Multiple dimensions of residential environments, neighborhood experiences, and jogging behavior in the RECORD Study

Objective

The purpose of this study was to examine the associations between a broad range of environmental characteristics and jogging behavior while taking into account different complementary outcomes to describe the behavior.

Methods

Using the RECORD Cohort Study (7290 participants, 2007-2008, Paris region, France), multilevel models were used to investigate individual/neighborhood variables associated with the probability of jogging; the time spent jogging; and the location of the practice.

Results

The presence and quality of green and open spaces was associated both with a greater probability of jogging [risk ratio (RR) for the first vs. the fourth quartile = 1.22, 95% credible interval (CrI): 1.03-1.44] and with the practice of jogging within rather than outside the neighborhood (RR = 1.29; 95% CrI: 1.10-1.53). Moreover, a high social cohesion and the presence of enjoyable places were associated with a higher probability of jogging (RR = 1.15; 95% CrI: 1.00-1.31; RR = 1.22; 95% CrI: 1.03-1.44) while the presence of parks or a lake increased the probability of jogging inside rather than outside the neighborhood (RR = 1.29; 95% CrI: 1.10-1.53; RR = 1.14; 95% CrI: 1.03-1.26).

Conclusions

Paying attention to physical and social environments, related neighborhood experiences, and attitudes toward health may be an effective approach to promote outdoor physical activity.     

Pharmacovigilance in Europe and North America: divergent approaches

Although international medicines regulators adopt a common system to assess the safety and efficacy of new drugs, pre-market evaluation is recognized as incomplete given the much larger post-market experience to follow. Adverse drug reactions contribute to more than 100,000 deaths in the United States annually and are among the top 10 leading causes of death. Regulators are developing active surveillance approaches to assess the risks of medicines in the post-market phase to enhance passive adverse drug reaction reporting systems that capture only one to ten percent of ADRs. The objective of this study is to compare international approaches to active surveillance and the manner in which regulatory agencies access and use post-market evidence in their decisions. A conceptual framework is used to guide the comparative analysis of pharmacovigilance governance and policy in the United Kingdom, France, the European Union, the United States and Canada using data gathered from key informant interviews and document review. While research networks are emerging internationally, we found a greater reliance on industry funding and oversight of post-market research in Europe compared to an emphasis on publicly funded programs in North America.     

Analysis of possible triggers of acute myocardial infarction (the MILIS study)

Recent documentation of a circadian variation in acute myocardial infarction (AMI) suggests that AMI is not a random event, but may frequently result from identifiable triggering activities. The possible triggers reported by 849 patients enrolled in the Multicenter Investigation of Limitation of Infarct Size were analyzed. Possible triggers were identified by 48.5% of the population; the most common were emotional upset (18.4%) and moderate physical activity (14.1%). Multiple possible triggers were reported by 13% of the population. Younger patients, men and those without diabetes mellitus were more likely to report a possible trigger than were older patients, women and those with diabetes. The likelihood of reporting a trigger was not affected by infarct size. This study suggests that potentially identifiable triggers may play an important role in AMI. Because potential triggering activities are common in persons with coronary artery disease, yet infrequently result in AMI, further studies are needed to identify (1) the circumstances in which a potential trigger may cause an event, (2) the specific nature of potential triggering activites, (3) the frequency of such activities in individuals who do not develop AMI and (4) the presence or absence of identifiable triggers in various subgroups of patients with infarction.     

Activin-A: a novel dendritic cell-derived cytokine that potently attenuates CD40 ligand-specific cytokine and chemokine production

