r = –0.17, P = 0.48). The levelof AChE in saliva was 1820 times lower than AChE in erythrocytes. Conclusion It is probably not feasible to use saliva as a replacementfor blood for the measurement of AChE levels. This is becauseof the much lower levels of AChE in saliva relative to erythrocytes,the weak correlation between the two measurements and the previouslyreported high intra-individual variation of salivary AChE.     

CHRONIC ETHANOL EXPOSURE INCREASES LIPOPIGMENT ACCUMULATION IN HUMAN HEART

The amount and distribution of myocardial lipoptgments ( ‘agepigments’) were studied in alcoholic and control humanhearts, to test the hypothesis of ethanol-induced long- termoxidative damage in myocardium. The amount of myocardial lipopigmentswas measured by image analysis in six men (age 34–60 years)who had a history of chronic alcohol misuse and who died ofacute ethanol intoxication, and in their age-matched, non-alcoholiccontrols. Lipopigmentation in the intoxication cases was 33.5± 2.8% (mean ± SEM) higher compared to the controlsin the eight myocardial areas studied (P < 0.001). A linearcorrelation of myocardial lipopigmentation with age was noticedin both the intoxication group (R = 0.894) and the controls(R = 0.927). The amount of lipopigments varied largely fromone myocardial area to another, being highest in the most strainedareas (left ventricle, interventricular septum). The accumulationof lipopigments is considered a marker of oxidative stress andageing in the myocardium. The results support the role of freeradical-induced oxidative stress in the pathogenesis of ethanol-inducedcardiac abnormalities.     

ALCOHOLISM: A LONG-TERM FOLLOW-UP STUDY OF PARTICIPANTS IN AN ALCOHOL TREATMENT PROGRAMME

This paper reports the results of a long-term follow-up studyof 112 alcoholic patients admitted to an intensive 1-month residentialprogramme. Outcomes at the 6-month and 1-year stages were reportedin an earlier paper [G. K. Shaw et al. (1990) British Journalof Psychiatry 157, 190–196]. The length of the follow-upperiod in this study was an average of 9 years. Eighteen patientshad died before the long-term follow-up stage, and of the remaining94 a total of 60 patients were followed up. This study showsthat major improvements on social, psychological and drinkingbehaviour measures, made at 6 months and 1 year follow-up, were,on the whole, maintained and there was a progressive improvementon most variables at each follow-up stage. Major improvementswere achieved by those patients whose drinking was categorizedas ‘abstinent’, ‘controlled’ and ‘improved’.The proportion of patients categorized as ‘unchanged’dropped from 43% at 6 months to 33% at 1 year and to 15% at9 years. By the 1-year follow-up stage, the unchanged groupshowed deterioration on psychological variables such as neuroticism,self-esteem and satisfaction with life situations, continuedto make use of health service resources, and the high levelof alcohol-related physical and social complications remainedunchanged. This group had similar results at long-term follow-upwith the exception of neuroticism, which was significantly lowerin all drinking categories.     

Blood Pressure Variability at Annual Periodic Health Examination for Employees and Cardiovascular Risk Factors

The employees with hypertension at the annual periodic healthexamination (HE) for employees in Japan usually receive a re-examinationof blood pressure (BP) on another day and are often found tobe normotensive. In this study, we analyzed data from the HEat the workplace to determine whether or not such employeesshould receive medical care. Two groups of subjects were selected.One group (group 1) was composed of 50 subjects with normotensionat the HE (controls). Another group (group 2) was composed of33 subjects with hypertension at the annual HE but with normotensionin re-examinations. Cardiovascular risk factors were significantlyhigher in group 2 than in group 1: mean values of the body massindex (group 1, 22.2±2.7 vs. group 2, 24.3±3.1kg/m² p<0.01), total cholesterol (group 1, 197±36vs. group 2, 222±42 mg/dl, p<0.01), and low densitylipoprotein (group 1, 118±32 vs. group 2, 137±38mg/dl, p<0.05). The proportion of the employees with high-normalBP in group 2 (42.5%) was significantly higher than that ingroup 1 (28.0%) (p<0.01). These indicate that the employeeswith hypertension at the annual HE but with normotension inthe re-examination require further medical attention and shouldreceive medical supervision. The occupational physician shouldsupervise these employees.     

The effect of a computer-generated patient-held medical record summary and/or a written personal health record on patients' attitudes, knowledge and behaviour concerning health promotion

OBJECTIVE: The aim of the study was to examine the effect of a computer-generatedpatient-held medical record summary (CHR) and/or a written personalhealth record (PHR) on patients' attitudes, knowledge and behaviourconcerning health promotion. METHOD: It was conducted in five general practices in Oxfordshire. Patientsaged 25–65 years in each practice were randomly assignedto receive either a CHR plus PHR, CHR only, PHR only, or nopersonal record. Patients were recruited by mail (one practice)or opportunistically by nurses (four practices). Health checkswere carried out using the randomly assigned record, which thepatient retained. Attitudes to patient-held records, and pre-and post-intervention knowledge and behaviour concerning healthpromotion, were assessed using questionnaires. Only those whoresponded to ‘before’ and ‘after’ questionnaireswere included in the analysis. RESULTS: A sample of 261 patients was obtained from mail recruitmentand 103 from opportunistic nurse recruitment. Patients receivinga CHR as part of mail recruitment were significantly more likelyto attend for a health check (P = 0.016). Those receiving bothPHR and CHR were more likely to keep (P = 0.014) and use (P= 0.029) the record. Those receiving PHR as part of the packageimproved their knowledge of health promotion and became moreaware of and more likely to change their life-style (P = 0.022). CONCLUSIONS: The effectiveness of a computer-generated patient-held healthsummary and an explanatory booklet together is greater thaneither separately in changing patients' knowledge attitudesand behaviour concerning health promotion. Keywords. Patient-held record, primary care, health promotion, computerized medical record.