bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of chronic infection in children with otitis media with effusion: Evidence for intracellular persistence of bacteria
Authors: Coates Harvey , Thornton Ruth , Langlands Jennifer , Filion Pierre , Anthony D. Keil , Vijayasekaran Shyan , Richmond Peter
Published: June 2008

Objective

Demonstrate mucosal bacterial infection in children with otitis media with effusion (OME).

Study Design and Setting

Middle ear mucosal biopsies from 11 children with OME were examined for bacteria utilizing transmission electron microscopy. This was correlated with standard culture and polymerase chain reaction (PCR) of middle ear effusions.

Results

Gram‐positive coccal bacteria were demonstrated in middle ear mucosal epithelial cells of 4 of 11 (36%) children. Morphological appearance of bacteria and detection of pneumolysin DNA by PCR in middle ear fluid suggests a role for persistent intracellular infection with Streptococcus pneumoniae and other gram‐positive cocci in some cases of OME.

Conclusion

Intracellular bacterial infection of middle ear mucosal epithelial cells in children with OME may be an important mechanism for bacterial persistence, and contribute to inflammation and mucus production in the pathogenesis of this condition.

Significance

Persistent intracellular infection is a novel paradigm for OME pathogenesis in children and may influence antibiotic effectiveness in treatment of this condition.

© 2008 American Academy of Otolaryngology‐Head and Neck Surgery Foundation. All rights reserved.
Spontaneous CSF leaks: A paradigm for definitive repair and management of intracranial hypertension
Authors: Woodworth Bradford A. , Prince Anthony , Chiu Alexander G. , Cohen Noam A. , Schlosser Rodney J. , Bolger William E. , Kennedy David W. , Palmer James N.
Published: June 2008

Objective

To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes.

Study Design

Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow‐up.

Results

Fifty‐six patients underwent repair of spontaneous CSF leaks. Eighty‐two percent (46 of 56) were obese (average BMI 36.2 kg/m2). Nine patients had multiple CSF leaks. Fifty‐four patients (96%) had associated encephaloceles. Fifty‐three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow‐up). Intracranial pressures averaged 27 cm H2O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt.

Conclusions

Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
Measurement of hearing aid outcome in the elderly: Comparison between young and old elderly
Authors: Chang Wei‐Hsiu , Tseng Hsueh‐Ching , Chao Ting‐Kuang , Hsu Chuan‐Jen , Liu Tien‐Chen
Published: June 2008

Objective

To evaluate speech performance and subjective outcomes for older individuals who have hearing impairment and use digital hearing aids. The outcomes between young and old elderly users were compared.

Study Design

Prospective.

Subjects and Methods

Fifty‐nine patients with hearing loss fitted with digital hearing aids were included. They were divided into two groups. Group A consisted of 32 subjects aged 65 to 80 years, whereas group B had 27 subjects older than 80 years. Speech performance and subjective outcomes were measured 4 months after fitting of hearing aids. Hearing Handicap Inventory for the Elderly‐Screening Version (HHIE‐S), Client Oriented Scale of Improvement (COSI), satisfaction, and usage questionnaires were used as subjective assessments.

Results

Improvements in speech performance were not significantly different between these two groups. There were no statistical differences in terms of HHIE‐S score reduction, satisfaction rate, daily usage time, and COSI scores between both groups.

Conclusion

Age by itself is not a limiting factor for older patients with hearing impairment to benefit from digital hearing aids.
MRI analysis of the size and shape of the oropharynx in chronic whiplash
Authors: Elliott James , Cannata Emma , Christensen Eric , DeMaris Joel , Kummrow John , Manning Erin , Nielsen Elizabeth , Romero Tomas , Barnes Clifford , Jull Gwendolen
Published: June 2008

Obectives

To quantify differences in the size/shape of the oropharynx between female subjects with whiplash and controls.

Design

Retrospective cohort.

Methods

A total of 113 subjects (79 whiplash, 34 controls) were included. T1‐weighted MRI was used to measure 1) crosssectional area (CSA [mm2]) and 2) shape ratios for the oropharynx. Reliability data were established.

Results

Whiplash subjects had significantly smaller oropharynx CSAs (P < 0.001) and shape ratios (P < 0.001) compared with healthy controls. Self‐reported levels of pain and disability and duration of symptoms were not associated with size and shape of the oropharynx in whiplash subjects (P = 0.75 and P = 0.99, respectively). Age and BMI did influence the size (P = 0.01) and shape of the oropharynx (P < 0.001) in the whiplash subjects, but only 20 to 30 percent of the variance could be explained by these factors.

