Multivariable analysis of total cholesterol levels in male Swiss Armed Forces conscripts 2006-2012 (N = 174,872)

Background

Cholesterol is an important contributor to morbidity and mortality risks due to its association with obesity, cardiovascular disease, and cancer. A system of mandatory military conscription is a useful tool for disease-risk monitoring in a given male population. Swiss military conscription data are representative for more than 90 % of a given male birth cohort (with Swiss citizenship). The medical examination also includes voluntary laboratory testing, for which approximately 65 % of the young men present at conscription give consent.

Methods

Here we present the temporal and subgroup analyses of total serum cholesterol levels (TCL) among Swiss conscripts from 2006 to 2012 (N = 174,872; mean age = 19.75 years). The voluntary blood samples were tested by a central laboratory (Viollier AG) with identical measurement standards and strict quality control. To test differences in TCL by socioeconomic occupational status, sports test performance, Body Mass Index (BMI), age, and place of residence of the conscripts we used a multivariable regression model with TCL as dependent variable.

Results

Mean TCL decreased significantly, by 0.125 mmol/l (95 % CI 0.108–0.142, p < 0.001) from 4.225 mmol/l (95 % CI 4.210–4.240) in 2006 to 4.100 mmol/l (95 % CI 4.091–4.109) in 2012. Similarly, the prevalence of conscripts with an elevated TCL ≥ 5.17 mmol/l decreased from ≥10.2 % prior to 2011 to 6.9 % in 2011 and 8.2 % in 2012. Multivariate regression showed an association between elevated TCL and lower socioeconomic occupational status, lower sports test performance, higher BMI, higher age, and area of residence. There was no longer a significant increase in mean TCL among the three grades of obesity (BMI ≥ 30.0 kg/m2) as defined by the WHO. Within the BMI categories of normal weight and overweight, TCL was stratified by sports performance (better sports performance = lower TCL).

Conclusion

Decreasing TCL in 2011 and 2012 fits the known pattern of conscripted persons’ stabilizing BMI and sports test performance of the conscripts in recent years. However, small temporal drifts within the laboratory analyses cannot be ruled out as confounding factors. In conclusion, identifying subgroups with unfavorable lipid profiles will contribute to the continuing success of intensified public health programs.

Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial

BACKGROUND

Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia.

METHODS

In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomly assigned (1:1 ratio) to receive either prednisone 50 mg daily for 7 days or placebo. The computer-generated randomisation was done with variable block sizes of four to six and stratified by study centre. The primary endpoint was time to clinical stability defined as time (days) until stable vital signs for at least 24 h, and analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00973154.

FINDINGS

From Dec 1, 2009, to May 21, 2014, of 2911 patients assessed for eligibility, 785 patients were randomly assigned to either the prednisone group (n=392) or the placebo group (n=393). Median time to clinical stability was shorter in the prednisone group (3·0 days, IQR 2·5-3·4) than in the placebo group (4·4 days, 4·0-5·0; hazard ratio [HR] 1·33, 95% CI 1·15-1·50, p<0·0001). Pneumonia-associated complications until day 30 did not differ between groups (11 [3%] in the prednisone group and 22 [6%] in the placebo group; odds ratio [OR] 0·49 [95% CI 0·23-1·02]; p=0·056). The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment (76 [19%] vs 43 [11%]; OR 1·96, 95% CI 1·31-2·93, p=0·0010). Other adverse events compatible with corticosteroid use were rare and similar in both groups.

INTERPRETATION

Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency.

FUNDING

Swiss National Science Foundation, Viollier AG, Nora van Meeuwen Haefliger Stiftung, Julia und Gottfried Bangerter-Rhyner Stiftung.

Unexpected high prevalence of metabolic disorders and chronic disease among young male draftees--the Swiss Army XXI experience

QUESTIONS

What are the benefits of laboratory screening examinations entailed in the new army recruitment concept (Swiss Army XXI)? PRINCIPLES/METHODS: Between January 1 and June 30, 2004, a total of 7714 of 11,322 (68%) draftees from 6 Swiss army recruitment centres underwent clinical examination and laboratory testing.

RESULTS

In 1.7% of the draftees we found elevated levels of the C-reactive protein (CRP) as evidence of infection or inflammation. Although we found no case of acute hepatitis, 16 draftees had active hepatitis B and 1 patient had active hepatitis C. Diseases, which were found by laboratory screening, and which forbid service in the army, included Crohn's disease, terminal renal insufficiency and essential thrombocytosis. In conditions such as anaemia (0.1%) or latent iron deficiency (7.2%), the cause may have to be elucidated before the start of military training. In other draftees (9.8%), we found elevated alanine-amino-transferase (ALAT) levels as a hint to possible alcohol abuse, which might impair the ability to serve in special units of the army. Finally, elevated levels of ferritin (0.1%), glucose (0.4%), and cholesterol (1.4%) may indicate iron overload/haemochromatosis, impaired glucose tolerance or even overt diabetes mellitus and hypercholesterolaemia.

