Nutritional routines and attitudes among doctors and nurses in Scandinavia: a questionnaire based survey

BACKGROUND AND AIMS: Hospital malnutrition is prevalent, but nutritional practice in hospitals has a low priority. To improve the quality in nutritional routine, ESPEN has developed standards to improve the inadequate and insufficient nutritional treatments seen today. However, there is a discrepancy between the standards and clinical practice. This study was conducted to investigate nutritional practice in different hospital settings in relation to these standards (e.g.: screening of all patients, assessment of at-risk patients) among Scandinavian doctors and nurses. METHODS: A questionnaire about nutritional attitudes and routine was mailed to doctors and nurses in Denmark, Sweden and Norway. RESULTS: Altogether, 4512 (1753 doctors, 2759 nurses) answered the questionnaire. Both screening and assessment of at-risk patients differ between the countries. Nutritional screening was more common in Denmark (40%), compared to Sweden (21%) and Norway (16%). Measuring dietary intake in nutritional at-risk patients was more common in Denmark (46%), compared to Sweden (37%) and Norway (22%). However, all countries agreed that nutritional screening (92%, 88%, 88%) and measuring dietary intake (97%, 95%, 97%) were important, Denmark, Sweden and Norway, respectively. CONCLUSION: There is a large discrepancy between nutritional attitudes and practice. The standards suggested from the ESPEN are not fulfilled.     

Mortality patterns during a war in Guinea-Bissau 1998-99: changes in risk factors?

BACKGROUND: The crude mortality rate of the whole population and the mortality of children <5 years of age are the common indicators of the severity of a complex emergency situation. However, these indicators rarely take account of differences in socioeconomic conditions and vulnerability. METHODS: We followed a population in Guinea-Bissau, which fled when fighting took place in the capital during the war in 1998-99. The population stayed close to the area of conflict and returned as soon as a cease-fire was negotiated. A peace treaty was signed after half-a-year. The following 6 months was a period of returning and re-settlement, even though two outbreaks of fighting occurred. RESULTS: In the first half-year the mortality rate was 78% [mortality ratio (MR) = 1.78; 95% CI 1.61-1.97] increased and mortality for children <5 years of age doubled (MR = 2.07; 95% CI 1.79-2.38). In the last 6 months of the war, mortality was slightly increased for children and not at all for the total population. In the first half-year, households living in better houses and having members with schooling were less affected. In the 're-settlement' period two inequalities emerged; the largest ethnic group, Pepel, continued to have high mortality when the mortality of other groups declined; likewise girls continued to have an elevated mortality whereas mortality of boys declined. CONCLUSION: Whereas specific 'free' interventions reduced social inequalities for the groups affected, for the total population health-inequalities were slightly amplified during the war. Once the population returned to their urban homes, mortality fell to pre-war levels even though some fighting continued, limited humanitarian aid was available and the pre-war infra-structure had not been re-established.     

Serum Ionised Calcium and Cardiovascular Disease in 45-years Old Men and Women Followed for 18 Years

High level of total serum calcium within the normal range has been associated with increased cardiovascular risk. We wanted to evaluate whether the physiological active ionised form of calcium also was a risk factor for cardiovascular disease (CVD). Methods: A total of 974 participants from a health survey in 1981 in Copenhagen had ionised serum calcium and different cardiovascular risk factors measured. The participants were followed until 1999 in The National Hospital Patients Registry and The National Death Registry in Denmark regarding the diagnosis ischemic heart disease (IHD) and a broader definition of CVD. Persons with ionised serum calcium in the highest quintile were compared with persons in the lower four quintiles. Results: In a univariate analysis persons with ionised serum calcium in the highest quintile had increased risk of IHD (p = 0.001) and CVD (p = 0.02) compared to persons in the lower quintiles. The increased risk disappeared when gender and cardiovascular confounders were included in a Cox proportional hazards analysis (p = 0.20 for IHD and p = 0.50 for CVD, respectively). In a separate analysis of men and IHD the result remained insignificant (p = 0.07). Conclusions: Serum ionised calcium in the upper quintile in women and men together did not seem to be a risk factor in development of IHD and CVD, but a non-significant tendency towards increased risk of IHD was observed in men with ionised calcium in the upper quintile compared to men in the lower four quintiles.     