Conclusion

Significant difference in the size and shape of the oropharynx was noted in subjects with chronic whiplash compared with controls. Future studies are required to investigate the relationships between oropharynx morphometry and symptoms in patients with chronic whiplash.
Clinical and radiographic findings in children with spontaneous lymphatic malformation regression
Authors: Perkins Jonathan A. , Maniglia Claudia , Magit Anthony , Sidhu Manrita , Manning Scott C. , Chen Eunice Y.
Published: June 2008

Objective

Evaluate clinical and radiographic characteristics of spontaneously regressing lymphatic malformations (“lesions”).

Subjects and Methods

Retrospective review of 104 consecutive patients with cervicofacial lesions, with 1‐year follow‐up. Data collected: patient's age; lesion stage, location, radiographic characteristics; treatment. Data analysis using descriptive and Fischer exact tests.

Results

Spontaneously regressing lesions were identified in 13 of 104 (12.5%) patients. Five of 13 had in utero lesions, which persisted at birth; presenting age in the remaining eight patients was 2 to 138 months. Lesions regressed within 2 to 7 months. Lesion stage: I (7 of 13), II (2 of 13), III (4 of 13). Lesion location: left neck (9 of 13), right neck (4 of 13), posterior neck (10 of 13). All 13 resolving lesions were macrocystic with fewer than five septations in 11 of 13. Comparison of a resolving lesion cohort with a nonresolving lesion cohort demonstrated that disappearing lesions are more likely to have fewer than five septae and to be macrocystic (P < 0.05). Treatment was none in seven of 13, antibiotics in four of 13, and redundant skin excision in two of 13.

Conclusion

Spontaneous lesion regression can occur, and these lesions have distinct features. Lesions with these characteristics can be observed.
Authoritarian Reversals and Democratic Consolidation
Authors: SVOLIK MILAN
Published: June 2008

I present a new empirical approach to the study of democratic consolidation. This approach leads to new insights into the determinants of democratic consolidation that cannot be obtained with existing techniques. I distinguish between democracies that survive because they areconsolidatedand those democracies that arenot consolidatedbut survive because of some favorable circumstances. As a result, I can identify the determinants of two related yet distinct processes: the likelihood that a democracy consolidates, and the timing of authoritarian reversals in democracies that are not consolidated. I find that the level of economic development, type of democratic executive, and type of authoritarian past determine whether a democracy consolidates, but have no effect on the timing of reversals in democracies that are not consolidated. That risk is only associated with economic recessions. I also find that existing studies greatly underestimate the risk of early reversals while simultaneously overestimating the risk of late reversals, and that a large number of existing democracies are in fact consolidated.
Design, Inference, and the Strategic Logic of Suicide Terrorism
Authors: ASHWORTH SCOTT , CLINTON JOSHUA D. , MEIROWITZ ADAM , RAMSAY KRISTOPHER W.
Published: June 2008

In “The Strategic Logic of Suicide Terrorism,” Robert Pape (2003) presents an analysis of his suicide terrorism data. He uses the data to draw inferences about how territorial occupation and religious extremism affect the decision of terrorist groups to use suicide tactics. We show that the data are incapable of supporting Pape's conclusions because he “samples on the dependent variable.”—The data only contain cases in which suicide terror is used. We construct bounds (Manski, 1995) on the quantities relevant to Pape's hypotheses and show exactly how little can be learned about the relevant statistical associations from the data produced by Pape's research design.
Bilateral nasal polyps originating from the nasal septum: a case report
Authors: Akdogan M V , Aydin E , Ozgirgin O N
Published: June 2008

Introduction:

All nasal polyps originate from the mucosa of the nasal cavity or the paranasal sinuses. Most polyps originate from contact areas of the uncinate process, the middle turbinate or the ethmoid infundibulum. Polyps originating from the mucosa of the nasal septum are rare.

Case report:

We present a 77-year-old man with nasal polyps originating from the superior aspect of the nasal septum. These lesions had the typical histological appearance of nasal polyps.

Discussion:

Nasal polyps are inflammatory growths of the nasal or paranasal mucosa. Nasal polyps commonly present clinically with nasal obstruction, sinusitis and anosmia. Most polyps originate from the lateral walls of the nasal passage. Isolated septal polyps are rare but can cause symptoms such as nasal obstruction and olfactory disorders.
Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study
Authors: Gimeno D. , Kivimäki M. , Brunner E. J. , Elovainio M. , De Vogli R. , Steptoe A. , Kumari M. , Lowe G. D. O. , Rumley A. , Marmot M. G. , Ferrie J. E.
Published: June 2008

Background

A lack of longitudinal studies has made it difficult to establish the direction of associations between circulating concentrations of low-grade chronic inflammatory markers, such as C-reactive protein and interleukin-6, and cognitive symptoms of depression. The present study sought to assess whether C-reactive protein and interleukin-6 predict cognitive symptoms of depression or whether these symptoms predict inflammatory markers.