Activin-A is a transforming growth factor-beta (TGF-beta) superfamily member that plays a pivotal role in many developmental and reproductive processes. It is also involved in neuroprotection, apoptosis of tumor and some immune cells, wound healing, and cancer. Its role as an immune-regulating protein has not previously been described. Here we demonstrate for the first time that activin-A has potent autocrine effects on the capacity of human dendritic cells (DCs) to stimulate immune responses. Human monocyte-derived DCs (MoDCs) and the CD1c(+) and CD123(+) peripheral blood DC populations express both activin-A and the type I and II activin receptors. Furthermore, MoDCs and CD1c(+) myeloid DCs rapidly secrete high levels of activin-A after exposure to bacteria, specific toll-like receptor (TLR) ligands, or CD40 ligand (CD40L). Blocking autocrine activin-A signaling in DCs using its antagonist, follistatin, enhanced DC cytokine (IL-6, IL-10, IL-12p70, and tumor necrosis factor-alpha [TNF-alpha]) and chemokine (IL-8, IP-10, RANTES, and MCP-1) production during CD40L stimulation, but not TLR-4 ligation. Moreover, antagonizing DC-derived activin-A resulted in significantly enhanced expansion of viral antigen-specific effector CD8(+) T cells. These findings establish an immune-regulatory role for activin-A in DCs, highlighting the potential of antagonizing activin-A signaling in vivo to enhance vaccine immunogenicity.     

Predictors of diabetes-specific knowledge and treatment satisfaction among Costa Ricans

PURPOSE: The purpose of this study was to identify predictors of disease-specific knowledge and patient satisfaction among adult Costa Ricans with type 2 diabetes. Knowledge differences between Costa Ricans and Spanish-speaking US Latinos also were tested. The psychometric viability of a Spanish-language diabetes knowledge and client satisfaction measure with Costa Ricans was reviewed. METHODS: The Diabetes Knowledge Questionnaire (DKQ) and the Client Satisfaction Questionnaire (CSQ) were administered to 162 Costa Rican adults with type 2 diabetes who were receiving services in the greater San Jose area. Sociodemographic, medical history, and anecdotal information also was collected. RESULTS: More years of education, younger age, longer diabetes duration, and home glucose monitoring predicted diabetes knowledge. Home glucose monitoring and treatment with only oral hypoglycemics predicted significantly lower patient satisfaction. Costa Ricans exhibited greater diabetes knowledge than respondents in an earlier study with Spanish-speaking Latinos. CSQ psychometric limitations with Costa Ricans were identified. CONCLUSIONS: The greater diabetes knowledge among Costa Ricans than US Latinos is likely due to more consistent, stable, and accessible care. Older, less educated, and newly diagnosed Costa Rican diabetes patients require more focused attention.     

Persistence of virus-specific IgM and clinical recovery after Japanese encephalitis.

We have searched for evidence of a chronic Japanese encephalitis virus (JEV) infection in six Thai patients convalescing from acute Japanese encephalitis (JE) in whom JEV-specific IgM antibody was last detected 116 to 350 days after their acute illness. These six patients were compared with 94 other JE patients matched for age, sex and serological response and in whom JEV-specific IgM was either short-lived (less than 90 days) or not tested. All patients were evaluated for the presence or absence of seven abnormal neurological signs over a 1- to 2-year period. During the first 30 days of illness the mean numbers (+/- S.E.M.) of abnormal signs per patients for the IgM and control groups were 3.8 +/- 0.3 and 2.3 +/- 0.1, respectively (P less than 0.01). After 1 year the six IgM patients still had significantly more abnormal neurological signs than controls (1.3 +/- 0.3 and 0.6 +/- 0.1, respectively [P less than 0.01]). By 2 years, the IgM group showed no neurological impairment; examination of cerebrospinal fluids revealed no evidence of subclinical viral infections. The recovery of the six IgM patients between 1 and 2 years after their relatively severe acute illness suggests that IgM antibody persistence was related to acute virulence rather than chronicity of the JEV infection.     

A comparison of patients with seropositive and seronegative rheumatoid arthritis

Summary It has recently been suggested that a subpopulation of patients with rheumatoid arthritis, diagnosed on clinical, radiologic and pragmatic grounds, but with negative rheumatoid factor tests, represents a clinical entity quite distinct from that of seropositve rheumatoid arthritis. We have studied 60 sequentially presenting patients, 30 of whom were selected because they were seronegative, and 30 selected because they were seropositive in regard to IGM rheumatoid factor. The only major differences detected between the two groups on blind assessment were a greater tendency to deformity, a greater degree of erosion and the presence of subcutaneous nodules in the seropositive group. Seronegative and seropositive rheumatoid arthritis appear to have very similar clinical features, but differing degrees of severity.