Tackling the Urban Health Divide Though Enabling Intersectoral Action on Malnutrition in Chile and Kenya

As momentum grows for a sustainable urbanisation goal in the post-2015 development agenda, this paper reports on an action research study that sought to tackle the urban health divide by enabling intersectoral action on social determinants at the local level. The study was located in the cities of Mombasa in Kenya and Valparaíso in Chile, and the impact of the intervention on child nutrition was evaluated using a controlled design. The findings showed that an action research process using the social educational process known as PLA could effectively build the capacity of multisectoral teams to take coordinated action which in turn built the capacity of communities to sustain them. The impact on child nutrition was inconclusive and needed to be interpreted within the context of economic collapse in the intervention area. Four factors were found to have been crucial for creating the enabling environment for effective intersectoral action (i) supportive government policy (ii) broad participation and capacity building (iii) involving policy makers as advisors and establishing the credibility of the research and (iii) strengthening community action. If lessons learned from this study can be adapted and applied in other contexts then they could have a significant economic and societal impact on health and nutrition equity in informal urban settlements.     

Analysis of peripheral blood T-cell subsets in active thyroid-associated ophthalmopathy: absence of effect of octreotide-LAR on T-cell subsets in patients with thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy (TAO) is thought to be a T-cell-mediated autoimmune disorder. We sought to characterize abnormalities in the peripheral blood T-cell subsets in patients with TAO, and examine whether the long-acting somatostatin analogue, octreotide-LAR, treatment affects these cells. We analyzed peripheral blood T-cell subsets by flow cytometry in 26 euthyroid patients with moderately severe active TAO and 24 controls. Twenty-five of the patients with TAO were enrolled in a randomized trial to receive either 30 mg of octreotide-LAR (n = 11) or placebo (n = 14) every 4 weeks for 16 weeks; all 25 patients subsequently received octreotide-LAR 30 mg every 4 weeks from week 16 to 32. T-cell subsets were analysed at baseline, week 16, and week 32. At baseline, the relative percentage of CD4+ helper T-cells (p = 0.0003) and the CD4+/CD8+ ratio (p = 0.008) were significantly higher in patients with TAO compared to controls. Patients with TAO had higher na?ve active T cells (CD45RA+, CD45RA+ CD4+) and lower memory T cells (CD45RO+, CD45RO+ CD4+) than controls. At weeks 16 and 32, there were no significant differences in any T-cell subsets between the octreotide-LAR-treated and placebo groups. These results support a role of T cell in the pathogenesis of TAO, and show that octreotide-LAR has no effect on T-cell subsets during 32-weeks of treatment.     

Talk the walk: the importance of teaching patients how to use their walking stick effectively and safely

Background: Walking sticks are used widely by people with arthritis, principally to reduce pain and improve stability and balance. However, they are frequently used incorrectly and can be dangerous if not properly maintained. Methods: Fifty randomly selected patients attending a rheumatology department were surveyed to determine whether their stick was appropriate to their needs and whether they were using it correctly. Results: Of the 50 patients, 38% used their stick incorrectly, usually in the wrong hand. Forty‐four per cent of sticks were of the wrong length and 54% were in imperfect condition, the main defect being a worn ferrule. Among the minority (18 patients) who had received instruction and training, 72% used their stick correctly, while only 50% of those who had not been trained used their stick in the correct hand where applicable to their condition. Conclusions: These findings highlight the importance of educating patients on how to obtain greatest benefit from their walking stick and of the necessity to check it regularly for defects to ensure safe usage.     

Correction to: “Best Things”: Parents Describe Their Children with Autism Spectrum Disorder Over Time

Journal of Autism and Developmental Disorders -     

MR Denoising Increases Radiomic Biomarker Precision and Reproducibility in Oncologic Imaging

Journal of Digital Imaging - Several noise sources, such as the Johnson–Nyquist noise, affect MR images disturbing the visualization of structures and affecting the subsequent extraction of...     

