Individual weight change is associated with household food security status

This study examined the relation between household food security status and current measured weight and change in self-reported weight over 12 mo using data from the 1999-2000 and 2001-2002 National Health and Nutrition Examination Surveys. Current measured BMI categories were as follows: underweight (<18.5 kg/m(2)), overweight (> or =25 kg/m(2)), and obese (> or =30 kg/m(2)). Change in self-reported weight used 2 cut-off points, i.e., a gain/loss of at least 2.27 kg (5 lb) and at least 4.54 kg (10 lb). Household food security categories were as follows: fully secure, marginally secure, insecure without hunger, and insecure with hunger. Multivariate analyses were adjusted for race/ethnicity, household income, education level, and current health status. Compared with women in households that were fully food secure, women in households that were marginally food secure [odds ratio (OR) 1.58] and food insecure without hunger (OR 1.76) were significantly more likely to be obese. Compared with women in households that were fully food secure, those in households that were marginally food secure were significantly more likely to gain at least 4.54 kg (OR 1.68). Compared with men in households that were fully food secure, men in households that were marginally food secure were more likely to be obese and to gain at least 4.54 kg, but these effects were smaller in magnitude than those for women and insignificant in some specifications. This study corroborates previous cross-sectional associations between intermediate levels of food insecurity and obesity for women, and it finds an association between intermediate levels of food insecurity and 12-mo weight gain for women.     

Acculturation, education, nutrition education, and household composition are related to dietary practices among Cambodian refugee women in Lowell, MA

Refugees in the United States have higher rates of some chronic diseases than US-born residents or other first-generation immigrants. This may be partially a result of dietary practices in the United States. There is limited information about which factors are related to dietary practices in refugee populations, particularly those who have been in the United States for 10 to 20 years. Research with Cambodian communities may be useful for examining the relationship between refugee characteristics and dietary practices. Two focus groups (n=11) and a survey (n=150) of Cambodian refugee women were conducted in Lowell, MA, from 2007 to 2008. χ² analyses, t tests, and analysis of variance tests were used to describe differences in dietary practices (24-hour recall and a targeted qualitative food assessment) by group characteristics. Higher acculturation was related to higher likelihood of eating brown rice/whole grains, and to lower likelihood of eating high-sodium Asian sauces. Higher education was related to higher likelihood of eating vegetables and fruits and to eating white rice fewer times. Nutrition education and receiving dietary advice from a health care provider were related to higher likelihood of eating whole grains/brown rice. Having a child at home was related to a higher likelihood of eating fast food. Among Cambodian refugees who have been in the United States for 10 to 20 years, dietary practices appear to have a relationship with acculturation (positive association), the interrupted education common to refugees (negative association), nutrition education from either programs or health care providers (positive association), and having a child at home (negative association).     

Dietary modification and moderate antioxidant supplementation differentially affect serum carotenoids, antioxidant levels and markers of oxidative stress in older humans

Oxidative stress is thought to be a factor in the progression of chronic diseases, and even the aging process itself. We examined the effect of two moderate vitamin, mineral and phytochemical supplements and a dietary intervention on markers of oxidative stress and antioxidant status in older humans. Subjects (n = 60, 65-85 y old) were enrolled in a 5-wk, double-blind, placebo-controlled study. The subjects were randomly assigned to a group with one of four interventions: antioxidant supplement capsule, antioxidant supplement tablet, high carotenoid diet or placebo. Postintervention serum levels of some of the supplemented carotenoids and alpha-tocopherol were higher in all treated groups compared with the placebo group and with preintervention levels within groups. Markers of oxidative stress or antioxidant capacity were not significantly different from preintervention levels, although the diet and supplement capsule groups had lower levels of some of those markers than the placebo group postintervention. The results suggest that both moderate antioxidant supplementation and a diet high in carotenoids elevate serum carotenoids and antioxidant levels in an older adult population, although with different specific effects.     

