Homozygous familial hypercholesterolemia (HoFH) in Germany: an epidemiological survey

Introduction

In Europe a disease is recognized as rare if less than 1 in 2000 people suffer from the specific disease. In patients with familial homozygous hypercholesterolemia (HoFH) the accumulation of low-density lipoprotein cholesterol (LDL-C) leads to generalized atherosclerosis due to an insufficient functioning of the LDL-C receptors. Patients die early sometimes even in the mid-30s, from myocardial infarction or stroke. For the German population, insufficient epidemiological evidence exists.

Methods

A systematic literature search in EMBASE and Medline was performed in conjunction with a targeted manual search for epidemiological HoFH studies. Additionally a nationwide survey was conducted in Germany in all identified apheresis- and lipid centers. The purpose of the survey was the validation of the systematic literature search results based on empirical (practice) data.

Results

In total 961 publications were found, 874 were excluded based on pre-defined exclusion criteria leaving only 87 for further review. After review of the identified abstracts (n = 87) 23 publications were identified as epidemiological studies. Only one publication was found which reported a prevalence of 1:1,000,000. The qualitative survey among 187 physicians in Germany also revealed a low prevalence: 95 HoFH patients were identified in 35 centers.

Conclusion

The estimated frequency of homozygous familial hypercholesterolemia patients in Germany is around 95 (1:860,000) and the disease should be recognized as rare according to the definition of the European Medical Agency.

Drug action team strategies in Scotland

OBJECTIVE

To compare the Strategic Plans of Scottish Drug Action Teams (DATs) to the recommendations of the Scottish Office Ministerial Task Force Report.

DESIGN

Extraction of information from the strategic plans of DATs.

SETTING

All 15 Scottish DATs 1995-96.

RESULTS

Five DATs did not include a membership list in their Strategy, and two stated the organisations represented, but not the identity of individual members. Where individuals were identified, Health Boards, Social Work departments, Education and Police were always members. The median number of members was 12 (range 4-16). Most areas had plans to improve information on drug misuse. Every plan mentioned preventive work with young people. In Criminal Justice settings, use of Children's Hearings (20% of plans), substitute prescribing linked to probation (13%) and prison aftercare schemes (33%) were mentioned less commonly. Substitute prescribing (87% of DATs), the role of General Practitioners (100%) and monitoring mechanisms (87%) were the service issues mentioned most often. Of other service issues in the Ministerial Report, those mentioned least by DATs were childcare linked to services (20%); services for people from ethnic minorities (33%); education on dangers of injecting to existing drug users (33%); women--only residential services (33%); services for women (46%) and role of pharmacists (53%).

CONCLUSION

Membership was from a core of statutory agencies. Young people were the priority of most DATs. Criminal Justice arrangements and services for special groups of people were not well developed in many plans. DATs should review their focus on these groups.

Differential depressant effects of general anesthetics on the cardiovascular response to cocaine in mice

In recent years, murine models have gained increasing importance for studies of cardiovascular physiology and pharmacology, largely due to the development of transgenic strains with specific alterations in phenotype. Differential effects of general anesthetic agents on the cardiovascular responses to cocaine have been reported in larger mammals; therefore, we studied the effects of commonly used anesthetics on heart function and on blood pressure responses to cocaine in Swiss Webster mice. We positioned a polyethylene catheter (PE-10) in the right carotid artery or left ventricle of mice anesthetized with equivalent anesthetic dose of either ketamine-xylazine (KX, 40 mg/kg + 5 mg/kg), pentobarbital (PEN, 40 mg/kg) or alpha-chloralose-urethane (CU, 80 mg/kg + 100 mg/kg). Cocaine (0.3 mg/kg, 1 mg/kg and 3 mg/kg) was administrated via the left jugular vein by bolus injection. In the KX group, the basal mean arterial pressure (MAP) and systolic left ventricular pressure (LVP) were 110 +/- 12 and 120 +/- 13 mmHg, respectively, close to conscious values. However, PEN and CU significantly decreased the basal parameters (P < 0.01 compared to the KX group). The lowest dose of cocaine (0.3 mg/kg) elicited minimal changes. Significant responses were obtained with a 1-mg/kg dose of cocaine (P < 0.01 compared to baseline). However, at 3 mg/kg, a toxic effect of cocaine appeared in all three anesthetic groups. Compared to published conscious animal data, anesthetic agents attenuated the cardiovascular effects of cocaine. Taken together, our results indicate that minimally effective doses of general anesthetics may significantly alter the basal hemodynamic state and the responses to sympathomimetic agents in the murine model, as has been reported in larger mammalian species. We concluded that anesthesia with ketamine-xylazine provides baseline hemodynamic values close to reported values in conscious animals, but also attenuates the hemodynamic response to cocaine.

Children's feeding programs in Atlantic Canada: reducing or reproducing inequities?

This study analyzed, through case studies of day-to-day observations and interviews with recipients and operators, the operations of nine children's feeding programs in Nova Scotia, New Brunswick, and Newfoundland. We found that children's feeding programs result in the stigmatization of participants and families, despite an ideology of equality. Most programs adopt a family substitution role in the lives of children they serve and function in a way that excludes parental participation. Programs also transmit a hidden curriculum to children that teaches them how to behave and how a 'proper' family functions. We found that the professionalization of food and nutrition, a desire for an expanded client base, and dependency creation through the provision of other material goods, permit programs to exert increasing institutional control over recipients, a process we, following Illich, call the dragnet. While these programs may be meeting some nutritional needs in a few poverty-stricken children, they ultimately reproduce, rather than reduce, inequities.

