Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study

OBJECTIVES

To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.

DESIGN

Cross-sectional multi-centre study in eight European countries.

PARTICIPANTS

16,220 children, ages 2-9 years.

METHODS

Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception.

RESULTS

Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe.

CONCLUSION

Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.

Screening for depression: only one piece of the puzzle

In this issue of NDT, van den Beukel et al. from the Netherlands suggest that a 5-item survey questionnaire might be used to replace the Beck Depression Index to screen patients with chronic kidney disease (CKD) for depression. The nephrology community is at a tipping point in terms of the assessment of outcomes, especially among patients on dialysis. Indeed, the entire healthcare community has begun to shift its focus to patient-reported outcomes (PROs), including quality of life, patient satisfaction and the psychosocial determinants of health. Beyond depression, there are a myriad of aspects of psychological distress that include anxiety, worrying, fear of progression of kidney disease and the fear of the future in general, death and dying, hopelessness, questions around the meaning of life and the experience of recurrent psychological and physical trauma through the CKD trajectory. We encourage the community and its researchers to embrace and research PROs, with the aim to create a holistic, patient-centered model of care for patients at all stages of CKD, including those on chronic dialysis and after transplantation, keeping the whole person-and their families-in mind.

Perceived stress and incidence of Type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men

AIM

To explore incident cases of diagnosed diabetes over 35 years of follow-up in relation to self-perceived stress at baseline.

METHODS

This was a population-based random sample of 7251 men derived from the Primary Prevention Trial Study, aged 47-56 years at baseline and without prior history of diabetes, coronary heart disease and stroke. Incident diabetes was identified from hospital discharge and death registries as principal or secondary diagnosis. Cox proportional hazards regression was used to evaluate the potential association between stress and diabetes.

RESULTS

During a 35-year follow-up, a total of 899 men were identified with diabetes. The crude incidence was 5.2 per 1000 persons-years. At baseline, 15.5% men reported permanent stress related to conditions at work or home. After adjusting for age and competing risk of death, the estimated 35-year conditional probability of diabetes in men with permanent stress was 42.6%, compared with 31.0% for those with periodic stress and 31.2% with no stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes [hazard ratio 1.52 (95% CI 1.26-1.82)] compared with men with no (referent) or periodic stress [hazard ratio 1.09 (95% CI 0.94-1.27)]. The association between stress and diabetes was slightly attenuated but remained significant after adjustment for age, socio-economic status, physical inactivity, BMI, systolic blood pressure and use of anti-hypertensive medication [hazard ratio 1.45 (95% CI 1.20-1.75)]. When examining principal diagnosis of diabetes cases separately from secondary diagnoses cases, the excess risk of diabetes associated with permanent stress remained significant both in age (only) and multivariable adjusted models.

CONCLUSION

Self-perceived permanent stress is an important long-term predictor of diagnosed diabetes, independently of socio-economic status, BMI and other conventional Type 2 diabetes risk factors.

Use of the Internet for home testing for Chlamydia trachomatis in Sweden: who are the users?

Sweden was the first country to introduce online Chlamydia trachomatis testing for both men and women and this article provides information about the user characteristics and which risk groups are reached with this method. During the years 2005-2007 a questionnaire was administered with a response rate of 86% (n = 6025) (62.5% women, 37.5% men). Over 60% of respondents were aged below 26 years and single. The average years of education for men and women was 14 (range 9.0-26.0). The mean Internet usage time was 22.4 hours/week among men and 15.5 hours/week among women. Only 22% men and 34% women had tested themselves for C. trachomatis at clinics previously. Respondents reported a higher frequency of previous sexually transmitted infections (STIs) compared with other Internet users (i.e. C. trachomatis: men 19%, women 24%). Eighty percent of online test users had engaged in sex with ≥ 2 partners without a condom during the previous year. Online C. trachomatis test users are mostly young people with high sexual risk behaviour.

Effects of absorbed hydrogen on the electronic properties of (Zr2Fe)(1-x)H(x) metallic glasses

The electrical conductivity (σ) of hydrogen doped (Zr(2)Fe)(1-x)H(x) metallic glasses has been measured in the temperature range from 290 down to 5 K. The decrease of the room temperature conductivity and the increase of its temperature coefficient are explained as consequences of increased disorder due to hydrogen doping. σ(T) for (Zr(2)Fe)(1-x)H(x) metallic glasses at low temperatures decreases with the increase of temperature, forming a minimum at T(min), before it starts a monotonic increase with increasing temperature. Both the functional forms and the magnitudes of the observed σ(T) are interpreted in terms of weak localization, electron-electron interaction and spin-fluctuation effects. Our results reveal that the electron-phonon scattering rate varies with the square of temperature from low temperatures up to 100 K and changes behaviour to a linear form at higher temperatures. At low temperatures, the minimum in σ(T) is shifted to higher temperatures, which is ascribed to the increase of the screening parameter of the Coulomb interaction F* associated with the enhancement of the spin fluctuations arising from the increase of the hydrogen doping. The spin-orbit scattering rate and the electron diffusion constant are reduced by hydrogen doping.