Arteriolar responses to vasodilator stimuli and elevated P(O2) in renin congenic and Dahl salt-sensitive rats

OBJECTIVES: Angiotensin II suppression leads to impaired vascular relaxation in normotensive animals on a high-salt diet. The goal of this study was to determine whether normal vascular reactivity could be restored by transferring the chromosomal region carrying the Dahl salt-resistant (R) renin gene into the Dahl salt-sensitive (SS) genetic background in a strain of renin congenic rats (RGRR). METHODS: Male RGRR and SS rats were fed low-salt (0.4%) and high-salt (4%) diets for 4 weeks. The responses of cremaster muscle arterioles to acetylcholine (ACh), sodium nitroprusside (SNP), and elevated PO2 were assessed using video microscopy. RESULTS: ACh-induced dilation was significantly enhanced in RGRR on a high-salt diet compared to SS rats, while dilation to the NO donor SNP was similar in both strains. A high-salt diet significantly enhanced arteriolar constriction in response to elevated PO2, in both SS and RGRR rats. CONCLUSIONS: These data suggest that transfer of the chromosomal region containing the renin gene is crucial in the recovery of ACh-induced dilation of arterioles in RGRR rats vs. SS rats, and that factors in the SS genetic background contribute to an enhanced sensitivity to elevated PO2, independent of genes on chromosome 13.     

Effect of single doses of dexamethasone and adrenocorticotrop hormone on serum bone markers in healthy subjects and in patients with adrenal incidentalomas and Cushing's syndrome

The aim of the present study was to explore whether short-term changes in glucocorticoid activity which occur during dynamic testing of the pituitary adrenal axis with dexamethasone, ACTH, or metyrapone could have an effect on serum osteocalcin (OC) and beta-crosslaps (beta-CTx) concentrations in healthy subjects, in patients with adrenal incidentalomas and in those with Cushing's syndrome. The study included 40 healthy subjects (35 women and 5 men, age range 18-69 yr), 49 patients with adrenal incidentalomas (34 women and 15 men, age range 19-77 yr) and 8 patients with Cushing's syndrome (5 cortisol-producing adenomas and 3 pituitary-dependent Cushing's syndrome, 3 women and 5 men, age range 19-70 yr). Serum OC and beta-CTx concentrations were determined with electrochemoluminescent immunoassays at midnight, after an overnight fast between 08:00 and 09:00 h, after an overnight dexamethasone test (1 mg, orally) and after a single dose of metyrapone (30 mg/kg, orally). In healthy subjects and in patients with adrenal incidentalomas, serum bone marker concentrations were also measured after a single dose of ACTH injection (Cortrosyn depot, 1 mg im). Patients with Cushing's syndrome, but not those with adrenal incidentalomas, showed significantly lower serum OC at midnight (18.5+/-12 ng/ml, mean+/-SD) and between 08:00 and 09:00 h (17.7+/-9.6 ng/ml) compared to corresponding values obtained in healthy subjects (24.5+/-7.0 and 28.3+/-12.2 ng/ml, respectively). Serum OC concentrations were significantly decreased after a single dose of 1-mg dexamethasone in healthy subjects (from 28.3+/-12.2 to 21.8+/-9.5 ng/ml) and in patients with adrenal incidentalomas (from 29.8+/-15.9 to 24.1+/-14.1 ng/ml), whereas serum OC concentrations remained unchanged in patients with Cushing's syndrome. In addition, serum OC concentrations were even more markedly decreased after a single dose of ACTH injection in both healthy subjects (12.5+/-4.6 ng/ml) and in patients with adrenal incidentalomas (12.2+/-6.5 ng/ml). By contrast, metyrapone administration failed to induce significant changes in OC levels. There were no significant differences in beta-CTx concentrations between the three groups or after drug treatments. Thus, serum OC levels should be interpreted with caution when obtained during testing of the pituitary-adrenal axis with dexamethasone or ACTH.