Levosimendan: the inotrope of choice in cardiogenic shock secondary to takotsubo cardiomyopathy?

Takotsubo cardiomyopathy (TC) has become an increasingly recognised entity in Western literature since its initial reporting in Japan. The pathogenesis underlying the myocardial stunning and systolic dysfunction is thought to be induced by elevated systemic levels of catecholamines and neuropeptides. Whilst the majority of patients are haemodynamically stable, a small proportion can develop cardiogenic shock. This creates a therapeutic dilemma because inotropic support using exogenous catecholamines (adrenaline, dobutamine, dopamine) may be counter-productive. Two cases where the calcium sensitiser levosimendan (a non-catecholamine inotrope) was used successfully in TC-related cardiogenic shock are presented. The management of circulatory compromise in TC is then discussed.     

Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: a method of assessing the Circle of Willis

Transcranial pulsed Doppler ultrasound and spectral analysis were used for detection of blood velocities in the basal cerebral arteries. The Doppler transducer was placed superior to the zygomatic arch and during insonation of the middle cerebral artery care was taken to obtain maximum Doppler-shift frequency signals since this allowed a small angle between the ultrasound beam and this artery. Doppler signals were obtained from the middle, anterior, and posterior cerebral arteries in 20 volunteers with the average depth of the Doppler gate at 4.9 (4.6-5.2 cm), 5.2 (4.9-5.4 cm), and 6.3 cm (6.0-6.9 cm), respectively. These measurements were in agreement with those obtained for 15 cadaver studies, in whom the distance from the proposed site of the Doppler transducer to each basal cerebral artery was measured as 4.7 +/- 0.6, 5.3 +/- 0.5, and 5.9 +/- 0.9 cm, respectively. The reproducibility of middle cerebral artery blood velocity values was tested in seven subjects and showed a variation of not more than 8% in any individual. The method was used in combination with common carotid compression to assess four patients who had occlusive extracranial carotid disease; in three the disease was more severe on one side and reversal of blood flow in the proximal ipsilateral anterior cerebral artery was demonstrated, consistent with cross flow from the contralateral side via the anterior communicating artery of the Circle of Willis. In the fourth patient augmentation of posterior cerebral artery blood velocities during common carotid compression indicated the major collateral source was from the vertebrobasilar system.     

One year surveillance of HIV-1 infection in Johannesburg, South Africa

A sero-epidemiological surveillance study to monitor the prevalence of HIV-1 infection in Johannesburg, South Africa, was commenced in February 1988. The population selected for study were attenders at clinics for sexually transmitted diseases (STD) and at family planning (FP) clinics. In the 12 months of the study 6631 sera were tested. Of the STD attenders, 15 of 1224 black females (1.2%) and 21 of 2482 black males (0.8%) were positive. Of the 449 white males tested 49 were homosexual, amongst whom 10 (20.4%) were positive; in the heterosexual white male group 4 of 400 (1.0%) were positive. Of the FP clinic attenders, 4 of 1459 black females (0.3%) were positive. 68 of the 6631 sera tested were indeterminate for infection. No attenders were positive for HIV-2 infection. These data confirmed the entry of HIV infection into the black population in South Africa.     

Transcranial Doppler assessment of cerebral collateral during carotid endarterectomy

Sixteen patients (mean age 59 +/- 9 years) who were to undergo carotid endarterectomy were examined pre- and peroperatively using pulsed Doppler-shifted ultrasound; blood velocities in the middle cerebral artery were measured before and during common carotid compression in the conscious patient, and before and during measurement of carotid stump pressures at surgery in the anaesthetized patient. Measurements at endarterectomy showed a significant difference in middle cerebral artery blood velocities from patients with stump pressures of greater and less than 50 mmHg (t = 4.0, P less than 0.005). A threshold of 10 cm s-1 distinguished between stump pressures of greater and less than 50 mmHg in 15 of the 16 patients. Pre-operative blood velocity measurements during carotid compression did not correlate with those taken peroperatively at carotid clamping.