Lens fluorescence in relation to glucose tolerance and genetic predisposition to type 2 diabetes mellitus in a population-based study

PURPOSE: The fluorescence of the lens has the characteristics of a life-long cumulative index of glycemia, and it is elevated in patients with diabetes in proportion to the duration of diabetes and the level of glycemia. Consequently, lens fluorometry should be capable of providing an estimate of prediagnostic disease duration when patients are diagnosed with type 2 diabetes. Among euglycemic subjects, first-degree relatives of patients with type 2 diabetes tend to have higher glycemia levels than subjects who are unrelated to diabetes patients. They should therefore also have the higher lens fluorescence values. METHODS: The study comprised 218 Caucasian subjects in self-reported good health aged 30-88 years who were recruited from population-based studies to represent approximately equal proportions of different type 2 diabetes family history characteristics: no diabetic relative, first-degree offspring, second-degree offspring, not first-degree offspring but possibly second-degree offspring, or uncertain family history. Characterization of subjects included oral glucose tolerance testing and lens fluorometry. RESULTS: Type 2 diabetes was diagnosed in 10 subjects (4.6% of the population) and impaired glucose tolerance in 12 subjects (5.5%). Regression analysis indicated a prediagnostic duration of type 2 diabetes of 2.7 years versus 0.1 years for impaired glucose tolerance. Neither group demonstrated significantly increased lens fluorescence compared with euglycemic subjects. Being a first-degree relative of a patient with type 2 diabetes was associated with higher lens fluorescence than having no relative with diabetes (p = 0.02). CONCLUSIONS: Population screening by fasting blood glucose measurement can advance the diagnosis and initiation of treatment of type 2 diabetes mellitus by nearly a decade, compared with previous studies of patients diagnosed in routine clinical practice. In addition to higher than normal glycemia, euglycemic subjects who are offspring of patients with type 2 diabetes also have both elevated lens fluorescence and elevated glycemia. Fasting blood glucose measurement remains the method of choice for type 2 diabetes screening.     

Male-Biased Sex Ratios and Vitellogenin Induction in Zebrafish Exposed to Effluent Water from a Swedish Pulp Mill

Juvenile zebrafish (Danio rerio) were exposed to different dilutions (0, 0.67, 2.5, 10, and 50%) of effluent water from a Swedish pulp mill that previously has been reported to be androgenic to fish. Exposure was performed between days 10–38 days post-hatch. Fish were sampled for whole-body vitellogenin concentrations at day 38 post-hatch and for histological examination of gonads at day 60 post-hatch. In fish exposed to the highest concentration of pulp mill effluent, elevated concentrations of vitellogenin were measured. The androgenicity of the pulp mill water was confirmed by the increased number of males recorded at 60 days post-hatch. Image analysis of testes indicated stimulation of spennato genesis. Intersex fish were observed in all exposure groups. An androgenic activity equivalent to 5.6 ng/L dihydroxytestosterone was measured using the yeast androgen screen (YAS) assay. The present study demonstrates that both androgenic and estrogenic effects can be detected when exposing zebrafish during the juvenile period to complex mixtures of chemicals.     

NMR-based metabonomic studies reveal changes in the biochemical profile of plasma and urine from pigs fed high-fibre rye bread

This study presents an NMR-based metabonomic approach to elucidate the overall endogenous biochemical effects of a wholegrain diet. Two diets with similar levels of dietary fibre and macronutrients, but with contrasting levels of wholegrain ingredients, were prepared from wholegrain rye (wholegrain diet (WGD)) and non-wholegrain wheat (non-wholegrain diet (NWD)) and fed to four pigs in a crossover design. Plasma samples were collected after 7 d on each diet, and 1H NMR spectra were acquired on these. Partial least squares regression discriminant analysis (PLS-DA) on spectra obtained for plasma samples revealed that the spectral region at 3.25 parts per million dominates the differentiation between the two diets, as the WGD is associated with higher spectral intensity in this region. Spiking experiments and LC-MS analyses of the plasma verified that this spectral difference could be ascribed to a significantly higher content of betaine in WGD plasma samples compared with NWD samples. In an identical study with the same diets, urine samples were collected, and 1H NMR spectra were acquired on these. PLS-DA on spectra obtained for urine samples revealed changes in the intensities of spectral regions, which could be ascribed to differences in the content of betaine and creatine/creatinine between the two diets, and LC-MS analyses verified a significantly lower content of creatinine in WGD urine samples compared with NWD urine samples. In conclusion, using an explorative approach, the present studies disclosed biochemical effects of a wholegrain diet on plasma betaine content and excretion of betaine and creatinine.