Describing the burden of non-communicable disease risk factors among adults with diabetes in Wallis and Futuna

BACKGROUND

The South Pacific Territory of Wallis and Futuna has a high burden of non-communicable diseases (NCD): 18% of adults have diabetes mellitus (DM) and 87% are classified as overweight or obese.

OBJECTIVE

To characterise the burden of additional World Health Organization (WHO) recognised NCD risk factors, such as smoking, obesity, high blood pressure, eating less than five fruit or vegetable servings per day and a sedentary lifestyle, among adults with DM.

DESIGN

Re-analysis of cross-sectional data from a 2009 national survey. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Of 487 adults sampled, 87 (18%) had DM. Nearly 99% of individuals with DM had at least one additional NCD risk factor, and 62% had three or more concurrent NCD risk factors. Individuals with DM were more likely to be obese (OR 1.66, 95%CI 1.01-2.74) and had a much higher prevalence of high blood pressure (OR 3.02, 95%CI 1.87-4.86).

CONCLUSION

DM is rarely identified in the absence of other NCD risk factors. We recommend an integrated approach to the management of DM and other NCD risk factors in routine care rather than a disease-specific approach.

Soft drink consumption in Pacific Island countries and territories: a review of trade data

INTRODUCTION

Pacific Islands Countries and Territories (PICTs) have some of the highest rates of obesity and diabetes in the world. Research has demonstrated a strong link between sugar-sweetened beverage (SSB) consumption and subsequent risk of overweight, obesity, dental caries and type II diabetes. To address the impact of SSBs on noncommunicable diseases, it is crucial to understand the level of SSB consumption in PICTs.

METHODS

The volume of soft drinks imported and exported was requested from PICTs to estimate the litres of soft drink consumption per head of population. Analysis was confined to PICTs who did not produce their own soft drinks because production data was limited. The Harmonised Commodity Description and Coding System (HS) category 22.02 was used which includes both diet and sugar-sweetened soft drinks. The trade data estimates were then compared with school survey data to explore how the data sources corresponded given the strengths and weaknesses of each.

RESULTS

Soft drink import volumes were a feasible way of estimating total soft drink consumption in PICTs and look at trends over time. Seven out of eleven non-producing PICTs contacted were able to provide volume of soft drinks imported. In 2011, estimates of soft drink consumption per person were 84L in Palau, 47L in the Commonwealth of the Northern Mariana Islands (CNMI), 41L in Niue, 31L in Tonga, 22L in Federates States of Micronesia, 8L in Tuvalu and 1L in Kiribati.

CONCLUSIONS

Trade data is a feasible way of monitoring soft drink consumption and may be useful to evaluate the impact of changes in government policy on importation of soft drinks. Data quality could be maximised by including export data, adjusting for visitor numbers and cross-checking exports from corresponding countries. To monitor SSB consumption, a wider range of categories could be included such as categories for sugar-sweetened juice and sweetened-milk drinks.

Using new electrofishing technology to amp-up fish sampling in estuarine habitats

A prototype, boat-mounted electrofisher capable of operation in estuarine waters (where electrical conductivities often exceed 20 000 µS cm(-1)) was assessed. Electrofishing was compared to fyke and mesh netting in four riverine estuaries and to seining in a lagoonal estuary (consisting of a series of brackish coastal lakes separated from the sea by a barrier system of sand dunes). Fish assemblage composition, length distributions and the probability of detecting ecological fish guilds (relating to estuary use, position in the water column and body size) were compared among gears. The assemblage composition of electrofishing samples differed from those of fyke nets in all riverine estuaries and from mesh netting in two. The assemblage composition of electrofishing samples differed from those of seining in structured seagrass habitats of the lagoonal estuary. When all species were pooled, the electrofisher sampled a broader range of lengths than either fyke or mesh netting in riverine estuaries or seining in lagoonal estuaries. The bias of electrofishing and netting towards particular species and size classes affected the probability of detecting some ecological guilds, highlighting the potential implications of gear choice on understanding estuarine ecological function. The detection of guilds varied with gear type and environmental conditions, including stratification, water depth and surface electrical conductivity. Assessments with the aim to characterize the structure of fish assemblages will benefit from the use of multiple gears. Electrofishing shows immense promise for discretely sampling highly structured habitats to test hypotheses about their use.