Method

In a prospective occupational cohort study of British white-collar civil servants (the Whitehall II study), serum C-reactive protein, interleukin-6 and cognitive symptoms of depression were measured at baseline in 1991–1993 and at follow-up in 2002–2004, an average follow-up of 11.8 years. Symptoms of depression were measured with four items describing cognitive symptoms of depression from the General Health Questionnaire. The number of participants varied between 3339 and 3070 (mean age 50 years, 30% women) depending on the analysis.

Results

Baseline C-reactive protein (β=0.046, p=0.004) and interleukin-6 (β=0.046, p=0.005) predicted cognitive symptoms of depression at follow-up, while baseline symptoms of depression did not predict inflammatory markers at follow-up. After full adjustment for sociodemographic, behavioural and biological risk factors, health conditions, medication use and baseline cognitive systems of depression, baseline C-reactive protein (β=0.038, p=0.036) and interleukin-6 (β=0.041, p=0.018) remained predictive of cognitive symptoms of depression at follow-up.

Conclusions

These findings suggest that inflammation precedes depression at least with regard to the cognitive symptoms of depression.
Ankle and hip strategies for balance recovery of a biped subjected to an impact
Authors: Nenchev Dragomir N. , Nishio Akinori
Published: June 2008

A humanoid robot should be able to keep balance even in the presence of disturbing forces. Studies of human body reaction patterns to sudden external forces (impacts) are useful for developing balance control strategies. In this paper, we show how to implement two such reaction patterns, called ankle and hip strategy, using a small humanoid robot. Simple dynamical models in the sagittal plane are employed. The decision for invoking one of the reaction patterns is based on acceleration data measured during the impact. The experiments confirm that the robot is able to react swiftly, similar to a human.
Gas distribution mapping of multiple odour sources using a mobile robot
Authors: Loutfi Amy , Coradeschi Silvia , Lilienthal Achim J. , Gonzalez Javier
Published: June 2008

Mobile olfactory robots can be used in a number of relevant application areas where a better understanding of a gas distribution is needed, such as environmental monitoring and safety and security related fields. In this paper, we present a method to integrate the classification of odours together with gas distribution mapping. The resulting odour map is then correlated with the spatial information collected from a laser range scanner to form a combined map. Experiments are performed using a mobile robot in large and unmodified indoor and outdoor environments. Multiple odour sources are used and are identified using only transient information from the gas sensor response. The resulting multi-level map can be used as a representation of the collected odour data.
Performance-based reactive navigation for non-holonomic mobile robots
Authors: Defoort Michael , Palos Jorge , Kokosy Annemarie , Floquet Thierry , Perruquetti Wilfrid
Published: June 2008

This paper presents an architecture for the navigation of an autonomous mobile robot evolving in environments with obstacles. Instead of addressing the motion planning and control problems in different contexts, these issues are described in connected modules with performance requirement considerations. The path planning problem is formulated as a constrained receding horizon planning problem and is solved in real time with an efficient computational method that combines non-linear control theory, B-spline basis function and non-linear programming. An integral sliding mode controller is used for trajectory tracking. The closed-loop stability of the tracking errors is guaranteed in spite of unknown disturbances. It is also shown that this strategy is particularly useful if integral sliding mode control is combined with other methods to further robustify against perturbations. The effectiveness, perfect performance of obstacle avoidance, real time and high robustness properties are demonstrated by experimental results.
Patterns of body weight in the Baltic Republics
Authors: Pomerleau Joceline , Pudule Iveta , Grinberga Daiga , Kadziauskiene Kamelija , Abaravicius Algis , Bartkeviciute Roma , Vaask Sirje , Robertson Aileen , McKee Martin
Published: June 2008

Objective

Previously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries.

Design

Three cross-sectional surveys conducted in the summer of 1997.

Setting

Estonia, Latvia and Lithuania.

Subjects

Representative national samples of adults with measured weight and height (Estonia: n = 1154; Latvia: n = 2292; Lithuania: n = 2096).

Results

Between-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity.

Conclusions

Obesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population.
Seasonal consumption of salad vegetables and fresh fruit in relation to the development of cardiovascular disease and cancer
Authors: Cox Brian D , Whichelow Margaret J , Prevost A Toby
Published: June 2008

Objective

To investigate the protective association between seasonality of consumption of fresh fruit or salad vegetables and cancer and cardiovascular disease (CVD) development.

Design and setting

Face-to-face interviews, including a food frequency questionnaire, were conducted on 1489 men and 1900 women, aged 35–75 years, who were respondents in the British Health and Lifestyle Survey 1984/85 (HALS1). CVD and cancer morbidity and mortality were determined from the 1991/92 British Health and Lifestyle Survey (HALS2) and by NHS Register ‘flagging’.

