Evaluation of the mediterranean diet cost in Extremadura: adherence and relationship with available income

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute - Spain

Background

Cardiovascular diseases are the leading cause of death in developed countries. In this context, the Mediterranean diet (MD) is widely recognized as cardioprotective, although its implementation cost has been little studied and rarely employed as an argument for debate.

Although previous Spanish studies have corroborated a higher monetary cost associated with increased adherence to the MD, there exist large disparities among studies, and none of them has related the cost of MD to available income, which is highly relevant for assessing the degree of affordability by families.

Purpose

The aim of this study is twofold. First, to estimate the cost and degree of adherence of the MD in a population of Extremadura. Second, to provide evidence on the cost of the MD in relation to available incomes.

Methods

A population study including 2.833 subjects between 25 and 79 years old (54% women), randomly selected from Don Benito-Villanueva de la Serena (Badajoz, Spain). Diet questionnaire contained 175 food items and 7 items related to alcoholic beverages. Consumption frequencies were translated in terms of grams or millilitres. Price for each item was obtained using price supermarket comparators from the same geographical area. Total monthly cost was obtained using monthly quantities consumed and the price of each category.  Final cost was related to Panagiotakos adherence degree and to available income. Data of available income was obtained from the Income Tax Statistics by municipality.

Results

Median monthly cost was EUR 203.63 (IQR 154.04-265.37): 216.91 for men and 191.22 for women. Median monthly cost per age cohort showed an inverted U-shape, with a maximum in the 45-54 years-old cohort (EUR 212.1; IQR 155.47-274.63) and a minimum for the 75-79 years-old cohort (EUR 179; IQR 130.21-224.99). Median monthly cost was very similar for primary, secondary and higher educational levels (208.18, 206.57 and 205.70, respectively), but 14% lower for those without primary studies. MD cost was lower in rural compared with urban areas (188 versus 223 euros, respectively)

The percentage of population showing a high MD adherence was 59% whereas the percentage with a low adherence was 12%. The cost associated with a high MD adherence was EUR 228.38.

The average cost represents 14% of the available income, ranging from 10.5% for the group with low MD adherence, to 15.72% for the group with a high adherence.

Conclusions

Higher adherence to the MD can reach almost 20% of the available income. This can lead to low-income families opting for cheaper, energy-dense, and consequently, less healthy dietary patterns. Emphasis should be placed on education strategies to recreate the MD at an affordable price or to introduce changes to consumer taxes (VAT) that favor DM pattern.

Ultrasound-based lectures on cardiovascular physiology and reflexes for medical students

Ultrasound has become a widely used diagnostic technique. While its role in patient evaluation is well known, its utility during preclinical courses such as anatomy and physiology is becoming increasingly recognized. The aim of the present study was to assess the feasibility/utility of integrating ultrasound-based sessions into conventional undergraduate medical school programs of physiology of the cardiovascular system and cardiovascular reflexes and to evaluate student perceptions of an ultrasound-based didactic session. Second-year medical students enrolled in the University of Padova attended a didactic session during which basic concepts regarding ultrasound instrumentation, image production, and spatial orientation were presented. Five anatomic sectors (the heart, aorta, neck vessels, inferior vena cava, and femoral veins) were then examined on a volunteer. Student perceptions of the images that were projected, the usefulness of the presentation, and the reproducibility of the experience were assessed at the end of the lecture with an anonymous questionnaire consisting of positive and negative items that were rated using a 5-point Likert scale and with two questions. One hundred eleven students attended the lecture; 99% of them found it very interesting, and none considered it boring or a waste of time. More than 96% thought it helped them to gain a better comprehension of the subject and would recommend it to a colleague. In conclusion, as ultrasound has been found to be a valuable resource for the teaching of physiology of the cardiovascular system and cardiovascular reflexes, efforts should be made to integrate ultrasound sessions into the traditional human physiology curriculum.

Contrast-enhanced ultrasound in the evaluation of parotid gland lesions: an update of the literature

High-resolution ultrasound is the first line examination for parotid gland diffuse disease and focal lesions, normally using grey-scale and colour-Doppler ultrasound. Unfortunately, grey-scale and colour-Doppler ultrasound features of benign and malignant salivary gland lesions may overlap, particularly with benign tumors, where pleomorphic adenomas are often indistinguishable from malignant lesions. With atypical lesions, contrast-enhanced magnetic resonance imaging is usually the second level imaging modality requested. The introduction of ultrasound contrast agents has opened further possible perspectives to improve the interpretation of parotid diseases, particularly the differentiation between benign and malignant lesions. We present a review of the current literature on contrast-enhanced ultrasound for the assessment of parotid gland lesions, considering all characteristics of the technique, evidence of usefulness, future perspectives and limitations.