Evaluation of a peer health education project in the gambia, west Africa

The purpose of this study was to evaluate a peer health education program among high school students in The Gambia, West Africa. Using convenience sampling, two of the ten high schools targeted by the program (one urban and one rural) were selected for evaluation. A total of eighty respondents, forty from each school, were randomly selected for participation. A validated questionnaire with both open and closed-ended questions was the data collection instrument which was subject to qualitative content analysis and quantitative descriptive analysis. Altogether, seventy-four participants completed the questionnaire for a response rate of 92.5 percent. Respondents' almost universal awareness of the peer health education program and their ability to recall the presentations suggested that peer education is an effective and acceptable means of disseminating information among youths. Over 90 percent of respondents applied the health information to their own lives, suggesting that peer health education can also have an influence on health behaviors of youths. Within the context of a developing country, peer health education was found to be culturally appropriate and allowed for the efficient utilization of local resources.

Natural protection against HIV-1 infection provided by HIV-2

Significant differences have been observed in the rates of transmission and disease development in human immunodeficiency virus (HIV) types 1 and 2. Because many HIV-2-infected people remain asymptomatic for prolonged periods, the hypothesis that HIV-2 might protect against subsequent infection by HIV-1 was considered. During a 9-year period in Dakar, Senegal, the seroincidence of both HIV types was measured in a cohort of commercial sex workers. Despite a higher incidence of other sexually transmitted diseases (STDs), HIV-2-infected women had a lower incidence of HIV-1 than did HIV-seronegative women, with a relative risk of 0.32 (P = 0.008). An understanding of the cross-protective mechanisms involved may be directly relevant to HIV-1 vaccine development.

Reduced rate of disease development after HIV-2 infection as compared to HIV-1

Human immunodeficiency virus type-2 (HIV-2) is a close relative of the prototype acquired immunodeficiency syndrome (AIDS) virus, HIV-1. HIV-2 is biologically similar to HIV-1, but information is lacking concerning clinical outcomes of HIV-2-infected individuals. From 1985 to 1993, a prospective clinical study was conducted in women with HIV-2 and HIV-1 infection to determine and compare rates of disease development. HIV-1-infected women had a 67% probability of AIDS-free survival 5 years after seroconversion in contrast with 100% for HIV-2-infected women. In addition to having significantly less HIV-related disease outcome in HIV-2 enrollees compared to HIV-1 enrollees, the rate of developing abnormal CD4+ lymphocyte counts with HIV-2 infection was also significantly reduced. This natural history study demonstrates that HIV-2 has a reduced virulence compared to HIV-1.

Prevalence and risk determinants of human immunodeficiency virus type 2 (HIV-2) and human immunodeficiency virus type 1 (HIV-1) in west African female prostitutes

The authors studied the prevalence and risk determinants for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) in female prostitutes from Dakar (1985-1990), Ziguinchor (1987-1990), and Kaolack (1987-1990), Senegal, West Africa. Each cohort showed a distinct distribution of HIVs: 10.0% HIV-2 and 4.1% HIV-1 in Dakar, 38.1% HIV-2 and 0.4% HIV-1 in Ziguinchor, and 27.4% HIV-2 and 1.3% HIV-1 in Kaolack. In 1,275 female prostitutes from Dakar, increase years of sexual activity and a history of scarification were associated with HIV-2 seropositivity. In contrast, HIV-1 seroprevalence was associated with a shorter duration of prostitution and a history of hospitalization. In 278 female prostitutes from Ziguinchor, HIV-2 seroprevalence was associated with women of Guinea-Bissau nationality and increased years of sexual activity. In 157 female prostitutes from Kaolack, HIV-2 seroprevalence was associated with increased years of sexual activity and a history of never using condoms. The authors also studied the risk determinants for HIV-2 in the 1,280 Senegalese prostitutes pooled from all three sites. Controlling for ethnic group, women from Ziguinchor and Kaolack were more likely to be HIV-2 seropositive as compared with women from the Dakar site. Increased years of sexual activity were associated with HIV-2 seropositivity, while a history of excision and BCG vaccinations decreased the risk of HIV-2 infection.

Human T-lymphotropic virus type 4 and the human immunodeficiency virus in West Africa

A new human T-lymphotropic virus (HTLV-4) was recently described in healthy people from Senegal. This virus has many properties in common with members of the human T-lymphotropic viruses, particularly the human immunodeficiency virus or HIV, the etiologic agent of acquired immune deficiency syndrome (AIDS), but does not appear to be associated with immunodeficiency-related disorders. In the present study, serum samples were obtained from 4248 individuals from six West African countries, including Senegal, Guinea, Guinea Bissau, Mauritania, Burkina Faso, and Ivory Coast. These samples, collected during 1985-1987, were from people categorized as healthy control, sexually active risk, and disease populations. All samples were analyzed for reactivity to HTLV-4 and HIV by radioimmunoprecipitation-sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. Evidence for HTLV-4 infection was found in five of the six countries. The seroprevalence varied markedly from country to country. Healthy sexually active individuals in the risk category had the highest levels of HTLV-4 infection compared to individuals in the healthy control category and the disease category, the latter including AIDS patients. The seroprevalence of HIV infection in most of these countries was quite low, although tightly associated with the rare cases of AIDS. The biology of HTLV-4 infection thus differs from that of HIV in Central Africa or the United States and Europe. The presence of these viruses and their different pathogenicities in several countries of West Africa indicate the necessity for serologic assays that will distinguish between them. Further studies of their origin and distribution as well as of their biology will be important in advancing our understanding of AIDS.