Results

Risk was assessed by odds ratio (OR) for trend per frequency category. In men, frequent winter salad vegetable consumption was more closely protective than that in summer for cancer (winter OR = 0.79 [0.62–0.99], P = 0.045, summer OR = 0.83 [0.69–1.01], NS) and CVD (winter OR = 0.85 [0.72–1.00], P = 0.049, summer OR = 0.95 [0.82–1.10], NS). Fresh fruit consumption showed no significant protection. In women, frequent salad vegetable consumption at any season was significantly protective of CVD (winter OR = 0.76 [0.65–0.89], P < 0.001, summer OR = 0.76 [0.65–0.89], P < 0.001), although not of cancer. Frequent fresh fruit consumption in women was significantly protective of CVD (winter OR = 0.84 [0.74–0.94], P = 0.004, summer OR = 0.85 [0.74–0.97], P = 0.014) but not quite significant, and only in winter, for cancer (winter OR = 0.87 [0.76–1.00], P = 0.052, summer OR = 0.88 [0.75–1.02], P = 0.097). Maintenance of salad vegetable consumption from summer to winter, to within one frequency category, was associated with further protection for cancer in men (P = 0.050) and CVD in women (P = 0.024).

Conclusions

Diets high in fresh fruit and salad vegetables appear protective against cancer and CVD. It is important to take into account the seasonality of consumption in estimating and establishing significance of risk.
Economic crisis and malnutrition: socioeconomic determinants of anthropometric status of preschool children and their mothers in an African urban area
Authors: Delpeuch F , Traissac P , Martin-Prével Y , Massamba JP , Maire B
Published: June 2008

Objective

To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis.

Design

Cross-sectional cluster sample survey.

Setting

Brazzaville, capital city of the Congo.

Subjects

Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n=2373) and their mothers (n=1512).

Results

The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mother's age and child's age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P=0.048 and P=0.004, respectively), schooling of the mother (P=0.004 and P < 10−3) and living in the peripheral district (P=0.005 and P < 10−3). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mother's height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P=0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10−4), to the marital status (P=0.01) and to the occupation of the mother (P < 10−4).

Conclusions

Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the children's nutritional status.
Relationships between vitamin A, iron status and helminthiasis in Bangladeshi school children
Authors: Persson V , Ahmed F , Gebre-Medhin M , Greiner T
Published: June 2008

Objective

To explore the relationships between biochemical indicators of vitamin A and iron status and the intestinal helminthsAscaris lumbricoidesand hookworm in primary school children.

Setting

Two rural governmental schools in northwestern Bangladesh.

Design

Cross-sectional study.

Subjects

The sample consisted of 164 children in grades 3–5.

Methods

Serum retinol and β-carotene (by high-performance liquid chromatography, HPLC), haemoglobin (HemoCue), ferritin (enzyme-linked immunoadsorbent assay, ELIZA) and height and weight were measured. Dietary intake of vitamin A was assessed using a food frequency questionnaire and faecal analyses were done using Stoll's egg-count technique.

Results

The mean serum retinol was 26.8 μg dl−1and 20% had a level of <20 μg dl−1, the cut-off value for low vitamin A status. There was a strong positive association between serum β-carotene and serum retinol (r= 0.44,P<0.001), suggesting those with higher retinol levels had a higher carotene intake. Thirty-one per cent were anaemic (Hb <11.5 g dl−1), 30% had iron deficiency (serum ferritin <12.0 μg l−1) and 14% were suffering from iron deficiency anaemia. Children with a serum retinol level of 20 μg dl−1had significantly lower ferritin (14.0 compared to 26.0 μg l−1,P= 0.005) and Hb levels (11.7 compared to 12.4 g dl−1,P= 0.005) than those with higher levels. The proportion of iron deficiency anaemia was significantly greater among children with hookworm. Our data suggest that hookworm exerts its impact on iron status independently of the vitamin A status of the host.

Conclusions

Programmes to improve iron status should consider including both vitamin A prevention programmes and deworming.
The role of vitamins in the prevention and control of anaemia
Authors: Fishman Steven M , Christian Parul , West Keith P
Published: June 2008

Objective

While iron deficiency is regarded as the major cause of nutritional anaemia, changes in vitamins A, B12, C and E, folic acid and riboflavin status have also been linked to its development and control. This paper provides a systematic review of vitamin supplementation trials relating to the control of nutritional anaemia.

Methods

A MEDLINE search was used to find reports of vitamin supplementation trials that reported changes in anaemia or iron status.

Results

Vitamin A can improve haematological indicators and enhance the efficacy of iron supplementation. Both folate and vitamin B12can cure and prevent megaloblastic anaemia. Riboflavin enhances the haematological response to iron, and its deficiency may account for a significant proportion of anaemia in many populations. Vitamin C enhances the absorption of dietary iron, although population-based data showing its efficacy in reducing anaemia or iron deficiency are lacking. Vitamin E supplementation given to preterm infants has not reduced the severity of the anaemia of prematurity. Vitamin B6effectively treats sideroblastic anaemia. Multivitamin supplementation may raise haemoglobin (Hb) concentration, but few studies have isolated the effect of multivitamins from iron on haematological status.