CONCLUSIONS

The results of our studies indicate that laboratory evaluation may confirm findings of the medical examination and may help to explain unspecific symptoms. Draftees with severe diseases and conditions caused by serious underlying disease can be excluded from military services early on the basis of laboratory testing. Future cost benefit analyses will have to show whether laboratory screening and consecutive early preventive measures are also advantageous to society as a whole and will reduce public health costs.

Unexpected high prevalence of metabolic disorders and chronic disease among young male draftees--the Swiss Army XXI experience

QUESTIONS

What are the benefits of laboratory screening examinations entailed in the new army recruitment concept (Swiss Army XXI)? PRINCIPLES/METHODS: Between January 1 and June 30, 2004, a total of 7714 of 11,322 (68%) draftees from 6 Swiss army recruitment centres underwent clinical examination and laboratory testing.

RESULTS

In 1.7% of the draftees we found elevated levels of the C-reactive protein (CRP) as evidence of infection or inflammation. Although we found no case of acute hepatitis, 16 draftees had active hepatitis B and 1 patient had active hepatitis C. Diseases, which were found by laboratory screening, and which forbid service in the army, included Crohn's disease, terminal renal insufficiency and essential thrombocytosis. In conditions such as anaemia (0.1%) or latent iron deficiency (7.2%), the cause may have to be elucidated before the start of military training. In other draftees (9.8%), we found elevated alanine-amino-transferase (ALAT) levels as a hint to possible alcohol abuse, which might impair the ability to serve in special units of the army. Finally, elevated levels of ferritin (0.1%), glucose (0.4%), and cholesterol (1.4%) may indicate iron overload/haemochromatosis, impaired glucose tolerance or even overt diabetes mellitus and hypercholesterolaemia.

CONCLUSIONS

The results of our studies indicate that laboratory evaluation may confirm findings of the medical examination and may help to explain unspecific symptoms. Draftees with severe diseases and conditions caused by serious underlying disease can be excluded from military services early on the basis of laboratory testing. Future cost benefit analyses will have to show whether laboratory screening and consecutive early preventive measures are also advantageous to society as a whole and will reduce public health costs.

Progesterone increase under DHEA-substitution in males

Two case reports of men suffering from excessive fatigue and depression are presented, both treated with 50 or 25 mg DHEA per day over a period of 1 year. Under DHEA treatment one subject reported being less tired and the other experienced improved well-being without depressive episodes and an increase in libido. Investigations of sex hormone parameters in plasma before and under treatment revealed a decrease of testosterone and an increase of progesterone in both, possibly dose-dependent to DHEA application. It is hypothesised that the increase of progesterone is parallel to an increase of its metabolite allopregnanolone (which was not determined), that might explain the improvement in well-being. The increase of progesterone under DHEA supplementation in males should receive further attention.

A novel insertion element from Mycobacterium avium, IS1245, is a specific target for analysis of strain relatedness

The insertion sequence IS1245 is a novel mycobacterial repetitive element identified in Mycobacterium avium. It encodes a transposase which exhibits a 64% amino acid similarity with IS1081, an insertion element present in the M. tuberculosis complex. The host range of IS1245 appears limited to M. avium as this element was not identified in M. intracellulare or in any other of 18 mycobacteria species tested. When IS1245 was used for restriction fragment length polymorphism (RFLP) analysis, human isolates characteristically presented a high number of copies (median, 16; range, 3 to 27) and a diversity of RFLP patterns comparable to that found by pulsed-field gel electrophoresis. Isolates from nonhuman sources differed both in number of copies and in RFLP pattern diversity: while swine isolates shared the characteristics of human strains, those from several avian sources exhibited a very low copy number of IS1245 and appeared clonal on the basis of RFLP.

Genotypic characterization of Mycobacterium avium strains recovered from animals and their comparison to human strains

Mycobacterium avium was recovered from 21 birds and 10 pigs. Bird isolates carried IS901 and a few copies of IS1245 and appeared highly related by pulsed-field gel electrophoresis. Pig isolates showed features previously described in human isolates: a lack of IS901, a high copy number of IS1245, and marked polymorphism by pulsed-field gel electrophoresis.