Energy density but not fat content of foods affected energy intake in lean and obese women

BACKGROUND: Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases. When the fat content and energy density vary independently of one another, however, energy density, but not fat content, influences intake. OBJECTIVE: The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant. DESIGN: In a within-subjects design, 17 lean and 17 obese women consumed meals in the laboratory for four, 4-d test periods. In 3 of these test periods the energy density (4.4 and 6.7 kJ/g) or the fat content (16% and 36% of energy) of compulsory entrees representing 50% of each subject's usual energy intake was manipulated. Additional self-selected foods were consumed ad libitum at meals and as snacks. RESULTS: There were no systematic differences in palatability of the manipulated foods across conditions. Obese and lean participants responded similarly to the dietary manipulations. Intake of self-selected foods at meals was reduced significantly by 16% for both lean and obese subjects in the low- compared with the high-energy-density condition. The fat content of the compulsory foods had no significant effect on energy intake. Ratings of hunger did not differ between diets. CONCLUSION: These results indicate that when a portion of the diet was manipulated, the energy density, but not the fat content, of the foods affected total energy intake at meals in both lean and obese women.     

Retention and attendance with supervised buprenorphine treatment: a case-note review

Since 2001, the Langton Centre has used supervised administration of buprenorphine in treating heroin dependence, without distinguishing between detoxification and maintenance; most people commencing treatment may remain on buprenorphine indefinitely. The aim of this study was to describe retention in treatment, reasons for leaving, re-entry and pattern of attendance, and compare retention in practice with results from research trials, using a file review of sequential presentations for buprenorphine treatment. Retention in treatment was 37% at 6 months, the same as in Australian research trials of buprenorphine maintenance (37%); most people dropped-out without consultation or dose tapering. Repeated episodes of treatment constituted 45% of all episodes; missed scheduled doses were common. Participation in buprenorphine treatment often involves repeated, short episodes and erratic attendance. Measures to improve retention in treatment could improve treatment efficacy. [Bell J, Burrell T. Retention and attendance with supervised buprenorphine treatment: a case-note review. Drug Alcohol Rev 2006;25:161 - 165]     

Recent health care transitions and emergency department use by chronic long term care residents: a population-based cohort study

ObjectivesLong term care (LTC) residents commonly experience transitions between health care settings that can have important health consequences. The objective of this study was to quantify the effect of recent transitions on the risk of emergency department (ED) transfer among chronic LTC residents. Two types of transitions were considered: admission into LTC and discharge from hospital.DesignRetrospective cohort study using linked administrative data from Ontario, Canada.ParticipantsAll chronic LTC residents in Ontario older than 66 years on the date of the 2005 provincial LTC facility census.MeasurementsUsing facility census date as baseline, admission to LTC was defined as the number of days between LTC admission and baseline. Residents were categorized as one of: newly admitted (≤30 days), shorter-stay (31–90 days), or longer-stay (≥91 days). Within each group, residents were further subdivided based on having had a recent discharge from hospital. The first ED visit for each resident during the 6-month follow-up was counted, as were death and other competing risks. The cumulative incidence of ED transfer for each group was estimated and logistic regression was used to test whether differences between groups persisted after controlling for resident characteristics.ResultsOf the 64,589 residents, 3.0% were newly admitted, 4.9% were shorter-stay, and 92.1% were longer-stay. The 6-month cumulative incidences of ED transfers were 35.0% for newly admitted, 30.7% for shorter-stay, and 22.0% for longer-stay. The odds of an ED transfer were higher for newly admitted and shorter-stay residents relative to longer-stay residents, even after adjustment for resident characteristics (adjusted odds ratio, 95% confidence interval 1.9, 1.7–2.1; and 1.5, 1.4–1.7, respectively). Regardless of time since LTC admission, residents with a recent discharge from hospital had a cumulative incidence of nearly 40% and an increase in the odds of ED transfer of at least 50% compared with those who had not been in hospital.ConclusionsHealth care transitions, especially those from hospital, are associated with an increase in ED transfers among older chronic LTC residents. These findings highlight the need for a stronger focus on transitional care, especially posthospital care, for LTC residents.     

Body mass index trajectories from adolescence to midlife: differential effects of parental and respondent education by race/ethnicity and gender

Objectives. Race/ethnicity and education are among the strongest social determinants of body mass index (BMI) throughout the life course, yet we know relatively little about how these social factors both independently and interactively contribute to the rate at which BMI changes from adolescence to midlife. The purpose of this study is to (1) examine variation in trajectories of BMI from adolescence to midlife by mothers' and respondents' education and (2) determine if the effects of mothers' and respondents' education on BMI trajectories differ by race/ethnicity and gender. Design. We used nationally representative data from the National Longitudinal Survey of Youth. Our sample included White (n=4433), Black (n=2420), and Hispanic (n=1501) respondents. Self-reported height and weight were collected on 16 occasions from 1981 to 2008. We employed two-level linear growth models to specify BMI trajectories. Results. Mothers' education was inversely associated with BMI and BMI change among women. Among men, mothers' education was inversely associated with BMI; these educational disparities persisted for Whites, diminished for Blacks, and widened for Hispanics. Respondents' education was inversely associated with BMI among women, but was positively associated with the rate of BMI change among Black women. Respondents' education was inversely associated with BMI among White and Hispanic men, and positively associated with BMI among Black men. These educational disparities widened for White and Black men, but narrowed for Hispanic men. Conclutions. Our results suggest that by simultaneously considering multiple sources of stratification, we can more fully understand how the unequal distribution of advantages or disadvantages across social groups affects BMI across the life course.     