Metabolic and ventilatory effects of oral glucose load at rest and during incremental aerobic muscular work in young healthy adults

We measured respiratory ratio (RR), pulmonary ventilation (VE) and end-tidal carbon dioxide partial pressure (ETPCO2) at rest and during cycling aerobic workloads (20%, 40%, 60% of estimated maximal oxygen uptake). Measurements were taken after overnight fasting and after an oral glucose load. RR, VE and ETPCO2 increased with workload. Glucose load caused RR and VE increments at rest (0.75 ± 0.01 vs. 0.86 ± 0.02, p < 0.01, and 10.8 ± 0.43 vs. 12.1 ± 0.49 l/min, p < 0.01, respectively) and for each workload (20% estimated maximal oxygen uptake: 0.77 ± 0.01 vs. 0.855 ± 0.02, p < 0.01, and 16.2 ± 0.73 vs. 17.7 ± 0.8 l/min, p < 0.01; 40% estimated maximal oxygen uptake: 0.76 ± 0.02 vs. 0.82 ± 0.01, p < 0.01, and 25.9 ± 1.1 vs. 28.3 ± 1.3 l/min, p < 0.05; 60% estimated maximal oxygen uptake: 0.85 ± 0.02 vs. 0.91 ± 0.02, p < 0.01, and 37.4 ± 1.7 vs. 40.9 ± 1.9 l/min, p < 0.05) but ETPCO2 did not change. The differences in RR before and after glucose load became smaller as the workload increased. Linear regression analysis of VE and carbon dioxide output yielded virtually identical results for both fasting and glucose load conditions. We have concluded that: a) for the metabolic carbon dioxide load increment due to glucose-induced RR increment, the physiological response is an increase of VE at all workloads. This response modulates constant ETPCO2 values; b) on workload increment, skeletal muscle increasingly utilises more and more glycogen stores, regardless of the blood glucose availability. This reduces the usefulness of dietary manipulations decreasing carbon dioxide metabolic load during muscular work in respiratory failure; c) the absolute value of metabolic carbon dioxide load exerts a role in ventilation regulation at rest and during aerobic exercise.

CEUS in the study of bladder, method, administration and evaluation, a technical note

PURPOSE

Contrast-enhanced ultrasound (CEUS) is the application of ultrasound contrast agents (UCAs) to traditional medical sonography. The development of UCAs allowed to overcome some of the limitations of conventional B-mode and Doppler ultrasound techniques and enabled the display of the parenchymal microvasculature. Purpose of this paper is to delineate the elements of a solid and science-based technique in the execution of urinary bladder CEUS.

METHODS

We describe the technical execution of urinary bladder CEUS and the use of perfusion softwares to perform contrast enhancement quantitative analysis with generation of time-intensity curves from regions of interest.

RESULTS

During CEUS, normal bladder wall shows a wash-in time of 13 s, a time to peak (TTP) >40 s, a signal intensity (SI) <45 % and a wash-out time >80 s; Low-grade urothelial cell carcinoma (UCC) shows a wash-in time of 13 s, a time to peak TTP >28 s, a SI <45 % and a wash-out time of 40 s; High-grade UCC shows a wash-in time of 13 s, a TTP >28 s, a SI >50 % and a wash-out time of 58 s.

CONCLUSIONS

CEUS is a useful tool for an accurate characterization of bladder UCC although it has some drawbacks. To avoid misunderstandings, a widely accepted classification and a standardized terminology about the most significant parameters of this application should be adopted in the immediate future.

Characterization of the anisotropic mechanical behaviour of colonic tissues: experimental activity and constitutive formulation

The aim was to investigate the biomechanical behaviour of colonic tissues by a coupled experimental and numerical approach. The wall of the colon is composed of different tissue layers. Within each layer, different fibre families are distributed according to specific spatial orientations, which lead to a strongly anisotropic configuration. Accounting for the complex histology of the tissues, mechanical tests must be planned and designed to evaluate the behaviour of the colonic wall in different directions. Uni-axial tensile tests were performed on tissue specimens from 15 fresh pig colons, accounting for six different loading directions (five specimens for each loading direction). The next step of the investigation was to define an appropriate constitutive framework and develop a procedure for identification of the constitutive parameters. A specific hyperelastic formulation was developed that accounted for the multilayered conformation of the colonic wall and the fibre-reinforced configuration of the tissues. The parameters were identified by inverse analyses of the mechanical tests. The comparison of model results with experimental data, together with the evaluation of satisfaction of material thermomechanics principles, confirmed the reliability of the analysis developed. This work forms the basis for more comprehensive activities that aim to provide computational tools for the interpretation of surgical procedures that involve the gastrointestinal tract, considering the specific biomedical devices adopted.

