Evolution of health inequalities in Catalonia [Spain]

OBJECTIVE: To analyze the evolution of social inequalities in health in Catalonia (Spain) in the last 20 years. METHODS: Mortality in 354 small areas of Catalonia (288 cities in Catalonia and 66 health areas in the city of Barcelona) was analyzed for the 1984-98 period. Indicators of self-perceived health status, lifestyles, and health services utilization by social class and gender were compared for 1994 and 2002. Factors related to occupational health, immigration and health, environmental health, and policies to reduce social inequalities in health were also analyzed. RESULTS: Although most health indicators improved, multiple inequalities in health were found in both 1994 and 2002. These inequalities were the same in 2002 as in 1994 or, in some cases, worse. The collectives with the worst indicators were persons living in the most deprived areas, those from disadvantaged social classes, women, and immigrants from low-income countries. CONCLUSION: Social inequalities in health have persisted over the past 20 years in Catalonia. We present some recommendations on health information systems, research, and policies to reduce these inequalities.     

Induction of Colitis in Young Rats by Dextran Sulfate Sodium

Models using dextran sulfate sodium (DSS) to induce experimental colitis in rodents have been performed mostly in adult animals. For this reason, we aimed to develop a model of colitis in young rats. DSS was administered to 30-day-old rats at concentrations ranging from 0.5 to 5% in drinking water. Young rats were remarkably sensitive to DSS since clinical symptoms rapidly rose with 5% DSS and most animals died after the fifth day. With 1 and 2% DSS, the severity of mucosal lesions was also high on day 7, the animals showing leukocytosis and anemia. At 0.5% DSS, leukocytosis and mild colonic lesions were induced. This concentration of DSS significantly increased myeloperoxidase activity and goblet cell number in the colon, indicating mucosal inflammation. Since food consumption was not reduced by 0.5% DSS, we suggest that this protocol can be used to study the effects of dietary supplements on intestinal inflammatory processes.     

Astrocytes enhance lipopolysaccharide-induced nitric oxide production by microglial cells

Several stimuli result in glial activation and induce nitric oxide (NO) production in microglial and astroglial cells. The bacterial endotoxin lipopolysaccharide (LPS) has been widely used to achieve glial activation in vitro, and several studies show that both microglial and, to a lesser extent, astroglial cell cultures produce NO after LPS treatment. However, NO production in endotoxin-treated astrocyte cultures is controversial. We characterized NO production in microglial, astroglial and mixed glial cell cultures treated with lipopolysaccharide, measured as nitrite accumulation in the culture media. We also identified the NO-producing cells by immunocytochemistry, using specific markers for the inducible NO synthase (iNOS) isoform, microglial and astroglial cells. Only microglial cells showed iNOS immunoreactivity. Thus, contaminating microglial cells were responsible for NO production in the secondary astrocyte cultures. We then analysed the effect of astrocytes on NO production by microglial cells using microglial-astroglial cocultures, and we observed that this production was clearly enhanced in the presence of astroglial cells. Soluble factors released by astrocytes did not appear to be directly responsible for such an effect, whereas nonsoluble factors present in the cell membrane of LPS-treated astrocytes could account, at least in part, for this enhancement.     

Preventive effect of social support on mortality among elderly population: a longitudinal study

BACKGROUND: The main objective of this study is to analyze the relationship between social support and the mortality among a non-institutionalized population cohort age 60 or above residing in Barcelona studied throughout the 1996-1999 monitoring period for the purpose of analyzing the relationship between the social support and the mortality of this cohort. METHODS: In 1996, a telephone survey was conducted of 755 individuals (316 males and 439 females) who had been surveyed in the 1992 Barcelona health survey and who, were age 60 or above that year. The questionnaire included socio-demographic, morbility and health condition, social support and social network-related variables. The deaths during the 1996-1999 period were recorded. Logic regression was used for analyzing the social support-mortality relationship. RESULTS: The deaths for the period in question totaled 55 individuals (5.9% of the females and 9.2% of the males). Among the variables reflecting social support, for the males solely the situation of living with someone was found, in the bivariate analysis, to have a significant relationship to the mortality, which was higher for those males who lived with other family members, but not with their wives or female partner (OR = 3.7; IC 95% 1.4-9.6). Among the females, the existence of support from neighbors, the size of the family network, the number of contacts with the community network and the situation of living with someone else were related to the mortality in the bivariate analysis, although in the multivariate logic regression, solely the support of neighbors (OR = 3.6; IC: 1.1-11.1) was found to have a significant relationship. CONCLUSIONS: The results are consistent with prior studies revealing a relationship between the social support variables and the mortality. The relationship between the different social support variables and the possible prevention mechanisms should be taken up in future studies.     

