Time to change the glomerular filtration rate estimating formula in primary care?

BackgroundThe most commonly used equation for estimated glomerular filtration rate (eGFR) is nowadays the four-variable Modification of Diet in Renal Disease (MDRD) equation. This formula was derived from patients with non-diabetic chronic kidney disease (CKD) with mean GFR 40 ml/min.MethodsWe compared the MDRD study equation and the recently developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation by applying the two formulas in 1747 middle-aged cardiovascular risk persons in primary care.ResultsThe prevalence of renal insufficiency defined as eGFR < 60 ml/min was 6.7% (95% CI 5.6–8.0) according to the MDRD formula, and 3.6% (95% CI 2.8–4.6) according to the CKD-EPI formula. The subjects who were classified as having CKD according to the MDRD equation, but no-CKD according to the CKD-EPI formula, were mostly women (86%) and slightly younger than the subjects having CKD according to both formulas.ConclusionThe characteristics of the subjects commonly treated in primary care resemble more closely the population from which the CKD-EPI than the MDRD study equation was derived from. Thus, we suppose that in general practice, the CKD-EPI equation is more suitable for estimating renal function than the MDRD equation.     

Body mass index and health-related quality of life in apparently healthy individuals

Purpose

Obesity is known to be associated with a range of chronic medical comorbidities, but little is known about the impact of overweight and obesity on health-related quality of life (HRQoL) in persons without chronic diseases. The aim of this study was to assess HRQoL, body mass index (BMI) and health behavior patterns in a community sample of subjects who had no long-lasting medical comorbidities

Methods

We assessed HRQoL in 1,187 apparently healthy individuals (mean age 57 ± 7 years), of whom 24 % were classified as normal weight, 49 % as overweight, 20 % as obese and 7 % as very obese. Two different instruments of HRQoL were used: the generic Short-Form Health Survey (SF-36) questionnaire and the preference-based instrument EuroQol (EQ-5D).

Results

All physical components of the SF-36 decreased linearly according to BMI categories in women. In men, only poorer physical functioning scale showed linearity with rising BMI. Scores on the mental components of the SF-36 did not differ by BMI categories in either gender. The EQ-5D index and EuroQol visual analogue scale scores decreased linearly with rising BMI only in women.

Conclusions

In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender.     

The reliability of self-reported drinking in adolescence

AIMS: To study the reliability of adolescents' self-reported drinking and perceived drunkenness in surveys. METHODS: The data from two cross-sectional school-based questionnaire surveys with representative cluster samples (the European School Survey Project on Alcohol and Other Drugs, ESPAD) in Finland were used; there were 2161 (1995) and 3109 (1999) 15-year-old respondents. The response rates were 94% and 90% respectively. The measurements analysed were an open-ended and a set of closed-category questions concerning the latest drinking occasion. RESULTS: The set of three closed questions used in 1995 yielded mean amounts of 6.6 (girls) and 8.7 (boys) centilitres of pure alcohol whereas the figures obtained from the open question were 8.5 (girls) and 11.8 (boys) centilitres. With the closed set extended in 1999 into five questions, the two figures among girls were 7.7 (closed) and 7.7 (open) centilitres; the corresponding figures among boys were 11.3 (closed) and 11.7 (open) centilitres. Individual level correlations between the two measures among girls were 0.69 in 1995 and 0.69 in 1999; and 0.69 (1995) and 0.65 (1999) among boys. The numbers of students reporting specific beverage type use were higher when using closed questions compared with an open question. Drunkenness self-reports related logically to amounts of alcohol drunk. CONCLUSIONS: The adolescent drinking amount self-reports seem reasonably reliable and valid both on a population and individual level. A set of closed questions may capture the amount drunk even better than an open question.     

Assessment of cardiovascular risk in primary health care

Objective

This study aimed at investigating whether cardiovascular risk factors and their impact on total risk estimation differ between men and women.

Design

Cross-sectional cohort study.

Subjects

Finnish cardiovascular risk subjects (n = 904) without established cardiovascular disease, renal disease, or known diabetes.

Main outcome measures

Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), oral glucose tolerance test, and total cardiovascular risk using SCORE risk charts.

Results

According to the SCORE risk charts, 27.0% (95% CI 23.1–31.2) of the women and 63.1% (95% CI 58.3–67.7) of the men (p < 0.001) were classified as high-risk subjects. Of the women classified as low-risk subjects according to SCORE, 25% had either subclinical peripheral arterial disease or renal insufficiency.

Conclusions

The SCORE system does not take into account cardiovascular risk factors typical in women, and thus underestimates their total cardiovascular risk. Measurement of ABI and eGFR in primary care might improve cardiovascular risk assessment. especially in women.Key Words: Ankle-brachial index, cardiovascular risk estimation, gender difference, glucose disorders, renal functionMore women than men die from cardiovascular disease in Europe, but the non-conventional risk factors in women may remain undiagnosed or ignored.

• In a cohort of middle-aged cardiovascular risk subjects in primary care, 27% of the women and 63% of the men (p < 0.001) were classified as high-risk subjects according to the SCORE risk charts.
• Of the women classified as low-risk subjects according to SCORE, 25% had either subclinical peripheral arterial disease or renal insufficiency.
• Measurement of ABI and eGFR in primary care might improve cardiovascular risk assessment, especially in women.

