Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials.

BACKGROUND: In the past only physiological and clinical outcomes have been used to assess the effect of asthma interventions and the effect of the intervention on the lives of the patients has not been determined. The objective of this study was to assess health related impairment of quality of life in adult asthmatic patients and to develop a questionnaire for measuring quality of life in clinical trials in asthma. METHODS: Impairment of quality of life in adults with asthma was evaluated from structured interviews in which patients were asked to identify the parts of their daily lives affected by asthma. On the basis of these results, an asthma quality of life questionnaire was developed in an interviewer and self administered form and tested for comprehension and acceptability. A total of 150 adults with asthma and with a wide range of airway hyperresponsiveness were enrolled from previous clinical trials, local asthma clinics, and notices in the media. RESULTS: Areas of quality of life impairment included symptoms classically associated with asthma, responses to environmental stimuli, the need to avoid these stimuli, limitation of activities, and emotional dysfunction. Areas of impairment were similar across strata of airway hyperresponsiveness, age, and treatment requirements and between sexes, thus allowing a single questionnaire suitable for all adults with asthma to be developed. The questionnaire contains 32 items and takes 5-10 minutes to administer; in the pretesting it was shown to be acceptable to a wide range of patients. CONCLUSIONS: The questionnaire includes areas of quality of life impairment that are important to adult asthmatic patients. It has been designed to be responsive to within subject change and therefore may be used as a measure of outcome in clinical trials in asthma.     

How disabled are patients with somatoform disorders?

The purpose of this study was to evaluate the level and quality of psychosocial disabilities in patients suffering from somatoform disorders (SFD). Of 221 patients referred for psychiatric and cognitive-behavioral inpatient treatment, 37 were diagnosed according to DSM-IV as having SFD, 56 as pain disorder, 70 met the criteria for the subsyndromal form of SFD called the “Somatic Symptom Index” (SSI). The control group consisted of 58 patients with other mental disorders. All patients completed the Dysfunctional Analysis Questionnaire (DAQ) which measures social, vocational, personal, familial, and cognitive disabilities on psychometric scales. The results showed substantial disabilities in all somatoform subgroups; however, the levels and patterns of dysfunction in these patients were not statistically different from those in the control group. Impairment was generally more severe when patients had a comorbidity of somatoform and affective disorders. It is concluded that SFDs are associated with marked psychosocial disabilities similar to those seen in other mental disorders. The strongest predictor for psychosocial dysfunction is the comorbidity of somatoform with affective disorders, but not with anxiety disorders.     

MRI of the Stener lesion

Objective. To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. Design. Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. Results. The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00–0.17 and a specificity of 0.53–0.83. The values for inter- and intraobserver agreement were measured. The intraobserver for GRASS was 0.27–0.75 (most experienced reader 0.75). Conclusions. 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.     

A systemic route for drug loading to lymphatic phagocytes

Lymph nodes are primary germination and proliferation sites for many types of pathogens. Maintaining therapeutic levels of appropriate chemotherapeutic agents in the lymph node tissue is critical for the treatment of both infection and cancer. This study was intended to develop a systemic route for loading lymph node phagocytes with drugs, using a lymph node specific nanocarrier. The latter is assembled as a 10-15 nm particle with a drug-carrying core and a phagocyte-homing poly(1-->6)-alpha-d-glucose based interface. Biokinetics and microdistribution of the model carrier were investigated in vivo. Nanocarrier accumulation in lymph nodes reached 30-35% dose/g in central lymph nodes, with deposition in various phagocytic cell populations. The latter included cells harboring inhaled microparticles translocated to lymph nodes from the lungs. In view of the nanocarrier ability to transport and release significant amounts of various drug substances, the data suggests feasibility of systemic drug loading to lymphatic phagocytes and, through drug release, to the neighboring cells.     

Alkoholkonsum der Kinder

Objective

Based on the initial survey of the project “Strengthen parents for dealing with the alcohol consumption of their children” parental style was quantified. The survey addressed the following issues: 1. The parents information of the alcohol consumption of their adolescents. 2. Adequate rules when dealing with the alcohol consumption of their children. 3. Parent?s reactions to a potential intoxication of their children.

Method

2,793 parents of students in grades 8–10 were surveyed in Baden-Württemberg, Berlin, Saxony and Schleswig-Holstein. The questionnaires were passed back through the teachers. The questionnaires were collected by the teachers.

Results

The results show that parents feel well informed about alcohol related education of children. 71?% use the internet as an information source. Approx. 95?% of the parents have talked with their children about alcohol consumption, particularly adviced them of health damages and development of dependence. Those rules of behavior guaranteeing a safe way home are favored by parents. In response to rule violations the parents talk with their children first. The comparison with current youth surveys shows that parents underestimate their children?s drinking.

Conclusions

Alcohol and its consequences are a topic of conversation among parents and children. The parents need support to argue objectively and according to youth. The Internet should be used for drug prevention education activities.     