Single-cell analysis of intrathyroidal lymphocytes shows differential cytokine expression in Hashimoto's and Graves' disease

Most human organ-specific autoimmune diseases such as Hashimoto's thyroiditis (HT) are considered to be Th1 mediated, and a quantitative dominance of Th1 cells in thyroid infiltrates from both Graves' disease (GD) and HT affected glands has been reported. However, Th2 dominance would be expected in GD, where thyroid hyperfunction induced by stimulating antibodies predominates over tissue destruction. We have analyzed the interleukin-4 (IL-4), interferon-γ (IFN-γ) production by T cells at the single-cell level, both in infiltrating lymphocytes isolated from digested GD and HT thyroid glands and in derived T cell lines, by direct intracellular cytokine detection. Results showed a heterogeneous pattern of cytokine production in bulk GD infiltrates and derived T cell lines, and a similar pattern was observed in the much larger HT infiltrates. Both type 1 and type 2 cytokines were simultaneously produced by the infiltrating populations, and T cells with both patterns as well as intermediate patterns similar to ThO cells could be detected ex vivo. However, the larger T lymphocytes, presumably activated and responsible for the autoimmune damage, predominantly produced IL-4 in GD and IFN-γ in HT. The specificity of the Th2 responses in GD was suggested by the enrichment in IL-4 production after antigen-specific expansion of two oligoclonal T cell lines. These data show that both type 1 and type 2 cytokines are produced in the thyroid glands affected by autoimmunity and that the difference between diseases may be the effect of a functionally dominant population at a given time. This in vivo chronically activated antigen-specific population, producing type 1 or type 2 cytokines locally, may be responsible for the effect finally leading to one of the disease states.     

Compliance with and tolerance of mefloquine and chloroquine + proguanil malaria chemoprophylaxis in French short-term travellers to sub-Saharan Africa

To compare the compliance with and tolerance of mefloquine (MQ) and chloroquine + proguanil (CQ-PRO) chemoprophylaxis, we conducted a study using a self-reported questionnaire in 2 groups of native French adult visitors to Senegal or Kenya. CQ (100 mg daily) + PRO (200 mg daily) prophylaxis was prescribed for all patients travelling to Senegal and for those going to Kenya when MQ was contraindicated; MQ (250 mg weekly) was prescribed for the other subjects. There were no significant differences in age, sex, exposition and measures of protection against mosquito bites, concomitant drug use or mean duration of chemoprophylaxis between the 2 groups, and compliance during travel was excellent in both. Chemoprophylaxis was more frequently interrupted prematurely in the MQ group. The rates of overall side-effects attributed to malaria chemoprophylaxis were 16% for MQ against 12% for CQ-PRO (not significant). However, nonserious neuropsychiatric adverse events are more frequent with MQ: 11.5% compared to 2% with CQ-PRO. MQ should be used with caution.     

Dead Loa loa filaria in a subconjunctival site. Apropos of a case

The authors report a case of a dead adult Loa loa filarial worm, in a subconjunctival position, but well recognisable. This manifestation, with no notable functional consequence, had never been previously reported.     

Information needs of the traumatic brain injury patient's family members regarding the consequences of the injury and associated perception of physical, cognitive, emotional and quality of life changes

We studied physical cognitive emotional and quality of life changes noted by relatives in a sample of 65 severely traumatic brain injured TBI patients several years after injury The purpose of the present study was to evaluate the families perception of these changes and their need for information con cerning the consequences of TBI Our results indicated that the perceived changes in behavioural and affective symptoms and in the patient s quality of life were most closely associated with the need expressed by family members for information concerning TBI We also found that family relationships were especially affected by problems in the behavioural and affective domain and the decrease in patient quality of life as reported by relatives These findings underline the importance of providing the relatives of TBI patients with information about the consequences of the injury with particular emphasis on behavioural and emotional disturbances in order that they might cope better with these problems