Analysis of the biomechanical behaviour of gastrointestinal regions adopting an experimental and computational approach

An integrated experimental and computational procedure is provided for the evaluation of the biomechanical behaviour that characterizes the pressure-volume response of gastrointestinal regions. The experimental activity pertains to inflation tests performed on specific gastrointestinal conduct segments. Different inflation processes are performed according to progressively increasing volumes. Each inflation test is performed by a rapid liquid in-flaw, up to a prescribed volume, which is held constant for about 300s to allow the development of relaxation processes. The different tests are interspersed by 600s of rest to allow the recovery of the specimen mechanical condition. A physio-mechanical model is developed to interpret both the elastic behaviour of the sample, as the pressure-volume trend during the rapid liquid in-flaw, and the time-dependent response, as the pressure drop during the relaxation processes. The minimization of discrepancy between experimental data and model results entails the identification of the parameters that characterize the viscoelastic model adopted for the definition of the behaviour of the gastrointestinal regions. The reliability of the procedure is assessed by the characterization of the response of samples from rat small intestine.

Update on ultrasound elastography: miscellanea. Prostate, testicle, musculo-skeletal

Nowadays ultrasound elastosonography is an established technique, although with limited clinical application, used to assess tissue stiffness, which is a parameter that in most cases is associated with malignancy. However, although a consistent number of articles have been published about several applications of elastosonography, its use in certain human body districts is still not well defined. In this paper we write on the use of elastosonography in prostate, testicle and musculo-skeletal apparatus. We report and compare the work of several authors, different type of elastosonography (shear wave, strain elastography, etc.) and instrumental data obtained in the study of both benign and malignant lesions.

Terrestrial gamma-ray flashes as powerful particle accelerators

Strong electric discharges associated with thunderstorms can produce terrestrial gamma-ray flashes (TGFs), i.e., intense bursts of x rays and γ rays lasting a few milliseconds or less. We present in this Letter new TGF timing and spectral data based on the observations of the Italian Space Agency AGILE satellite. We determine that the TGF emission above 10 MeV has a significant power-law spectral component reaching energies up to 100 MeV. These results challenge TGF theoretical models based on runaway electron acceleration. The TGF discharge electric field accelerates particles over the large distances for which maximal voltages of hundreds of megavolts can be established. The combination of huge potentials and large electric fields in TGFs can efficiently accelerate particles in large numbers, and we reconsider here the photon spectrum and the neutron production by photonuclear reactions in the atmosphere.

Distribution and localization of microsatellites in the Perigord black truffle genome and identification of new molecular markers

The level of genetic diversity and genetic structure in the Perigord black truffle (Tuber melanosporum Vittad.) has been debated for several years, mainly due to the lack of appropriate genetic markers. Microsatellites or simple sequence repeats (SSRs) are important for the genome organisation, phenotypic diversity and are one of the most popular molecular markers. In this study, we surveyed the T. melanosporum genome (1) to characterise its SSR pattern; (2) to compare it with SSR patterns found in 48 other fungal and three oomycetes genomes and (3) to identify new polymorphic SSR markers for population genetics. The T. melanosporum genome is rich in SSRs with 22,425 SSRs with mono-nucleotides being the most frequent motifs. SSRs were found in all genomic regions although they are more frequent in non-coding regions (introns and intergenic regions). Sixty out of 135 PCR-amplified mono-, di-, tri-, tetra, penta, and hexa-nucleotides were polymorphic (44%) within black truffle populations and 27 were randomly selected and analysed on 139 T. melanosporum isolates from France, Italy and Spain. The number of alleles varied from 2 to 18 and the expected heterozygosity from 0.124 to 0.815. One hundred and thirty-two different multilocus genotypes out of the 139 T. melanosporum isolates were identified and the genotypic diversity was high (0.999). Polymorphic SSRs were found in UTR regulatory regions of fruiting bodies and ectomycorrhiza regulated genes, suggesting that they may play a role in phenotypic variation. In conclusion, SSRs developed in this study were highly polymorphic and our results showed that T. melanosporum is a species with an important genetic diversity, which is in agreement with its recently uncovered heterothallic mating system.