Arsenic Concentrations in Soils Impacted by Dam Failure of Coal-Ash Pond in Zemianske Kostolany,Slovakia

In this study, the concentrations of arsenic were determined in the soils around old coal-ash pond. The soils in the study area were severely contaminated with arsenic after dam failure of the coal-ash pond. The mean concentrations of arsenic in soils collected from three sampling depths of 0–20, 20–40 and >40 cm were 173, 155 and 426 μg/g, respectively, exceeding greatly the Dutch intervention threshold for this element. Arsenic concentrations were positively correlated with total iron and aluminium contents in the soils (r = 0.73, p < 0.001 and r = 0.72, p < 0.001, respectively), indicating that oxyhydroxides of iron and aluminium may control the distribution of arsenic in these soils. Ammonium nitrate extractant was used to mimic availability of arsenic for plant uptake from the soils. Between 0.05 and 6.21% of the total soil arsenic were extracted using a single extraction test and a significant positive correlation between soil leachate pH and arsenic extractability (r = 0.70, p < 0.01) was observed. This suggested that soil pH might play a role in the bioavailability of arsenic.     

Synthesis of a macromolecular camptothecin conjugate with dual phase drug release

A water soluble macromolecular conjugate of camptothecin (CPT) with a new, dual phase hydrolytic drug release mechanism was prepared on the basis of a 60 kDa biodegradable hydrophilic "stealth" polyacetal, poly(1-hydroxymethylethylene hydroxy-methyl formal). Succinamido-glycinate was used as a prodrug releasing group. A model preparation with 7.5% CPT content w/w was water soluble. The lipophilic camptothecin prodrug, camptothecin-(O20)-succinimidoglycinate, was released from the conjugate with t(1/2) = 2.2 +/- 0.1 h in rodent plasma. The blood clearance in a rodent model as measured by CPT was release limited, t(1/2) = 2.1 +/- 0.2 h, while the conjugate half-life was 14.2 +/- 1.7 h. In a xenograft tumor model, the conjugate demonstrated higher antineoplastic efficacy than CPT at a less than equitoxic dose. This improved therapeutic window is in line with the modified drug pharmacokinetics and with camptothecin release in a stabilized lipophilic prodrug form. Regulation of prodrug release and hydrolysis rates through linker structure modification will open the way to further improve both pharmacokinetics and pharmacodynamics.     

Survey of restaurants regarding smoking policies.

The New Hampshire Indoor Smoking Act was implemented in 1994 to protect the public's health by regulating smoking in enclosed places. A survey was conducted of New Hampshire restaurants to determine smoking policies, to determine restaurant characteristics associated with smoking policies, and to evaluate compliance with the Indoor Smoking Act. A list of New Hampshire restaurants was obtained from a marketing firm. Establishments were selected randomly until 400 had completed a 22-question telephone survey. Forty-four percent of restaurants permitted smoking. Characteristics positively associated with permitting smoking were being a non-fast-food restaurant, selling alcohol, selling tobacco, and having greater than the median number of seats. Of restaurants permitting smoking, 96.1% had a designated smoking area, 87.0% had a ventilation system to minimize secondhand smoke, 83.6% had a physical barrier between smoking and nonsmoking areas, and 53.1% exhibited signs marking the smoking area. Forty percent of restaurants permitting smoking met all four requirements of the Indoor Smoking Act. Smoking policies differ, by type of restaurant. Compliance with the Indoor Smoking Act is low.     

Chemopreventive effects of in vitro digested and fermented bread in human colon cells

Purpose

Bread as a staple food product represents an important source for dietary fibre consumption. Effects of wheat bread, wholemeal wheat bread and wholemeal rye bread on mechanisms which could have impact on chemoprevention were analysed in colon cells after in vitro fermentation.

Methods

Effects of fermented bread samples on gene expression, glutathione S-transferase activity and glutathione content, differentiation, growth and apoptosis were investigated using the human colon adenoma cell line LT97. Additionally, apoptosis was studied in normal and tumour colon tissue by determination of caspase activities.

Results

The expression of 76 genes (biotransformation, differentiation, apoptosis) was significantly upregulated (1.5-fold) in LT97 cells. The fermented bread samples were able to significantly increase glutathione S-transferase activity (1.8-fold) and glutathione content (1.4-fold) of the cells. Alkaline phosphatase activity as a marker of differentiation was also significantly enhanced (1.7-fold). The fermented bread samples significantly inhibited LT97 cell growth and increased the level of apoptotic cells (1.8-fold). Only marginal effects on apoptosis in tumour compared to normal tissue were observed.

Conclusions

This is the first study which presents chemopreventive effects of different breads after in vitro fermentation. In spite of differences in composition, the results were comparable between the bread types. Nevertheless, they indicate a potential involvement of this staple food product regarding the prevention of colon cancer.