Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.     

TAS1R3 and TAS2R38 Polymorphisms Affect Sweet Taste Perception: An Observational Study on Healthy and Obese Subjects

Background: The inter-individual differences in taste perception find a possible rationale in genetic variations. We verified whether the presence of four different single nucleotide polymorphisms (SNPs) in genes encoding for bitter (TAS2R38; 145G > C; 785T > C) and sweet (TAS1R3; −1572C > T; −1266C > T) taste receptors influenced the recognition of the basic tastes. Furthermore, we tested if the allelic distribution of such SNPs varied according to BMI and whether the associations between SNPs and taste recognition were influenced by the presence of overweight/obesity. Methods: DNA of 85 overweight/obese patients and 57 normal weight volunteers was used to investigate the SNPs. For the taste test, filter paper strips were applied. Each of the basic tastes (sweet, sour, salty, bitter) plus pure rapeseed oil, and water were tested. Results: Individuals carrying the AV/AV diplotype of the TAS2R38 gene (A49P G/G and V262 T/T) were less sensitive to sweet taste recognition. These alterations remained significant after adjustment for gender and BMI. Moreover, a significant decrease in overall taste recognition associated with BMI and age was found. There was no significant difference in allelic distribution for the investigated polymorphisms between normal and overweight/obese patients. Conclusions: Our findings suggest that overall taste recognition depends on age and BMI. In the total population, the inter-individual ability to identify the sweet taste at different concentrations was related to the presence of at least one genetic variant for the bitter receptor gene but not to the BMI.     

Genetic testing for hereditary nonpolyposis colorectal cancer

Approximately 80 per cent of patients with colorectal cancer have sporadic disease whereas the remaining 20 per cent seem to have a genetic component. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common autosomal dominant hereditary syndrome predisposing to colorectal cancer. Various methods have been described to screen for HNPCC and to directly test for mismatch repair gene mutations. This study evaluates the initial results of 1) microsatellite instability (MSI) and immunohistochemistry (IHC) staining of tumors and 2) genetic sequencing for mismatch repair gene mutations in patients suspected to have HNPCC. Appropriate patients for HNPCC testing were identified through a high-risk colorectal cancer clinic. Of those patients screened only those who met Amsterdam criteria (AC) for HNPCC or were young age onset (YAO) (<40 years of age) were eligible for testing. The tumors underwent testing for MSI and had IHC performed in those patients with available tumor specimens. MSI was performed on the five markers approved by the NIH consensus conference. MSI-High (MSI-H) was defined as two or more markers being unstable. IHC was done with commercially available stains for MLH1 and MSH2. All patients had sequencing of the MLH1 and MSH2 genes performed to search for mutations by a commercial laboratory. Genetic counseling was provided and written informed consent was obtained. Fourteen patients were part of kindreds that met the AC. An additional 10 patients were <40 years of age at diagnosis of colorectal cancer but lacked any family history. Testing for MSI and IHC was performed on those available tissue blocks. Of the AC patients five had MSH2 mutations and two had MLH1 variants. Of the five with MSH2 mutations three of four had MSI-H tumors and all four had loss of expression of MSH2 on IHC. Of the MLH1 variants only one had MSI-H tumor and lacked expression of MLH-1 on IHC. Of those patients with no mutation identified three of six had MSI-H tumors. For those patients YAO no genetic mutations were identified. Two of the seven had MSI-H tumors. Genetic testing for HNPCC even in those patients fulfilling the rigid AC yielded mutations in only five of 14 patients with variants of unknown significance being found in an additional two patients. Only one MSH2 variant of unknown significance was identified in the 10 YAO patients, which would suggest that screening in this group of patients with MSI and/or IHC would be appropriate.     

Measuring health data management maturity in Abu Dhabi

The World Economic Forum recently released a Global Health Data Charter. The objective of this qualitative case study was to determine if the Charter's eight principles, along with a set of data management practice standards, could be used as an assessment tool to determine the maturity of data management practices within a health organization. The Health Authority — Abu Dhabi (HAAD) — represented the bounded holistic case for this study. The data collection methods included structured interviews, completion of an assessment tool, and electronic documentation review. The findings demonstrated good to excellent compliance between HAAD's data management practices and the Charter principles, indicating a high level of data management maturity. Applying the Charter as the assessment framework proved to be successful. This framework provided a simple yet comprehensive approach to rapidly determine HAAD's level of health data management maturity. This assessment tool may prove to be useful for other health organizations.     