Social and health-related correlates of intergenerational and intragenerational social mobility among Swedish men and women

OBJECTIVE

To explore the pattern and determinants of inter- and intragenerational occupational mobility among Swedish men and women.

STUDY DESIGN

A Swedish 14-year prospective longitudinal study (response rate 96.5%).

METHODS

Detailed information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available at 16, 21 and 30 years of age. Odds ratios and 99% confidence intervals were calculated using logistic regression to determine social mobility.

RESULTS

The results indicated that being popular at school predicted upward mobility, and being less popular at school predicted downward mobility. Additionally, material deprivation, economic deprivation, shorter height (women) and poor health behavioural factors predicted downward mobility. Among this cohort, being less popular at school was more common among subjects whose parents had low socio-economic status. Occupational mobility was not influenced by ethnic background.

CONCLUSIONS

Apart from height (women), health status was not associated with mobility for men or women either inter- or intragenerationally. Unfavourable school environment was a consistent predictor of mobility for both genders. The results indicate that schools should be used as a setting for interventions aimed at reducing socio-economic health inequities. Targeted school interventions that are designed to assist higher educational attainment of socio-economically disadvantaged youth would help to break the social chain of risk experienced during this time, and thereby alter their life course in ways that would reduce subsequent social inequities in health and well-being.

[Frangible bullets: wounding capability and clinical aspects of their use]

The article deals with basic characteristics of the frangible bullets and it documents a very specific behaviour of chosen types of these bullets in testing blocks as a substitute materials of alive tissues. The frangible bullets have several important advantages compared to the classical sorts of firearms bullets. The highest benefit could be seen especially in the limited penetrating capability and very low ricochet hazard connected with the use of these bullets. The absence of poisonous elements in the material of frangible bullets (for instance lead) is highly appreciated from the ecology reasons nowadays as well. The cartridges assembled with frangible bullets are used most of all for the practise reasons by law enforcement units, but can be used very effectively also in combat situations. Results of own shooting experiments confirm that the wound potential of bullet can be changed in a very large extent with the change of the manufacturing technology and the bullets geometry. Newly developed frangible bullets and the already manufactured bullets available on the market are characterized by very specific terminal ballistic features. Some frangible bullets behave in a comparable way to full metal jacketed bullets while penetrating soft tissues. Another frangible bullets of different designs fragment to the pieces in soft tissues and cause very serious wounds with persistent effects. The usage of frangible bullets and a potential risk of misuse of this specific sort of ammunition require also new approaches in the medicine for the treatment of the gunshot wounds.

Tau truncation is a productive posttranslational modification of neurofibrillary degeneration in Alzheimer's disease

Deposits of the misfolded neuronal protein tau are major hallmarks of neurodegeneration in Alzheimer's disease (AD) and other tauopathies. The etiology of the transformation process of the intrinsically disordered soluble protein tau into the insoluble misordered aggregate has attracted much attention. Tau undergoes multiple modifications in AD, most notably hyperphosphorylation and truncation. Hyperphosphorylation is widely regarded as the hottest candidate for the inducer of the neurofibrillary pathology. However, the true nature of the impetus that initiates the whole process in the human brains remains unknown. In AD, several site-specific tau cleavages were identified and became connected to the progression of the disease. In addition, western blot analyses of tau species in AD brains reveal multitudes of various truncated forms. In this review we summarize evidence showing that tau truncation alone is sufficient to induce the complete cascade of neurofibrillary pathology, including hyperphosphorylation and accumulation of misfolded insoluble forms of tau. Therefore, proteolytical abnormalities in the stressed neurons and production of aberrant tau cleavage products deserve closer attention and should be considered as early therapeutic targets for Alzheimer's disease.

c-Abl and Arg are activated in human primary melanomas, promote melanoma cell invasion via distinct pathways, and drive metastatic progression