Conclusions

In general, the public health impact of vitamin supplementation in controlling anaemia is not clear. Neither are the complex interactions involving multiple vitamins in haematopoiesis sufficiently understood to explain the observed variability in haematological responses to vitamins by age, population, vitamin mixture and dosages. Further research is needed to understand the roles of individual and combined vitamin deficiencies on anaemia to design appropriate micronutrient interventions to prevent anaemia.
Sociodemographic determinants of perceived influences on food choice in a nationally representative sample of Irish adults
Authors: Kearney M , Kearney JM , Dunne A , Gibney MJ
Published: June 2008

Objective

To identify the most important motivations for food choice from the point of view of the consumer in the Irish population, and to characterize those subjects who do and do not regard nutrition as a significant consideration in food choice.

Design

As part of a pan-European Union (EU) survey on consumer attitudes to food, nutrition and health, a quota-controlled, nationally representative sample of Irish adults (n = 1009) aged 15 years upwards, completed an interview-assisted, close-ended questionnaire. Subjects selected three factors, from a list of 15, which they believed had the greatest influence on their food choice.

Setting

The interviews for the survey were conducted in subjects' homes.

Results

‘Quality/freshness of food’ was the most frequently selected food choice factor (51%) followed by ’taste‘ (43%) and ‘trying to eat a healthy diet’ (36%). Female gender, increasing age and higher levels of education were found to be independent sociodemographic factors affecting the selection of ‘trying to eat a healthy diet’ as an important factor in food choice.

Conclusions

Although included in the top five most frequently selected factors affecting food choice, nutrition/healthy eating does not appear to have top priority for the majority of Irish adults. There are differences between the various sociodemographic groups within the population; males and younger subjects appear to require specific nutrition promotion messages.
Association of fractures with caffeine and alcohol in postmenopausal women: the Iowa Women's Health Study
Authors: Hansen Solveig A , Folsom Aaron R , Kushi Lawrence H , Sellers Thomas A
Published: June 2008

Objective

To assess whether alcoholic and caffeinated beverages are associated with risk of fractures in women.

Setting

Population-based sample surveyed by post.

Subjects

A total of 34703 postmenopausal Iowan women aged 55–69 years were surveyed.

Design

A cohort of women reported alcoholic and caffeinated beverage intake and were followed for 6.5 years for fracture occurrence. Relative risks (RR) and 95% confidence intervals (CI) were computed using Cox proportional hazards regression. Covariates included age, tobacco use, physical activity, body mass index (BMI), waist to hip ratio (WHR), oestrogen use and calcium intake.

Results

At least one fracture was reported by 4378 women (389 upper arm, 288 forearm, 1128 wrist, 275 hip, 416 vertebral and 2920 other fractures). The adjusted RR for highest versus lowest caffeine intake quintiles was 1.09 (95% CI 0.99–1.21) for combined fracture sites. Wrist fractures were associated positively (RR for extreme quintiles 1.37, 95% CI 1.11–1.69) and upper arm fractures were negatively associated (RR 0.67, 95% CI 0.48–0.94) with caffeine intake. The age-adjusted RR of total fractures for highest versus lowest frequency of beer usage was 1.55 (95% CI 1.25–1.92) and for liquor was 1.25 (95% CI 1.03–1.54). No other association was found between any specific fracture site and alcohol intake.

Conclusions

We found a modest increase in fracture risk associated with highest caffeine intake, varying by site. Alcohol intake was low, but it also showed a weak positive association with fracture risk.
Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease
Authors: Bemelmans Wanda JE , Broer Jan , de Vries Jeanne HM , Hulshof Karin Fam , May Jo F , Jong Betty Meyboom-de
Published: June 2008

Objective

To investigate the impact of intensive group education on the Mediterranean diet on dietary intake and serum total cholesterol after 16 and 52 weeks, compared to a posted leaflet with the Dutch nutritional guidelines, in the context of primary prevention of cardiovascular disease (CVD).

Design

Controlled comparison study of an intervention group given intensive group education about the Mediterranean diet and a control group of hypercholesterolaemic persons given usual care by general practitioners (GPs).

Setting

A socioeconomically deprived area in the Netherlands with an elevated coronary heart disease (CHD) mortality ratio.

Subjects

Two hundred and sixty-six hypercholesterolaemic persons with at least two other CVD risk factors.

Results

After 52 weeks, the intervention group decreased total and saturated fat intake more than the control group (net differences were 1.8 en% (95%CI 0.2–3.4) and 1.1 en% (95%CI 0.4–1.9), respectively). According to the Mediterranean diet guidelines the intake of fish, fruit, poultry and bread increased in the intervention group, more than in the control group. Within the intervention group, intake of fish (+100%), poultry (+28%) and bread (+6%) was significantly increased after 1 year (P< 0.05). The intensive programme on dietary education did not significantly lower serum cholesterol level more (−3%) than the posted leaflet (−2%) (net difference 0.06 mmol l−1, 95%CI −0.10 to 0.22). Initially, the body mass index (BMI) decreased more in the intervention group, but after 1 year the intervention and control group gained weight equally (+1%).