Weight status, quality of life, and cigarette smoking among adolescents in Washington State

Purpose

We examine age- and sex-specific associations between weight status and intensity of cigarette smoking in a large sample of adolescents. Additionally, we test whether quality of life (QOL) and weight control behaviors (i.e., trying to lose, gain, or stay the same weight) mediate the association.

Methods

We used cross-sectional data from the 2010 Washington State Healthy Youth Survey collected in grades 8, 10, and 12 (n = 11,222). Multinomial logistic regression was used to model cigarette smoking (none, light, frequent) as a function of weight status, weight control behaviors, and QOL by sex and age. Indirect effects of presumed mediators were assessed using the product of coefficients approach.

Results

Weight status was not associated with smoking. Trying to stay the same weight was associated with lower odds of light smoking for younger girls (OR = 0.25; 95 % CI = 0.08, 0.84), whereas trying to lose weight was associated with higher odds of light smoking for older girls (OR = 1.73; 95 % CI = 1.11, 2.70). Low QOL was associated with higher odds of light and frequent smoking for both girls and boys (P < 0.001). The mediation effects of weight control behavior and QOL combined were significant in the associations between body mass index percentile and smoking among older girls.

Conclusion

Targeted interventions designed to promote QOL and healthy weight control behaviors among youth may help to decrease the prevalence of smoking.     

Effects of a chronic exercise training protocol on oxidative stress and right ventricular hypertrophy in monocrotaline-treated rats

1. In the present study, we investigated the effects of exercise training on cardiac hypertrophy and oxidative stress in a monocrotaline (MCT)-induced cor pulmonale model. Male Wistar rats were assigned to one of three groups: sedentary control (SC); sedentary MCT (SM); or trained MCT (TM). 2. Right ventricular hypertrophy (RVH) was induced by a single injection of MCT (60 mg/kg, i.p.). Exercise training consisted of running on a treadmill (five times a week, during Weeks 3, 4 and 5). Systemic oxidative stress was evaluated in erythrocytes by chemiluminescence (CL) and the activity of the anti-oxidant enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione S-transferase (GST) was determined. 3. At Week 3, MCT-treated animals exhibited RVH, lung congestion, decreased SOD activity and increased CAT activity. Exercise training reduced MCT-induced RVH and increased GST activity. At Week 4, MCT-induced RVH was accompanied by an increase in CL and GST activity. However, in TM animals there was a decrease in CL and augmented SOD activity. At Week 5, there were no survivors in the SM group, whereas GST activity was elevated in TM rats compared with SC rats. There was no difference in GPx activity throughout the experimental protocol between the groups. 4. Taken together, our results indicate that exercise training is able to ameliorate RVH and improve survival, which is associated with a reduction in oxidative stress in MCT-treated rats.     

Tying it all together? A competency-based linkage model for family medicine

Residency faculty in all specialties will be required by the Accreditation Council for Graduate Medical Education (ACGME) to fully implement competencies into residency programs by 2006. Understanding the new requirements is complicated by having several sets of guiding documents from different sources, including the general competencies of the ACGME, the Residency Review Committee for Family Practice requirements, the competencies developed by the Society of Teachers of Family Medicine, and the Recommended Curriculum Guidelines for Family Practice Residents by the American Academy of Family Physicians. A competency linkage model brings together the various guidelines and shows specifically how they are related. This model helps family practice residency faculty better understand the guiding expectations for their programs and develop more appropriate learning objectives and assessment methods.     

Survival analysis of long-term exposure to different sizes of airborne particulate matter and risk of infant mortality using a birth cohort in Seoul, Korea

Background

Several studies suggest that airborne particulate matter (PM) is associated with infant mortality; however, most focused on short-term exposure to larger particles.

Objectives

We evaluated associations between long-term exposure to different sizes of particles [total suspended particles (TSP), PM ≤ 10 μm in aerodynamic diameter (PM₁₀), ≤ 10–2.5 μm (PM_10–2.5), and ≤ 2.5 μm (PM_2.5)] and infant mortality in a cohort in Seoul, Korea, 2004–2007.