Premature mortality in Scottish injecting drug users: a life-history approach

In Scotland, deaths in drug users are known to be higher than in the rest of the UK and most of Europe. Reducing drug-related deaths is currently a national priority for the Scottish Government.  This study aimed to present a description of the life histories of a group of injecting drug users who have recently died, with a view to highlighting areas for further research. The Edinburgh Addiction Cohort study recently carried out 432 follow-up interviews between the years 2005 and 2007. Thirty-three cases who completed this extensive interview detailing early life, education, employment, drug use, opiate substitution treatment, criminal history, mental health problems and overdose have subsequently died, leaving this source of rich information about their lives. The design of the interview used the life grid approach. Information was also compiled from full primary care records and General Register Office death certificates. Early life adversity was apparent for many cases, with a steady progression into early criminal behaviour and drug misuse. Poor adult life outcomes illustrated the lifelong damaging effects of drug injecting. Death occurred significantly earlier than in the general population or those living in deprived communities who did not use drugs. In conclusion, a clearer understanding of the life histories of problem drug users would be advantageous for health-care professionals and policy-makers. More qualitative research studies are needed to highlight areas which might require early intervention and also complement the existing secondary data studies.

Contact patterns as a risk factor for bovine tuberculosis infection in a free-living adult brushtail possum Trichosurus vulpecula population

The aim of this study was to identify risk factors for bovine tuberculosis (TB) in a free-roaming, capture-mark-recapture monitored possum Trichosurus vulpecula population in a 22-ha study site at Castlepoint, New Zealand from 1 April 1989 to 31 March 1994. A matched case-control design was used to evaluate the influence of sex, habitat and contact opportunities on TB risk. Cases comprised possums identified as TB-positive throughout the study period. Controls were selected from the group of possums that were captured and showed no clinical signs of TB throughout the study period. Measures derived from a social network analysis of possum capture locations such as degree, clustering coefficient (CC) and betweenness were used to represent potential contact opportunities among possums. Network analysis measures recorded for individual possums in the 12-month period before a diagnosis of TB were evaluated in a conditional logistic regression model. We found no evidence of an association between case status and the total number of possums with which there was potential contact (degree) (P=0.5). The odds of cases being exposed to unit increases in the number of TB-positive contacts was 2.50 (95% CI 1.24-5.05; P<0.01) times that of controls. This effect was conditional on the total number of potential contacts made, with a negative interaction with increasing degree. These findings indicate that potential contact with TB-positive possums increases the odds of disease whereas potential contact with large numbers of possums does not. This suggests that multiple contacts with TB-positive possum(s) are necessary for transmission of TB and this is more likely to occur in networks that are smaller. We challenge the hypothesis that contact with large numbers of individuals increases the probability of becoming TB infected and argue that individual contact behaviour is a determinant of the creation of TB foci within free-living possum populations.

Dyspepsia treatment guidelines in general practice — an observational study

An observational study of prescribing for dyspepsia, in Glasgow, used Scottish Prescribing Analysis (SPA) and Prescribing Information for Scotland Computer Programme (PRISMS) data to monitor the implementation of a set of locally produced guidelines on dyspepsia. The main outcomes measured were the proportion of cimetidine prescribed generically, the ratio of prescriptions for cimetidine and ranitidine, the number of prescriptions for omeprazole per 1,000 patients per month and the total number of prescriptions for tripotassium dicitratobismuthate (De-Nol) per month. The results suggest that the dyspepsia guidelines have been successfully implemented as there has been an increase in the proportion of cimetidine prescribed generically, an increase in the use of cimetidine as the H2 antagonist of choice and an increase in the use of the recommended triple therapy regimen to eradicate Helicobacter pylori infection from patients with peptic ulcer disease. This study shows that consensus guidelines on a common clinical condition can be widely accepted in primary care if appropriately designed, developed and implemented. Their implementation can be followed from routine prescription information.

Dermatological findings in 61 mutation-positive individuals with cardiofaciocutaneous syndrome

BACKGROUND

The RASopathies are a class of human genetic syndromes that are caused by germline mutations in genes which encode components of the Ras/mitogen-activated protein kinase (MAPK) pathway. Cardiofaciocutaneous (CFC) syndrome is characterized by distinctive craniofacial features, congenital heart defects, and abnormalities of the skin and hair.

OBJECTIVES

Systematically to characterize the spectrum of dermatological findings in mutation-positive individuals with CFC syndrome.

METHODS

Dermatological surveys were designed by the authors and distributed to the study participants through CFC International or directly by the authors (K.A.R. and D.H.S.) between July 2006 and August 2009. A second follow-up survey was collected between December 2007 and August 2009. When available, digital images and medical records of the participants were obtained. Study participants included individuals with CFC syndrome who have a mutation in BRAF, MAP2K1, MAP2K2 or KRAS.

RESULTS

Individuals with CFC syndrome have a variety of dermatological manifestations caused by dysregulation of the MAPK pathway in development. Numerous acquired melanocytic naevi were one of the most striking features: more than 50 naevi were reported by 23% (14/61) of participants and of those, more than 100 naevi were reported by 36% (5/14). Keratosis pilaris was reported in 80% (49/61) of cases. Ulerythema ophryogenes was common, occurring in 90% (55/61). Infantile haemangiomas occurred at a greater frequency, 26% (16/61), as compared with the general population.