Conclusions

Despite beneficial changes in dietary habits in the intervention group compared with the control group, after 1 year BMI increased and total fat and saturated fat intake were still too high.
Dietary changes in African urban households in response to currency devaluation: foreseeable risks for health and nutrition
Authors: Fouéré Thierry , Maire Bernard , Delpeuch Francis , Martin-Prével Yves , Tchibindat Félicité , Adoua-Oyila Guy
Published: June 2008

Objective

To investigate the effects of currency devaluation on dietary change and nutritional vulnerability of poor households in two African capital cities.

Design

A qualitative study based on 120 semistructured individual interviews and four focus group discussions in each city.

Setting

Dakar, Senegal (western Africa) and Brazzaville, Congo (central Africa).

Subjects

All of the subjects were randomly selected women from modest or poor households, who spoke the local common language and were responsible for household meal preparation. Only those likely to restrict the dynamic of focus group discussions (because of language, age or education) were excluded.

Results

Changes were found in meal preparation characteristics (frequency, sharing pattern) and meal composition. There was frequent depletion of fat and vegetable contents in meals, frequent elimination of desserts and even the elimination of one daily meal. These changes specifically affected economically disadvantaged and socially isolated households, and those headed by women. Other changes were the reduction in the size of consumption units and the development of neighbourhood-specific street food – which has been a growing trend in Brazzaville since the outset of the economic crisis but is more recent in Dakar.

Conclusions

If lasting, these changes pose a dual health risk, i.e. reducing dietary diversity and altering the bacteriological quality of prepared meals. In addition, attempts to reduce the consumption units were found to upset community ties that bind these societies.
What is the cost of a healthy diet in terms of achieving RDAs?
Authors: Conforti Piero , D'Amicis Amleto
Published: June 2008

Objective

Assessing how the Italian average food pattern would be affected in terms of consumption structure and expenditure by the adoption of nutritional prescriptions.

Design

A linear programming model with nutritional and food habits constraints was employed to generate a pattern following recommended daily allowances (RDAs) and nutritional guidelines provided for the Italian population.

Setting

Food consumption data from ISTAT Household Budget Survey of Italian population.

Subjects

Italian families investigated by the Family Budget Survey of the National Institute of Statistics.

Results

Compared to actual behaviour, the pattern generated by the model implies an increased consumption of vegetables, pasta, rice and fresh fish, and a decreased consumption of meats, bread, sugars and cakes, and especially fats and oils. At given prices, total expenditure is lower than actual expenditure.

Conclusions

Differences between actual behaviour and the generated pattern are consistent with long-term trends in food consumption. The adoption of RDAs is unlikely to result in an increased food expenditure.
Milk choices made by women: what influences them, and does it impact on calcium intake?
Authors: Cashel KM , Crawford D , Deakin V
Published: June 2008

Objective

To identify influences on type of milk consumed and the impact of milk choice on calcium intakes in Australian women of pre- and postmenopausal age.

Design and setting

Questionnaires covering calcium intake, health-related dietary issues and priorities self-completed in a group setting.

Subjects

A total of 300 women recruited from community groups and government departments.

Results

Mean milk and calcium intake were higher in older (≥50 years) compared to younger women. Milk provided over 50% of calcium intake for both groups. Participants rated the importance of eating foods low in fat, energy or cholesterol, high in calcium or dietary fibre or of ‘limiting their intake of added sugar or sugary foods’. Younger and older women ranked eating foods low in fat as the most important food habit for their health, then ranked dietary fibre next in importance. Calcium ranked third for younger women, and fourth for older women. These rankings were reflected in the higher proportion of older women choosing fat-reduced milk in general, and skim milk in particular. This concern about eating foods low in fat was consistent with the choices made of skim, reduced fat/higher calcium or whole milk.

Conclusions

Results from this study suggest that concerns about fat are prejudicing the type of milk and amount of calcium consumed. Public health strategies targeting calcium intake need to address age-related differences in quantity and type of milk consumed, including the food attribute conflicts influencing these.
Five-year follow-up of a food-based vitamin A intervention in Tanzania
Authors: Kidala Diana , Greiner Ted , Gebre-Medhin Mehari
Published: June 2008

Objective

To evaluate the long-term effects of a horticultural and nutrition education intervention in rural Tanzania.

Design

A quasi-experimental post-test design was used.

Setting

The research was carried out in 10 villages in Singida region, Tanzania.