Methods

The study includes 359,459 births with 225 deaths. We applied extended Cox proportional hazards modeling with time-dependent covariates to three mortality categories: all causes, respiratory, and sudden infant death syndrome (SIDS). We calculated exposures from birth to death (or end of eligibility for outcome at 1 year of age) and pregnancy (gestation and each trimester) and treated exposures as time-dependent variables for subjects’ exposure for each pollutant. We adjusted by sex, gestational length, season of birth, maternal age and educational level, and heat index. Each cause of death and exposure time frame was analyzed separately.

Results

We found a relationship between gestational exposures to PM and infant mortality from all causes or respiratory causes for normal-birth-weight infants. For total mortality (all causes), risks were 1.44 (95% confidence interval, 1.06–1.97), 1.65 (1.18–2.31), 1.53 (1.22–1.90), and 1.19 (0.83–1.70) per interquartile range increase in TSP, PM₁₀, PM_2.5, and PM_10–2.5, respectively; for respiratory mortality, risks were 3.78 (1.18–12.13), 6.20 (1.50–25.66), 3.15 (1.26–7.85), and 2.86 (0.76–10.85). For SIDS, risks were 0.92 (0.33–2.58), 1.15 (0.38–3.48), 1.42 (0.71–2.87), and 0.57 (0.16–1.96), respectively.

Conclusions

Our findings provide supportive evidence of an association of long-term exposure to PM air pollution with infant mortality.     

Informatively missing quality of life and unmet needs sex data for immigrant and Anglo-Australian cancer patients and survivors

Purpose

Although cancer can seriously affect peoples’ sexual well-being, survivors and patients may be reluctant to answer questions about sex. This reluctance may be stronger for immigrants. This study aimed to investigate missing sex data rates and predictors of missingness in two large studies on immigrants and Anglo-Australian controls with cancer and to investigate whether those with missing sex data may have worse sexual outcomes than those with complete data.

Methods

We carried out two studies aimed at describing the quality of life (QoL) and unmet needs amongst Arabic, Chinese and Greek immigrants versus Anglo-Australians cancer survivors (n = 596, recruited from cancer registries) and patients (n = 845). Logistic regression was used to model the probability of having missing sex data in either of the questionnaires. We compared the mean of the unmet sex needs responses of those who had missing QoL sex data (but not needs) to those who had completed both, and vice versa.

Results

Missing sex data rates were as high as 65 %, with immigrants more likely to skip sex items than Anglo-Australians (p = 0.02 for registry study, p < 0.0001 for hospital study). Women, older participants and participants with more advanced disease had increased odds of missingness. There was evidence that data were informatively missing. Additionally, the questionnaire which stated that the sex questions are optional had higher missing data rates.

Conclusion

High missing data rates and informatively missing data can lead to biased results. Using the questionnaires that state that they may skip sex items may lead to an underestimation of sexual problems or an overestimation of quality of life.     

The M-OVIN study: does switching treatment to FSH and / or IUI lead to higher pregnancy rates in a subset of women with world health organization type II anovulation not conceiving after six ovulatory cycles with clomiphene citrate – a randomised controlled trial

Background

Clomiphene citrate (CC) is first line treatment in women with World Health Organization (WHO) type II anovulation and polycystic ovary syndrome (PCOS). Whereas 60% to 85% of these women will ovulate on CC, only about one half will have conceived after six cycles. If women do not conceive, treatment can be continued with gonadotropins or intra-uterine insemination (IUI). At present, it is unclear for how many cycles ovulation induction with CC should be repeated, and when to switch to ovulation induction with gonadotropins and/or IUI.

Methods/Design

We started a multicenter randomised controlled trial in the Netherlands comparing six cycles of CC plus intercourse or six cycles of gonadotrophins plus intercourse or six cycles of CC plus IUI or six cycles of gonadotrophins plus IUI.Women with WHO type II anovulation who ovulate but did not conceive after six ovulatory cycles of CC with a maximum of 150 mg daily for five days will be included.Our primary outcome is birth of a healthy child resulting from a pregnancy that was established in the first eight months after randomisation. Secondary outcomes are clinical pregnancy, miscarriage, multiple pregnancy and treatment costs. The analysis will be performed according to the intention to treat principle. Two comparisons will be made, one in which CC is compared to gonadotrophins and one in which the addition of IUI is compared to ovulation induction only. Assuming a live birth rate of 40% after CC, 55% after addition of IUI and 55% after ovulation induction with gonadotrophins, with an alpha of 5% and a power of 80%, we need to recruit 200 women per arm (800 women in total).An independent Data and Safety Monitoring Committee has criticized the data of the first 150 women and concluded that a sample size re-estimation should be performed after including 320 patients (i.e. 80 per arm).

Discussion

The trial will provide evidence on the most effective, safest and most cost effective treatment in women with WHO type II anovulation who do not conceive after six ovulatory cycles with CC with a maximum of 150 mg daily for five days. This evidence could imply the need for changing our guidelines, which may cause a shift in large practice variation to evidence based primary treatment for these women.

Trial registration number

Netherlands Trial register NTR1449