Mutagenicity of urine and faeces after treatment of rats with known genotoxins

In the present study the feasibility of using mutagenic activityin faeces and urine as indicator for exposure to mutagens andcarcinogens was investigated. For this purpose faeces and urineof rats treated with known genotoxins were compared for mutagenicityin the Ames test and for induction of sister chromatid exchanges(SCE test) in Chinese hamster ovary cells. Faeces and urineof animals treated with 2-acetylaminofluorene, benzidine, furazolidone,benzo[a]pyrene or cyclophosphamide were positive both in theAmes test and in the SCE test, although the effects in the lattertest were less clear than in the former. Treatment with thebladder carcinogen N-nitrosodibutylamine resulted in urine thatwas clearly positive in the Ames test and slightly positivein the SCE test. Faeces and urine of rats were positive in theSCE and negative in the Ames test after treatment with the livercarcinogen N-nitrosodiethanolamine, and negative in the Amestest after treatment with the liver carcinogen N-nitrosodimethylamine.Urine of rats treated with N-nitrosodimethylamine was also negativein the SCE test, faeces were not tested for SCE induction. Theresults show that glucuronidated and nonglucuronidated mutagenscan be demonstrated in faeces and urine up to several days aftertreatment of rats with genotoxic agents and it is concludedthat examination of faeces and urine side by side enlarges thepossibility of detecting exposure of the body to mutagens.     

'Be active, eat right', evaluation of an overweight prevention protocol among 5-year-old children: design of a cluster randomised controlled trial

Background  

The prevalence of overweight and obesity in children has at least doubled in the past 25 years with a major impact on health. In 2005 a prevention protocol was developed applicable within Youth Health Care. This study aims to assess the effects of this protocol on prevalence of overweight and health behaviour among children.     

Pediatric health-related quality of life questionnaires in clinical trials

PURPOSE OF REVIEW: This review summarizes recent studies on the feasibility, reliability and validity of pediatric health-related quality of life questionnaires and gives an overview of recent applications of these measures in pediatrics. RECENT FINDINGS: The often-applied short form of the Child Health Questionnaire (CHQ-PF28) provides reliable physical and psychosocial summary measures, but reliable estimates for each scale require the longer version (CHQ-PF50). In addition to this questionnaire, the Pediatric Quality of Life Inventory is another reliable and valid measure. The TNO-AZL Preschool Children Quality of Life questionnaire is a feasible and reliable measure for preschool children. Generally, generic questionnaires are less sensitive to the impact of specific diseases than are disease-specific questionnaires. Parent and self-reports provide different outlooks on quality of life, which complement each other. SUMMARY: There are several feasible, reliable and validated pediatric quality of life questionnaires that can be used in clinical trials. These include generic and disease-specific questionnaires and health profile measures, as well as preference-based measures in pediatric settings. Generally, a combination of these types of questionnaires would be the most appropriate approach. Moreover, a combination of parent and self-reports should be applied. Appropriate selection of outcome measures will enhance the quality of pediatric studies and the ability to assess treatment effects in clinical trials.     

Endovascular treatment of acute subclavian pseudo-aneurysm after fracture of the clavicle

Pseudo-aneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. Nerve compression has been described with delayed paralysis as a consequence. We report a case of delayed diagnosis of a subclavian pseudo-aneurysm after a closed fracture of the clavicle in a 93-year-old patient. Diagnosis was confirmed by ultrasound and multi-slice-Ct. Two attempts to treat the pseudo-aneurysm with percutaneous thrombin injection failed. Considering the age of the patient, it was decided to exclude the pseudo-aneurysm by endovascular approach. A Hemobahn endoprosthesis was inserted by the introduction of an 11F sheath after cutting down the brachial artery under local anaesthesia. Angiography revealed complete exclusion of the pseudo-aneurysm. Follow-up at 9 months by ultrasound confirmed exclusion of the pseudo-aneurysm. Plain X-ray of the endograft showed no stent fractures. Paresis of the arm had improved. This case illustrates that endovascular exclusion is a safe approach, with reduced morbidity, compared with open surgery. Concern about stent deformation and stent fractures has been expressed. With the introduction of highly flexible stents, one can hope that this complication is less likely to occur. Although follow-up is relatively short, we believe that endovascular exclusion of subclavian pseudo-aneurysms is preferable to a surgical approach.     

Maternal educational level and risk of gestational hypertension: the Generation R Study

We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrollment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrollment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrollment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrollment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.     

Prevalence estimates of asthma or COPD from a health interview survey and from general practitioner registration: what's the difference?

BACKGROUND: The aim of this study was to compare prevalence estimates of asthma or chronic obstructive pulmonary disease (COPD) derived from self-report in a health interview survey and from general practitioners' (GPs') medical records, and to explain any differences. METHODS: the presence of asthma or COPD was measured by self-report in a random sample of 104 general practices in the Netherlands (n = 19 685) participating in the second Dutch National Survey of General Practice (DNSGP-2). This was compared with the presence of GP-diagnosed asthma or COPD in the same population as recorded using the International Classification of Primary Care by their GPs during a 12-month period. Gender, age, health insurance, ethnic background, educational level, tobacco exposure, and other symptoms and conditions were evaluated as explanatory variables using logistic models. RESULTS: The prevalence of self-reported asthma or COPD (9.7%) was almost twice as high as the prevalence based on GP information (5.2%). The medical records of patients who reported having asthma or COPD, without having a diagnosis in their medical records, usually included other respiratory conditions. Patients reporting no asthma or COPD but whose medical records carried a diagnosis of asthma or COPD, were relatively older (P < 0.01) and tended to be exposed to smoking in their home (P < 0.05). CONCLUSIONS: Two methods for estimating prevalence of asthma or COPD yielded different results: compared with GP medical records, self-reported prevalence shows an overestimation in people who suffer from other respiratory conditions and an underestimation in elderly persons living in a smoky environment.