Gamma-ray localization of terrestrial gamma-ray flashes

Terrestrial gamma-ray flashes (TGFs) are very short bursts of high-energy photons and electrons originating in Earth's atmosphere. We present here a localization study of TGFs carried out at gamma-ray energies above 20 MeV based on an innovative event selection method. We use the AGILE satellite Silicon Tracker data that for the first time have been correlated with TGFs detected by the AGILE Mini-Calorimeter. We detect 8 TGFs with gamma-ray photons of energies above 20 MeV localized by the AGILE gamma-ray imager with an accuracy of ∼5-10° at 50 MeV. Remarkably, all TGF-associated gamma rays are compatible with a terrestrial production site closer to the subsatellite point than 400 km. Considering that our gamma rays reach the AGILE satellite at 540 km altitude with limited scattering or attenuation, our measurements provide the first precise direct localization of TGFs from space.

The olfactory system is affected by steroid aerosol treatment in mice

Asthma needs continuous treatment often for years. In humans, some drugs are administered via aerosol, therefore they come in contact with both respiratory and olfactory mucosa. We explored the possibility that antiasthma corticosteroid treatment could influence the olfactory function by passage through the nose. A group of mice was exposed twice daily for 42 days to fluticasone propionate aerosol and was compared with a control group. Olfactory behavior, respiratory mechanics, histology, and immunoreactivity in the olfactory system were assessed. Fluticasone-treated mice were slower in retrieving a piece of hidden food, but both groups were similarly fast when the food was visible. When a clearly detectable odor was present in the environment, all mice behaved in a similar way. Respiratory mechanics indices were similar in all mice except for the viscose resistance, which was reduced in fluticasone-treated mice. Olfactory mucosa of fluticasone-treated mice was thicker than that of controls. Slight but consistent differences in staining were present for Olfactory Marker Protein but not for other proteins. A mild impairment of olfactory function is present in mice chronically treated with fluticasone aerosol, apparently accompanied by slight modifications of the olfactory receptor cells, and suggests monitoring of olfactory function modifications in long-term steroid users.

A new method of measure of bubble gas volume shows that interleukin-6 injected into rats has no effect on gas embolism

The pleiotropic cytokine interleukin-6 increases in the plasma of rats after an air dive. Interleukin-6 shares both of inflammatory and anti-inflammatory properties and may condition the vascular system and gas embolism after an air dive. Up to now it is not known whether interleukin-6 has an effect on gas embolism. Aim of this work is to study the effect of interleukin-6 on gas embolism after a standard decompression protocol in a rat model. The volume of gas bubbles was measured in the heart cavities with a new method based on the buoyancy of the heart at different pressures which is physically sound, accurate and precise down to 10(-4) cm3. No effect was found after injecting physiological doses of interleukin-6 at different times before the air dive. The mortality of the rats in the first half hour after the decompression was associated with a substantial gas volume measured in the heart. Multi-variate logistic regression analysis showed that the female rats had a higher risk compared to male rats of developing a substantial bubble volume and of not surviving; the spring-summer season was a risk factor for the survival. Further studies are needed to see whether interleukin-6 in association with other cytokines has an effect on gas embolism.

Anesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report

Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. The choice of drugs and the choice of anesthesia in these patients can be very challenging for many reasons. A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.

Effect of the oestral cycle on respiratory mechanics in the rat

AIM

To assess the effect of the oestral cycle on the respiratory mechanics of the rat.

METHODS

We measured the main mechanical respiratory parameters, namely respiratory system and lung resistances and compliances, by the end-inflation occlusion method on two populations of female rats, during proestrous-oestrous and metaoestrous-diestrous phases.

RESULTS

Inflation-deflation loops of the lungs were found to be statistically higher in rats during metaoestrous-diestrous phase. No other statistically significant difference was found in the measured mechanical respiratory parameters.

CONCLUSION

Our results suggest that the naturally occurring fluctuations in serum sexual hormone levels during the sexual cycle influence the lung's hysteresis but do not influence the respiratory system and lung resistances or static compliances. A possible effect of female sexual hormones on surfactant activity is also suggested.

PSpice modeling of capacitive microfabricated ultrasonic transducers

Capacitive microfabricated ultrasonic transducers (cMUTs) are the newest and potentially the most promising devices to convert electrical into acoustic signals and vice-versa. These devices are based on the capacitance modulation of a microcondenser which is obtained by microfabrication onto a silicon substrate. The aim of this paper is to describe a PSpice model of the cMUT, based on an analytical distributed model previously reported (IEEE Trans. UFFC 49 (2) (2002) 159-168), which can be used to simulate the performances of a general ultrasound system, either in frequency or time domain. The PSpice model consists of a capacitor with a parallel resistor, which represent the static capacitance and the loss and bias resistances of the transducer, respectively, plus two quadrupoles (GLAPLACE) modeling the mechanical impedance of the membranes and the radiation impedance of the medium. The usefulness of a PSpice model is the possibility to simulate and optimize the cMUT transducers in transmission and reception, along with driving and receiving electronics, in a general ultrasound system. Experimental measurements on a 5 MHz cMUT operating in pulse-echo are in good agreement with model predictions.