Subjects

Mothers and their children aged 6–71 months (n = 236) from an experimental (Ilongero) and control (Ihanja) area were interviewed regarding knowledge and practices related to vitamin A nutrition. Intake of vitamin A-rich foods by the children during the 7 days prior to the interview was recorded. Stools were examined for helminths and serum samples were analysed for retinol and C-reactive protein (CRP) (n = 146) for the children aged 12–71 months.

Results

Knowledge and practices were more favourable to vitamin A intake in the experimental area than in the control area, and an increased frequency of intake of green leaves was associated with higher serum retinol values. The experimental area had lower mean serum retinol levels (13.7 μg dl−1, n = 75) than the control area (19.3 μg dl−1, n = 71). One likely confounder was the higher helminth infestation in the experimental area (n = 75, 79%) than in the control area (n = 71, 49%) (P > 0.001). Children with helminths (n = 94) had a lower mean serum retinol level than those without (n = 52) (12.3 ± 5 vs. 24 ± 10 μg dl−1; P = 0.001).

Conclusions

Food-based vitamin A programmes can make sustainable improvements in knowledge and dietary practices but these may not necessarily be reflected in increases in serum retinol. Programme implementation and evaluation should take confounders into consideration as, in this case, helminth infestation.
Efficacy and safety of ginseng
Authors: Kitts DD , Hu C
Published: June 2008

Ginseng (Panax ginseng, C.A. Meyer) has been a popular herbal remedy used in eastern Asian cultures for thousands of years. In North America, the ginseng species indigenous to both Canada and the United States (Panax quinquefolium) represents an important industry for both domestic and export markets. There are numerous theories and claims describing the efficacy of ginseng, which can combat stress, enhance both the central and immune systems and contribute towards maintaining optimal oxidative status against certain chronic disease states and aging. Risk issues concerning the safety of ginseng at recommended dosages are less prominent and scientifically based. While some epidemiological or clinical studies have reported indications of efficacy for specific health benefits or potential toxicity, there are an equal number of studies that provide contradictory evidence. This situation has led to questionable conclusions concerning specific health benefits or risks associated with ginseng. Recent advances in the development of standardized extracts for bothPanax ginseng(G-115) andPanax quinquefolius(CNT-2000) have and will continue to assist in the assessment of efficacy and safety standards for ginseng products. This paper reviews the scientific literature and evidence for ginseng efficacy and safety derived mostly fromin vitroand animal studies and places emphasis on the need for more randomized, double-blinded, placebo clinical studies that can provide unequivocal conclusions. An example of the efficacy and safety of ginseng is provided with the description of biological activity of a North American ginseng extract (NAGE), which includes illustrating mechanisms for antioxidant activity without prooxidant properties.
The efficacy and safety of feverfew (Tanacetum partheniumL.): an update of a systematic review
Authors: Ernst E , Pittler MH
Published: June 2008

Objective

Feverfew (Tanacetum partheniumL.) is a popular herbal remedy often advocated for the prevention of migraine. The aims of this systematic review are to update the evidence from rigorous clinical trials for or against the efficacy of feverfew for migraine prevention and to provide a safety profile of this herbal remedy.

Design

Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM and the Cochrane Library (all from their inception to December 1999). Only randomized, placebo-controlled, double-blind trials of feverfew mono-preparations for the prevention of migraine in human subjects were included. All articles were read by two independent reviewers. Data were extracted in a pre-defined, standardized fashion. The methodological quality of the trials was evaluated by the Jadad score. For the assessment of safety issues, major reference texts were also consulted.

Results

Six trials met the inclusion/exclusion criteria. The majority favour feverfew over placebo. Yet important caveats exist. The data also suggest that feverfew is associated with only mild and transient adverse effects and few other safety concerns.

Conclusions

Feverfew is likely to be effective in the prevention of migraine. There are no major safety problems.
Research and future trends in the pharmaceutical development of medicinal herbs from Chinese medicine
Authors: Lee Kuo-Hsiung
Published: June 2008

Issues concerning the past and future development of medicinal herbs from Chinese medicine (CM) are addressed in this paper. In the Western world, medicinal herbs are becoming increasingly popular and important in the public and scientific communities. In contrast to their regulated status in China and other countries, herbal medicines are regarded as dietary supplements in the US. Accordingly, research must continue worldwide to identify and improve the efficacy of the active principals of herbs both singly and in combination – from active ingredients, active fractions, and active herbal formulations. While Western medicine currently employs pure, single compounds, either natural or synthetic, CM has long used multiple combinations of compounds in the form of processed natural products, primarily medicinal herbs, to treat and relieve the symptoms of many different human diseases. CM may have fewer and less severe side effects than single pure drugs, making CM especially attractive to the consumer. In effect, CM's focus on combination therapy does serve both ancient and modern theories. However, research using modern analytical and chemical techniques is needed to ensure efficacy and safety, to provide qualitative and quantitative analyses for dietary supplements, and to develop new, effective and safe world-class drugs. Drug design is an iterative process. Bioactivity-directed fractionation and isolation identify active natural compounds from single herbs or formulations. These lead structures can be chemically modified and improved through knowledge of structure–activity relationship, mechanism of action, drug metabolism, molecular modelling and combinatorial chemistry studies. Finally, efficacy and toxicity determination as well as clinical trials can contribute to the generation of new drugs from CM. To continue the legacy of CM, as well as the worldwide uses of other medicinal herbs, continued investigation of active formulations, bioactive fractions, and isolated compounds is critical to drug development in the 21st century.
What is the research base for the use of dietary supplements?
Authors: Nesheim Malden C
Published: June 2008