Determinants for a low health-related quality of life in asthmatics

People with asthma suffer from impaired health-related quality of life (HRQL), but the determinants of HRQL among asthmatics are not completely understood. The aim of this investigation was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups. A cohort of three age groups in Sweden was investigated in 1990 using a questionnaire with focus on respiratory symptoms. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry, and allergy testing. Asthma was diagnosed in 616 subjects. Fifty-eight per cent (n = 359) of the subjects were women; and 24% were smokers, 22% ex-smokers, and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life. Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.     

The Lab: New Film Tells Need for Medical Technologists

Healthcare Strategic Planning: Approaches for the 21st Century , Alan M. Zuckerman, Chicago, IL: Health Administration Press, 1998, 120 pages, $35.00.

The Managed Health Care Dictionary , 2d ed., Richard Rognehaugh, Gaithersburg, MD: Aspen Publishers, 1998, 261 pages, $19.95.

Valuation of Physician Practices and Clinics , Bruce G. Krider, Gaithersburg, MD: Aspen Publishers, 1997, 178 pages, $100.00.     

Influenza subunit vaccine coated microneedle patches elicit comparable immune responses to intramuscular injection in guinea pigs

Delivery of influenza vaccine using innovative approaches such as microneedles has been researched extensively in the past decade. In this study we present concentration followed by formulation and coating of monobulks from 2008/2009 seasonal vaccine on to 3M's solid microstructured transdermal system (sMTS) by a GMP-scalable process. The hemagglutinin (HA) in monobulks was concentrated by tangential flow filtration (TFF) to achieve HA concentrations as high as 20 mg/ml. The stability of the coated antigens was evaluated by the functional assay, single radial immunodiffusion (SRID). The data generated show stability of the coated antigen upon storage at 4 °C and room temperature in the presence of desiccant for at least 8 weeks. Freeze–thaw stability data indicate the stability of the coated antigen in stressed conditions. The vaccine coated microstructures were evaluated in vivo in a guinea pig model, and resulted in immune titers comparable to the traditional trivalent vaccine administered intramuscularly. The data presented indicate the potential use of the technology in delivery of influenza vaccine. This paper also addresses the key issues of stability of coated antigen, reproducibility and scalability of the processes used in preparation of influenza vaccine coated microneedle patches that are important in developing a successful product.     

Casual Hook up Sex During the First Year of College: Prospective Associations with Attitudes about Sex and Love Relationships

This study examined bidirectional relationships among emerging adults’ involvement in casual hook up sex and attitudes about sex and love relationships. At the start and end of their first year in college, undergraduates (N = 163) responded to measures of sexual behavior, sexual attitudes, and attitudes about love relationships. In cross-sectional analyses, attitudes about sex and love both were associated with involvement in casual hook up sex. In prospective analyses, initial attitudes about sexual instrumentality uniquely predicted involvement in later hook up sex, even after controlling for past hook up sex. Furthermore, involvement in hook up sex during the first year of college predicted greater sexual permissiveness and comfort with casual genital contact, even after controlling for initial sexual attitudes and hook up behaviors. None of the associations between attitudes and behavior were qualified by gender. Experiences of causal hook up sex appear to have implications primarily for emerging adults’ attitudes about sexual interactions rather than their attitudes about love relationships.     

The Impact of Behavioral Intervention on Family Interactions at Mealtime in Pediatric Cystic Fibrosis

The current study evaluated the impact of a behavioral intervention (Be In Charge!), targeting caloric intake and weight gain in children with CF, on family interactions at mealtime. Forty-five families of children with cystic fibrosis (CF), ages 4 to 12 years, were randomized to Be In Charge! or nutrition education and assessed using the McMaster Mealtime Family Interaction Coding System. No differences were found in family functioning between the two interventions pre- to posttreatment or 1-year follow-up, except for Affect Management. A significantly greater percentage of families receiving Be In Charge! demonstrated improvement in Affect Management from pretreatment to 1-year follow-up. Implications for developing the next generation of behavioral interventions are discussed.     

Stabilization of cranberry anthocyanins in nutraceutical capsules

Anthocyanins can be considered spy-substances, useful in obtaining information regarding the shelf-life of food supplements containing cranberry juice or cranberry-derived extracts. The level of total anthocyanins, as evaluated by high-performance liquid chromatography-diode-array detector and analytically expressed as cyanidin aglycone, represents a ‘quality index’ useful for routine estimation of shelf-life. The objective of this work was to study the stability of anthocyanins in a commercial cranberry (Vaccinium macrocarpon) dried extract compared with the stability of the same extract contained in a food supplement enriched with α-tocopheryl succinate and ascorbic acid. The values obtained after exposure of the samples to natural light and to alternating hot and cold temperatures show considerable sensitivity of the commercial cranberry dried extract to the agents used for the same evaluation (time, temperature and light) and emphasize a positive effect of the enrichment of the derived preparation with α-tocopheryl succinate and ascorbic acid.