Cloning and characterization of two repeated sequences in the symbiotic fungus Tuber melanosporum Vitt

Two repeated DNA sequences of European strains of the symbiotic fungus Tuber melanosporum were isolated and characterized. One of these, SS14, representing about 0.05% of the fungal genome, was shown to be a T. melanosporum-specific sequence by Southern and dot-blot hybridization. The second one, named SS15, is about 0.0025% of the entire genome, and it is specific not only to T. melanosporum but also to the Asian black truffle Tuber indicum. Neither of these two fragments hybridizes with any of the other European truffle species tested. By sequence analysis of these two fragments, PCR primers were designed and used to selectively amplify DNA from T. melanosporum ascocarps and ectomycorrhizae by simple and multiplex PCR. No amplification products were obtained with DNA from either mycorrhizal roots or fruit bodies of other ectosymbiotic fungi. The two identified genomic traits also provided useful information for a better understanding of the phylogenetic relationships among black truffle species and for testing T. melanosporum intraspecific variability.

Typing Tuber melanosporum and Chinese black truffle species by molecular markers

Morphologically similar species such as Chinese black truffles and Tuber melanosporum were typed by restriction length polymorphism of internal transcribed spacers. This analysis together with sequence comparison revealed the presence of high genetic variability among fruit bodies collected in China. Selection of primer pairs allowed the internal transcribed spacer region of both Chinese truffles and T. melanosporum to be specifically amplified.

Cardiac output measurement by the thermodilution method: an in vitro test of accuracy of three commercially available automatic cardiac output computers

OBJECTIVE

To describe the accuracy and the reproducibility of the thermodilution flow measurements obtained using 3 commercially available cardiac output computers commonly used in intensive care units.

DESIGN

An experimental "in vitro" study. Twelve different values of control flow (Qctr) were measured (Qmsr) using 3 different cardiac output computers (Abbott Critical Care System, Oximetrix 3 SvO2/CO Computer, Baxter Oximeter/Cardiac Output Computer SAT-1; American Edwards Laboratories, 9520 A Cardiac Output Computer). Standard equipment and techniques were employed, taking account of the specific weight and heat of warm water relative to blood. In addition, separate sets of measurements were performed in order to investigate the effect on Qmsr of some variables which may influence the "indicator" loss (time for injection, depth of immersion of the catheter, temperature of the injected fluid).

SETTING

Our laboratory, inside the intensive care unit.

MEASUREMENTS AND RESULTS

The analysis of the linear regression of Qmsr versus Qctr (r values between 0.992 and 0.984; residual standard deviation values comprised between 0.24 and 0.49 l/min; intercepts and slopes not significantly different from identity line), the values of the percentage errors (PE = [Qctr-Qmsr].100/Qctr; PE mean values 7.9, 5.0 and 13.1), and those of the coefficients of variability (CV = standard deviation mean value, %; CV mean values 5.4, 5.8 and 4.6), show a good level of accuracy and reproducibility of the measurements. Our data confirm previously reported results. Furthermore, the cumulative effect of variables capable of influencing the "indicator" loss, even if corrected according to the "calculation constant" the manufacturers provide, was found to result in statistically significant changes of Qmsr.

CONCLUSION

The accuracy and reproducibility of the automatic cardiac computers tested is sufficient for practical clinical purpose. It may also depend on the modality of injection of the cooling bolus, which may significantly influence the effective "indicator" losses.

Hemodynamic effects of continuous positive-pressure ventilation and high-frequency jet ventilation with positive end-expiratory pressure in normal dogs

The hemodynamic effects of high-frequency jet ventilation (HFJV) at 60, 120, 240, and 480 breath/min, and conventional ventilation at 15 breath/min were compared in 6 anesthetized, paralyzed dogs, at 0, 10, and 20 cm H2O of positive end-expiratory pressure (PEEP). On HFJV at the same inspired oxygen, PaCO2, and PEEP levels, hemodynamic function improved significantly. Cardiac output was higher, whereas transmural CVP and pulmonary vascular resistances were lower. The improvement was primarily related to a decrease in mean airway pressure, particularly at higher PEEP levels. When PEEP was applied, hemodynamic function improved even when mean airway pressure was maintained constant. The findings suggest that lung volume was smaller during HFJV, and/or that lung volume changes during each respiratory cycle contributed to differences in venous return and ventricular function.