     

Protein quantity and quality in term and preterm infants: effects on urine creatinine and expression of amino acid excretion data

The effect of dietary protein quantity and quality on the excretion of creatinine in preterm and term neonatal infants has been investigated. Whey protein predominant formulas result in increased creatinine excretion as compared with either casein protein predominant formulas or with pooled human milk in preterm infants (p less than 0.001 by ANOVA). The volume of human milk (170 versus 185 versus 200 ml/kg/day) appears to have little effect in these infants. In term infants, few differences among the feeding groups were observed, although creatinine excretion did increase with time. The pattern of creatinine excretion among feeding groups was similar regardless of whether or not the data were expressed in milligrams per deciliter or in milligrams per 24 hours. Small correlations of creatinine excretion with birth weight were observed, but these appeared to vary, depending on the type of feeding. These diet-induced differences in creatinine excretion indicate the need for caution in expressing other urinary metabolites, such as amino acids, relative to creatinine excretion.     

Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial

The purpose of the study was to examine the effects of a workplace physical exercise intervention on the perceived intensity of headache and the intensity of symptoms in the neck and shoulders, as well as on the extension and flexion strength of the upper extremities. The study was a cluster randomized controlled trial. The cross-over design consisted of physical exercise intervention (15 weeks) and no-intervention (15 weeks). The subjects (n=53) were office workers (mean age 46.6 (SD 8.4)) who reported headache (n=41) symptoms in the neck (n=37) or shoulders (n=41), which had restricted their daily activities during the last 12 months. Pain symptoms were measured using the Borg CR10 scale and muscular strength with a 5RM test. Statistical analyses were based on linear mixed models. Physical exercise intervention resulted in a slight, but statistically significant, decrease in the intensity of headache and neck symptoms, as well as an increase in the extension strength of the upper extremities. The mean decrease in headache during the 5-week period was 0.64 CR10 (95% CI 0.28-1.00) (P=0.001) or 49% (95% CI 22-77), and 0.42 CR10 (95% CI 0.11-0.72) (P=0.002) or 49% (95% CI 13-85) in the intensity of neck symptoms. The mean increase in the extension strength of the upper extremities was 1.3 kg (95% CI 0.5-2.1) (P=0.001) or 4% (95% CI 1-6). The intervention had no effect on the intensity of shoulder symptoms or the flexion strength of the upper extremities. Specific exercise may be clinically important to alleviate headache and neck symptoms.     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

Women's roles and women's drinking: A comparative study in four European countries 1

The present study analyzes the influence of role combinations on heavy drinking in four European countries: Finland, France, Germany, and Switzerland. Data sets come from nationally representative surveys. A growing number of studies have investigated the influence of social roles on alcohol consumption. Different theories such as role accumulation, role overload, and role deprivation aim to explain the association between roles and poor mental health, including heavy alcohol consumption. The results show that roles and role combinations influence heavy drinking differently in each country. The findings also indicate that the social position of women in a country is strongly connected to the differing associations between specific role combinations and heavy drinking across countries. No single role theory can be applied cross‐culturally. Large‐scale surveys are needed to test statistically the association between role combinations and heavy drinking.     

Upper Gastrointestinal (GI) pH in Young,Healthy Men and Women

The pH in the upper gastrointestinal tract of young, healthy men and women was measured in the fasting state and after administration of a standard solid and liquid meal. Calibrated Heidelberg capsules were used to record the pH continuously over the study period of approximately 6 hr. In the fasted state, the median gastric pH was 1.7 and the median duodenal pH was 6.1. When the meal was administered the gastric pH climbed briefly to a median peak value of 6.7, then declined gradually back to the fasted state value over a period of less than 2 hr. In contrast to the pH behavior in the stomach, feeding a meal caused a reduction in the median duodenal pH to 5.4. In addition, there was considerable fluctuation in the postprandial duodenal pH on an intrasubject basis. The pH in the duodenum did not return to fasted state values within the 4-hr postprandial observation period. There was no tendency for the duodenal pH to be related to the gastric pH in either the fed or fasted phases of the study. Furthermore, pH in the upper GI tract of young, healthy subjects appears to be independent of gender. The differences in upper GI pH between the fasted and the fed state are discussed in terms of dosage form performance and absorption for orally administered drugs.     

Students' perceptions of effective classroom and clinical teaching in dental and dental hygiene education

Effective teaching behaviors have been studied in various arenas in higher education. However, there is limited research documenting effective teaching behaviors in dentistry and dental hygiene. Our qualitative study attempts to define effective teaching in both the classroom and clinic for dentistry and dental hygiene students. A total of 175 dental and dental hygiene undergraduate students nominated a total of forty instructors for teaching awards, providing a total of 695 qualitative statements reflecting their teaching in two learning contexts: the classroom and the clinic. Seven categories of effective teaching qualities were identified: individual rapport, organization, enthusiasm, learning, group interaction, exams and assignments, and breadth. Based on the frequency of the themes, effective teaching in the classroom was best defined by organization and rapport, whereas in the clinic, rapport was the most frequently described behavior. Moreover, dentistry students perceived enthusiasm as an effective teaching quality more frequently than did dental hygiene students, whereas dental hygiene students provided more responses to learning. These findings can provide guidance in preparing undergraduate dental and dental hygiene educators to enter the teaching environment. The ultimate goal to be achieved from identification of effective teaching qualities, as determined in this study, is improvement in clinical and classroom teaching for dentistry and dental hygiene programs.