Can the atherosclerosis prevention targets be achieved in type 2 diabetes?

Type 2 diabetes mellitus is beside hyperglycemia frequently accompanied by dyslipidemia, arterial hypertension, obesity and other atherosclerosis risks. The article summarizes current status demonstrating that we are far from recommended targets, especially with diabetes, blood pressure and lipid controls. More aggressive drug treatment together with life style changes will be necessary to reach our goals in Type 2 diabetic patients.     

Lung function is abnormal in 3-month-old infants with cystic fibrosis diagnosed by newborn screening

BACKGROUND: Long-term benefits of newborn screening (NBS) for cystic fibrosis (CF) have been established with respect to nutritional status, but effects on pulmonary health remain unclear. HYPOTHESIS: With early diagnosis and commencement of standardised treatment, lung function at ～3 months of age is normal in NBS infants with CF. METHODS: Lung clearance index (LCI) and functional residual capacity (FRC) using multiple breath washout (MBW), plethysmographic (pleth) FRC and forced expirations from raised lung volumes were measured in 71 infants with CF (participants in the London CF Collaboration) and 54 contemporaneous healthy controls age ～3 months. RESULTS: Compared with controls, and after adjustment for body size and age, LCI, FRC(MBW) and FRC(pleth) were significantly higher in infants with CF (mean difference (95% CI): 0.5 (0.1 to 0.9), p=0.02; 0.4 (0.1 to 0.7), p=0.02 and 0.9 (0.4 to 1.3), p<0.001, z-scores, respectively), while forced expiratory volume (FEV(0.5)) and flows (FEF(25-75)) were significantly lower (-0.9 (-1.3 to -0.6), p<0.001 and -0.7 (-1.1 to -0.2), p=0.004, z-scores, respectively). 21% (15/70) of infants with CF had an elevated LCI (>1.96 z-scores) and 25% (17/68) an abnormally low FEV(0.5) (below -1.96 z-scores). While only eight infants with CF had abnormalities of LCI and FEV(0.5), using both techniques identified abnormalities in 35% (24/68). Hyperinflation (FRC(pleth) >1.96 z-scores) was identified in 18% (10/56) of infants with CF and was significantly correlated with diminished FEF(25-75) (r=-0.43, p<0.001) but not with LCI or FEV(0.5). CONCLUSION: Despite early diagnosis of CF by NBS and protocol-driven treatment in specialist centres, abnormal lung function, with increased ventilation inhomogeneity and hyperinflation and diminished airway function, is evident in many infants with CF diagnosed through NBS by 3 months of age.     

Using Multiple Sampling Approaches to Measure Sexual Risk‐taking Among Young People in Haiti: Programmatic Implications

No previous published research has examined the applicability of varying methods for identifying young people who are at high risk of experiencing unintended pregnancy and acquiring HIV infection. This study compares three surveys of young people aged 15–24 in Port‐au‐Prince, Haiti, in terms of their sociodemographic characteristics and sexual behaviors and the surveys' usefulness for identifying young people at high risk and for program planning. The surveys consist of responses from: a representative sample of young people in the 2005–06 Haiti Demographic and Health Survey (HDHS), a 2004 facility‐based study, and a 2006–07 venue‐based study that used the Priorities for Local AIDS Control Efforts (PLACE) method. The facility‐based and PLACE studies included larger proportions of single, sexually experienced young people and people who knew someone with HIV/AIDS than did the HDHS. More respondents in the PLACE sample had multiple sex partners in the past year and received money or gifts in return for sex, compared with respondents in the facility study. At first and last sex, more PLACE respondents used contraceptives, including condoms. Experience of pregnancy was most commonly reported in the data from the facility‐based sample; however, more ever‐pregnant PLACE respondents than others reported ever having terminated a pregnancy. Program managers seeking to implement prevention activities should consider using facility‐ or venue‐based methods to identify and understand the behaviors of young people at high risk.     

Abnormalities in central auditory maturation in children with language-based learning problems.

OBJECTIVE: To examine maturation of the central auditory pathways in children with language-based learning problems (LP). METHODS: Cortical auditory evoked potentials (CAEPs) recorded from 26 children with LP were compared to CAEPs recorded from 38 typical children. CAEP responses were recorded in response to a speech sound, /uh/, which was presented in a stimulus train with decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360 ms. RESULTS: We identified three atypical morphological categories of CAEP responses in the LP group. Category 1 responses revealed delayed P1 latencies and absent N1/P2 components. Category 2 responses revealed typical P1 responses, but delayed N1 and P2 responses. Category 3 responses revealed generally low-amplitude CAEP responses. A fourth sub-group of LP children had normal CAEP responses. CONCLUSIONS: Overall, the majority of children with LP had abnormal CAEP responses. These children fell into distinct categories based on the abnormalities in maturational patterns of their CAEP responses. SIGNIFICANCE: We describe a rate sensitive stimulation paradigm which may be used to identify and categorize LP children who exhibit abnormal patterns of central auditory maturation.     