Despite 35 years of clinical trials, there is little improvement in 1-year survival rates for patients with metastatic melanoma, and the disease is essentially untreatable if not cured surgically. The paucity of chemotherapeutic agents that are effective for treating metastatic melanoma indicates a dire need to develop new therapies. Here, we found a previously unrecognized role for c-Abl and Arg in melanoma progression. We demonstrate that the kinase activities of c-Abl and Arg are elevated in primary melanomas (60%), in a subset of benign nevi (33%) and in some human melanoma cell lines. Using siRNA and pharmacological approaches, we show that c-Abl/Arg activation is functionally relevant because it is requiredfor melanoma cell proliferation, survival and invasion. Significantly, we identify the mechanism by which activated c-Abl promotes melanoma invasion by showing that it transcriptionally upregulates matrix metalloproteinase-1 (MMP-1), and using rescue approaches we demonstrate that c-Abl promotes invasion through a STAT3 → MMP-1 pathway. Additionally, we show that c-Abl and Arg are not merely redundant, as active Arg drives invasion in a STAT3-independent manner, and upregulates MMP-3 and MT1-MMP, in addition to MMP-1. Most importantly, c-Abl and Arg not only promote in vitro processes important for melanoma progression, but also promote metastasis in vivo, as inhibition of c-Abl/Arg kinase activity with the c-Abl/Arg inhibitor, nilotinib, dramatically inhibits metastasis in a mouse model. Taken together, these data identify c-Abl and Arg as critical, novel, drug targets in metastatic melanoma, and indicate that nilotinib may be useful in preventing metastasis in patients with melanomas harboring active c-Abl and Arg.

Why is the thyroid so prone to autoimmune disease?

The thyroid gland plays a major role in the human body; it produces the hormones necessary for appropriate energy levels and an active life. These hormones have a critical impact on early brain development and somatic growth. At the same time, the thyroid is highly vulnerable to autoimmune thyroid diseases (AITDs). They arise due to the complex interplay of genetic, environmental, and endogenous factors, and the specific combination is required to initiate thyroid autoimmunity. When the thyroid cell becomes the target of autoimmunity, it interacts with the immune system and appears to affect disease progression. It can produce different growth factors, adhesion molecules, and a large array of cytokines. Preventable environmental factors, including high iodine intake, selenium deficiency, and pollutants such as tobacco smoke, as well as infectious diseases and certain drugs, have been implicated in the development of AITDs in genetically predisposed individuals. The susceptibility of the thyroid to AITDs may come from the complexity of hormonal synthesis, peculiar oligoelement requirements, and specific capabilities of the thyroid cell's defense system. An improved understanding of this interplay could yield novel treatment pathways, some of which might be as simple as identifying the need to avoid smoking or to control the intake of some nutrients.

Mesenchymal stem cells rescue the Alzheimer's disease cell model from cell death induced by misfolded truncated tau

We have developed a stably transfected human cell model for Alzheimer's disease with doxycycline-inducible expression of human misfolded truncated tau protein (AT tau). We have showed that AT tau reduced the metabolic activity of the AT tau cells, slowed down cell proliferation, and induced caspase-3-independent apoptosis-like programmed cell death, tauoptosis. The aim of this study was to test the possible capability of rat mesenchymal stem cells (MSCs) to interfere with AT tau protein-induced cell death. AT tau cells after treatment with 10 μM all-trans retinoic acid were either co-cultivated with MSCs or supplemented with MSC secretome for 6 and 9 days. We found that both MSCs and MSC secretome promoted survival and increased the metabolic activity of the cells. Moreover stem cells induced cell differentiation and formation of neurites with numerous varicosities. Strikingly, treatment had no effect on tau expression suggesting that MSC induced self-protecting mechanism that prevented AT tau cells from tauoptosis. Our results showed that mesenchymal stem cells and their secretome are able to rescue the Alzheimer's disease cell model from cell death induced by misfolded truncated tau. We suggest that cell therapy may represent an alternative therapeutic avenue for treatment of human Alzheimer's disease and related tauopathies.

Dishwashers--a man-made ecological niche accommodating human opportunistic fungal pathogens

Habitats in human households may accommodate microorganisms outside the common spectrum of ubiquitous saprobes. Enrichment of fungi that may require specific environmental conditions was observed in dishwashers, 189 of which were sampled in private homes of 101 towns or communities. One-hundred-two were sampled from various localities in Slovenia; 42 from other European countries; 13 and 3 from North and South America, respectively; 5 from Israel; 10 from South Africa; 7 from Far East Asia; and 7 from Australia. Isolation was performed on samples incubated at 37°C. Species belonging to genera Aspergillus, Candida, Magnusiomyces, Fusarium, Penicillium and Rhodotorula were found occasionally, while the black yeasts Exophiala dermatitidis and Exophiala phaeomuriformis (Chaetothyriales) were persistently and most frequently isolated. Sixty-two percent of the dishwashers were positive for fungi, and 56% of these accommodated Exophiala. Both Exophiala species are known to be able to cause systemic disease in humans and frequently colonize the lungs of patients with cystic fibrosis. We conclude that high temperature, high moisture and alkaline pH values typically occurring in dishwashers can provide an alternative habitat for species also known to be pathogenic to humans.