CONCLUSIONS

CFC syndrome has a complex dermatological phenotype with many cutaneous features, some of which allow it to be differentiated from the other Ras/MAPK pathway syndromes. Multiple café-au-lait macules and papillomas were not identified in this CFC cohort, helping to distinguish CFC from other RASopathies such as neurofibromatosis type 1 and Costello syndrome.

The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent-in-stent technique

BACKGROUND AND PURPOSE

Blister aneurysms of the supraclinoid ICA represent a rare but well-documented cause of subarachnoid hemorrhage. These aneurysms are difficult to detect, and their surgical treatment is challenging, with high morbidity and mortality rates. The reports currently in the literature that describe the surgical and endovascular treatment of these aneurysms offer no clear consensus on the optimal treatment. We describe a staged endovascular treatment entailing stenting using a stent-in-stent technique, as well as planned but delayed embolization as the aneurysm increases in size to allow the introduction of coils.

MATERIALS AND METHODS

We performed a retrospective review of all cerebral angiograms performed at our institution over an 8-month period for evaluation of subarachnoid hemorrhage, identifying 6 ICA blister aneurysms.

RESULTS

All 6 blister aneurysms were located in the supraclinoid ICA. The stent-in-stent technique was used for the initial treatment of all patients. Three patients had no residual or recurrent aneurysm following initial treatment. Three patients required retreatment with coils after continued growth of the aneurysm, identified on follow-up angiography. Five patients had good recovery (average mRS score of 1), and 1 patient had poor neurologic recovery (mRS score of 3) due to a large hemorrhagic infarction.

CONCLUSIONS

Our case series suggests that staged endovascular treatment entailing the use of a stent-in-stent technique, augmented with subsequent coil embolization as necessary for progressive disease, is a viable endovascular option for treating ruptured supraclinoid blister aneurysms, allowing for parent artery preservation.

Progression of dopaminergic dysfunction in a LRRK2 kindred: a multitracer PET study

OBJECTIVE

Little is known about the progression of dopaminergic dysfunction in LRRK2-associated Parkinson disease (PD). We sought to characterize the neurochemical progression with multitracer PET in asymptomatic members of parkinsonian kindred (family D, Western Nebraska) carrying LRRK2 (R1441C) mutation.

METHOD

Thirteen family D subjects underwent PET scans of presynaptic dopaminergic integrity and five subjects were rescanned 2 to 3 years later.

RESULTS

In subjects 8, 9 (mutation carriers), and 13 (genealogically at risk subject), there was a decline in PET markers over the course of the study that was significantly greater than the expected rate of decline in healthy controls. Reduced dopamine transporter binding was the earliest indication of subclinical dopaminergic dysfunction and progression to clinical disease was generally associated with the emergence of abnormal fluorodopa uptake.

CONCLUSION

PET study of presymptomatic members of our LRRK2 kindred revealed dopaminergic dysfunction that progressed over time. This represents an ideal group to study the natural history of early disease and the potential effects of neuroprotective interventions.

Farm exposure in utero may protect against asthma, hay fever and eczema

The aim of the present study was to assess which factors contribute to the lower prevalence of allergic diseases in farmers' children, and the importance of timing of exposure. In a cross-sectional questionnaire survey, asthma symptoms, hay fever and eczema were assessed, as well as current, early and prenatal farm-related exposures in 1,333 farmers' children and 566 reference children aged 5-17 yrs. Farmers' children had a lower incidence of asthma symptoms and eczema. Current and maternal exposure during pregnancy to animals and/or grain and hay reduced the risk of asthma symptoms, hay fever and eczema. The exposure-response association for maternal exposure was nonlinear for most outcomes. After mutual adjustment, the effects of prenatal exposure remained unchanged whereas current exposure remained protective only for asthma medication, asthma ever and hay fever. Exposure during the first 2 yrs was not associated with symptoms, after controlling for prenatal exposure. A combination of prenatal and current exposure was most strongly associated with wheeze (odds ratio (OR) 0.48, 95% confidence interval (CI) 0.28-0.80), asthma medication (OR 0.50, 95% CI 0.30-0.82), asthma ever (OR 0.50, 95% CI 0.33-0.76), hay fever (OR 0.47, 95% CI 0.30-0.73) and eczema (OR 0.46, 95% CI 0.30-0.70). Prenatal exposure may contribute to the low prevalence of asthma, hay fever and eczema in farmers' children, but continued exposure may be required to maintain optimal protection.