The market for dietary supplements in the USA was estimated as about 11.8 billion dollars in 1997 with a growth rate of 10–14 % projected in the next 3 years. Data from the Food and Drug Administration collected in 1995 indicate that over 55 % of adults surveyed used some type of dietary supplement. The marketing of dietary supplements in the USA has been essentially deregulated by the passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA). This legislation defined dietary supplements, made manufacturers responsible for the safety of supplements and allowed certain statements of nutrition support to be made on supplement labels. The US Congress in passing the DSHEA indicated that supplements should be available on the market so that consumers could make decisions about their use for themselves and their families. Unfortunately, information about the research base for supplement claims is not readily accessible to health professionals and consumers. There is a need for authoritative reviews of the data underlying supplement claims to assist public health professionals in their role of providing advice to the public about dietary supplements.
Diet and lifestyle characteristics associated with dietary supplement use in women
Authors: Kirk Sara FL , Cade Janet E , Barrett Jennifer H , Conner Mark
Published: June 2008

Objectives:

To describe the characteristics of dietary supplement users in a large cohort of women and test the hypothesis that supplement users would be more likely to have a healthier lifestyle than non-users.

Design:

Comparison of nutrient intakes from food frequency questionnaire (FFQ) data for 8409 supplement users and 5413 non-users. Use of logistic regression modelling to determine predictors of supplement use in this cohort.

Subjects:

13,822 subjects from the UK Women's Cohort Study (UKWCS) for whom data on supplement use was available.

Results:

Significant differences in nutrient intakes from FFQ were seen between the two groups, with supplement users having higher intakes of all nutrients, except for fat and vitamin B12. Use of dietary supplements was associated with being vegetarian, vegan or fish-eating, consuming more fruit and vegetables, being more physically active and having a lower alcohol intake. Supplement use was less likely in those with a body mass index above 25 and those who reported smoking regularly.

Conclusions:

The findings are consistent with the hypothesis that supplement use is associated with a healthier lifestyle profile and an adequate nutritional intake, suggesting that supplement users do not need to take supplements to meet a nutrient deficiency.
Relationship between attitudes to health, body weight and physical activity and level of physical activity in a nationally representative sample in the European Union
Authors: Margetts BM , Rogers E , Widhal K , de Winter A-M Remaut , Zunft H-JF
Published: June 2008

Objective

To explore the factors that influence attitudes and beliefs about the effects of body weight and physical activity on health.

Design

Cross-sectional survey using a face-to-face interview-assisted questionnaire.

Setting

The survey was conducted between March and April 1997 in the 15 member states of the EU.

Subjects

Approximately 1000 adults aged 15 years plus from each country were selected by quota-controlled sampling; the total sample was of 15 239 persons (7162 males and 8077 females). Data were weighted by population size for each country and by age, gender and regional distribution within countries.

Results

Overall 27% of men and 35% of women reported not engaging in any form of recreational activity; rates were highest in those with a primary-level education (37% men, 43% women) compared with tertiary-level education (20% men, 25% women). Recreational activity levels declined with age and tended to be lowest in those who were more physically active at work. Eighteen per cent of respondents believed that physical activity was one of the two greatest influences on health; 13% mentioned body weight, 38% mentioned food, 41% mentioned smoking and 33% mentioned stress. Logistic regression was used to assess for the effects of gender, age, educational level, body mass index (BMI), smoking status, activity level and country on beliefs that body weight and physical activity influenced health. Primary-educated, overweight, ex- and non-smoking women were most likely to mention body weight as an influence; young tertiary-educated, thinner, non-smoking and active males were most likely to mention physical activity. There was wide variation across Europe in reported behaviour and beliefs, which persisted after taking account of all of the other factors in the regression model.

Conclusions

Relatively few people in some countries believed body weight and physical activity were important influences on health. Many people mentioned stress and it might be possible to use this interest to motivate changes in physical activity to relieve stress. It may be important to take a more integrated approach to activity patterns that consider the role of work and recreation. Although social and demographic factors were important, after adjusting for these factors there was still wide between-country variation in reported attitudes, beliefs and behaviour. This will need to be taken into account in any activity promotion campaigns.