Culturally defined community psychiatry in slovenia

Introduction

Community psychiatry is to be acknowledged as evidence based psychiatric treatment in Slovenia with some decades of lag behind other EU countries. Nevertheless some community psychiatric programmes were developed by four Slovenian psychiatric hospitals, one of them covering the most deprived region regarding BDP and service provision region with 220000 population. Team work of psychiatrist, two nurses and social worker covers only several patients and families with most severe disability and social deprivation. Communication and cooperation with other community agencies is, regardless their scarcity, crucial. Community work has to be adapted to specific cultural environment defined by multiethnicity and prevailing protestant ethics that influence workers, patients and carers alike.

Case report

Revolving door patient with severe mental illness living in extreme poverty in suburb area was approached with family visits. Her mother also presented signs and symptoms of mental disorder and was strongly reluctant to treatment. A number of interventions applied targeted to their living circumstances. Their needs were different from those defined by health and social workers, which resulted in absence of any community care in previously. With personal involvement of team workers, consensus was made and continuity of psychopharmacological treatment with the patient was achieved after many years of non-compliance. Further steps were planned regarding their actual local and social circumstances.

Conclusion

Community psychiatric interventions need to be culturally and socially adapted to the needs of their consumers. The case presented is to reflect special cultural, individual and social particularities that define specific community psychiatric work.

Body mass index, waist circumference and mortality in kidney transplant recipients

Higher body mass index (BMI) appears paradoxically associated with better outcomes in patients with chronic kidney disease. Whereas higher BMI reflects both increased visceral and subcutaneous fat and/or muscle mass, a combined assessment of BMI and waist circumference may enable differentiation of visceral adiposity from muscle and/or nonvisceral fat mass. We examined the association of BMI and waist circumference with all-cause mortality in a prospective cohort of 993 kidney transplant recipients. Associations were examined in Cox models with adjustment for demographic and comorbid conditions and for inflammatory markers. Unadjusted death hazard ratios (95%CI) associated with one standard deviation higher BMI and waist circumference were 0.94 (0.78, 1.13), p = 0.5 and 1.20 (1.00, 1.45), p = 0.05, respectively. Higher BMI was associated with lower mortality after adjustment for waist circumference (0.48 [0.34, 0.69], p < 0.001), and higher waist circumference was more strongly associated with higher mortality after adjustment for BMI (2.18 [1.55-3.08], p < 0.001). The associations of waist circumference with mortality remained significant after additional multivariable adjustments. Higher BMI and waist circumference display opposite associations with mortality in kidney transplant recipients. Waist circumference appears to be a better prognostic marker for obesity than BMI.

High microparticle concentration in cord plasma

We investigated if differences in the microparticle concentration and activity between newborn cord plasma and adult plasma exist.

METHODS

To enumerate and characterize microparticles (MP) FACS and ELISA were used.The effect of microparticles derived tissue factor (TF) on thrombin generation was measured indirectly by CAT (calibrated automated thrombography).

RESULTS

The flow cytometric measurements revealed an increased microparticle concentration in newborn cord compared with adult plasma. By the use of ELISA a significantly increased procoagulant activity of microparticles was found in newborn cord plasma as compared to adult plasma. Initiation of thrombin generation by adding phospholipids alone resulted in a significant lower prolongation of the lag time, time to peak in cord plasma, while the decrease of endogenous thrombin potential (ETP) and peak was comparable between newborns and adults.

CONCLUSION

Our results show a higher impact of microparticles on the haemostatic system of newborns than on that of adults. The three methods suggest a somewhat increased microparticle activity in newborn cord plasma, but argue against strong platelet activation during birth.

Relationship between thrombin generation and carotid intima-media thickness

Increasing evidence indicates that thrombin plays a role not only in thrombosis but also in the progression of atherosclerosis.

AIM

The relationship between thrombin generation and intima-media thickness (IMT) as an index of subclinical atherosclerosis was investigated. Participants, material, methods: We examined 163 asymptomatic middle-aged persons free of overt clinical atherosclerotic disease. They underwent ultrasonography of the common carotid arteries. In addition, thrombin generation was measured by means of CAT (calibrated automated thrombography). For our study we divided the healthy study participants into three age groups (<45, 45-60 and >60 years).

RESULTS

A significant positive correlation was seen between endogenous thrombin potential (ETP) (p = 0.012), time to peak (TTP) (p = 0.033) start tail (p = 0.007) and carotid IMT in the group of healthy volunteers younger than 45 years.

CONCLUSION

We demonstrated that in adults younger than 45 years without clinically overt atherosclerotic disease ETP was significantly associated with carotid IMT. It is tempting to speculate that ETP may serve as an index for subclinical atherosclerosis in persons below 45 years.