Role of videofluorography in assessing functional abnormalities in patients of head and neck cancer treated with chemoradiotherapy

Aim:   The major toxicity following treatment for head neck cancer is swallowing dysfunction which can be easily assessed by videofluorography (VFG), allowing documentation of the site and extent of abnormality thereby facilitating directed management.
Methods:   Between October 2003 and January 2007, 56 patients with locally advanced head and neck cancer were treated by an accelerated radiotherapy schedule with concurrent weekly cisplatin chemotherapy. Three months following treatment, these patients were locally disease free clinically, but complained of varying degrees of dysphagia and were subjected to a VFG evaluation.
Results:   This group comprised 52 men and four women with a median age of 56 years. The primary site distribution was: oral cavity (9), oropharynx (22), larynx (19), hypopharynx (5) and unknown primary (1). Swallowing function abnormalities in the form of structural displacement and temporal delays were documented and recorded as weakness of the tongue musculature ( n  = 6), palatal kink ( n  = 8), premature leak into the oropharynx ( n  = 20), impaired hyoid elevation ( n  = 23), impaired epiglottic tilt ( n  = 26), unilateral pharyngeal wall impairment ( n  = 16), residuum in vallecula or pyriform fossa ( n  = 30), aspiration in trachea ( n  = 29) and loss of nasopharyngeal seal ( n  = 7). Multiple abnormalities of different sub-sites were seen in each patient.
Conclusion:   VFG can document dysmotility disorders of upper aero-digestive tract like dysfunction of the base of tongue, larynx and pharyngeal musculature leading to stasis of the bolus and vallecular residuum, epiglottis dysmotility resulting in silent aspirations, and inadequate nasopharyngeal seal leading to nasal regurgitation. A clinical correlation alongwith quantification of VFG findings is required.     

Collagen XVIII modulation is altered during progression of oral dysplasia and carcinoma

Background:  Collagen XVIII is a ubiquitous basement membrane (BM) component and a precursor of endostatin.
Methods:  Using immunohistochemistry and in situ hybridization, we studied the expression and localization of collagen XVIII in different stages of normal oral wound healing, epithelial dysplasia and squamous cell carcinoma (SCC).
Results:  In mild epithelial dysplasias collagen XVIII appeared as a continuous signal in the BM, whereas in severe epithelial dysplasias and in the invasive areas of oral SCCs collagen XVIII was absent. In situ hybridization showed that collagen XVIII mRNA expression did not decrease in severe dysplasia or oral carcinoma samples when compared with the mild dysplasias.
Conclusions:  The results indicate that the absence of collagen XVIII protein in severe oral dysplasias is related to the processing of the protein rather than to changes in mRNA expression.     

The ESPAD Study: implications for prevention

The European Schools Project on Alcohol and other Drugs (ESPAD) was concerned with the substance use, beliefs, attitudes and risk factors among over 50,000 16-year-olds in 26 European countries. Based on this data, the present paper focuses on critical issues in prevention and uses a country-level analysis with focus on the extent that contextual and cultural factors interact with factors influencing the use of alcohol and other drugs. The results indicate that: (i) an emphasis on risks and dangers may be a poor prevention strategy since many young people do not believe the widely accepted dangers of certain forms of substance use (e.g. cigarette smoking); (ii) misperception of norms in relation to substance use, that is, the belief that use of alcohol and other drugs is more common than it actually is, emerged in most countries with the exception of Nordic countries; (iii) the correlation between perceived access to substances and actual use depended on the substance involved; correlations were strongest for cannabis but low for alcohol; (iv) the measure of problem behaviour was used in the ESPAD study (truancy from school), is correlated with substance use in a way that is opposite to that predicted in problem behaviour theory; and (v) there were no indications that the potential restraining factors that were examined in this study (involvement in athletics and leisure) acted in a way that prevented people from experimenting with drugs. The results of this analysis suggests that far from our having identified a core set of universal influences that act to determine substance use, the importance of cultural and contextual factors have been underestimated as has the importance of the specific substance involved.     

Extending the critical aspects of the water access indicator using East Africa as an example

The United Nations has declared 2005–2015 the Fresh Water Decade in which more people than ever before will gain access to water. Despite acknowledging that water quantity is important to health, so far only water quality is used in monitoring the Millennium Development Goals. This study examines the changes in national access figures when both water quality and quantity are taken into account to determine access. Using East Africa as an example shows that the number of people with access to water for the region decreased by 9% (7% urban and 10% rural). The largest difference in access is observed in Eritrea 25% (11% urban and 36% rural). Reduction is higher in rural areas. However, significant reduction in access is also observed in urban Ethiopia (14%). In conclusion, the indicators for access to water would be better articulated by adding water quantity to the indicator which currently only includes water quality, while the Demographic Health Survey and Multiple Indicator Cluster Survey routinely collects information on both aspects.