Herz–Kreislauf–Risiken des Sports

Zusammenfassung Herz-Kreislauf-Erkrankungen sind für fast 50% der Gesamt mortalität in Deutschland verantwortlich. Eine regelmäßige körperliche Aktivität ist länger fristig mit einer deutlichen Reduktion kardiovaskulärer Morbidität und Mortalität sowohl in der Primär- als auch in der Sekundärprävention bei bereits bestehender Erkrankung assoziiert. Prospektive epidemiologische Studien haben gezeigt, dass sich sowohl moderate als auch intensive körperliche Aktivität länger fristig positiv auf das Herz-Kreislauf-Risiko auswirken. Auch die Aufnahme einer moderaten körperlichen Aktivität erst in einem mittleren oder höheren Lebensalter ist mit einer Risikoreduktion für Herz-Kreislauf-Erkrankungen verbunden. Allerdings ist akute Anstrengung mit einem erhöhten Risiko assoziiert, ein koronares Ereignis auszulösen, vor allem bei untrainierten Patienten mit bestehender koronarer Herzkrankheit. Auch bei körperlich sehr aktiven Menschen ist das Risiko während und nach einer akuten Anstrengung signifikant erhöht. Menschen, die regelmäßig körperlich aktiv sind, haben allerdings während der akuten Anstrengung ein deutlich geringeres Risiko für einen plötzlichen Herztod oder einen akuten Myokardinfarkt als Menschen, die sich selten körperlich betätigen. Trotz des erhöhten Risikos während der akuten Anstrengung ist die regelmäßige körperliche Aktivität länger fristig ein wesentlicher Bestandteil der Prävention kardiovaskulärer und weiterer Erkrankungen. Daher empfehlen aktuelle Leitlinien einheitlich die regelmäßige körperliche Aktivität zur Prävention von Herz-Kreislauf-Erkrankungen.     

Survival analysis: up from Kaplan–Meier–Greenwood

In the type of survival analysis that now is routine, only the points of follow-up at which deaths from the cause at issue occurred make contributions to the Greenwood standard error (SE) of the survival rate's Kaplan-Meier (KM) point estimate. An equivalent of this 'KMG' analysis draws from defined subintervals of the survival period being addressed. The data on each subinterval consist of the number of deaths from the cause at issue and the amount of population-time of follow-up, d ( j ) and T ( j ), together with the duration of the interval, t ( j ). The KM point estimate is replicated by [Formula: see text] and the KMG interval estimate is replicated by treating the {d ( j )} as a set of point estimates of Poisson parameters {lambda( j )}, thus taking the SE of [Formula: see text] to be [Formula: see text] In both the KMG analysis and this equivalent of it, the SE used to derive the survival rate's lower confidence limit needs to be augmented by a factor that accounts for the loss of information due to censorings subsequent to the last 'failure' in the survival period at issue. But, SE-based interval estimation of survival rate actually needs to be replaced by a first-principles counterpart of it. A suitable point of departure in this is first-principles asymptotic interval estimation of the Poisson parameter [Formula: see text] if not the exact counterpart of this. A confidence limit for the survival rate can then be based on suitable augmentation or contraction of the {d ( j )} set to [Formula: see text] consistent with a given limit for lambda, the corresponding survival-rate limit being [Formula: see text] Suitable augmentation is constituted by an identical addition to each [Formula: see text] suitable contraction by an identical subtraction from each [Formula: see text].     

Controlled Release of Spirotetramat Using Starch–Chitosan–Alginate-Encapsulation

Bulletin of Environmental Contamination and Toxicology - This study was intended to develop an environment-friendly controlled release system for spirotetramat in an alginate matrix. Four...     

Effect of polyphenolic extracts from red wine and 4–OH–coumaric acid on 1,2–dimethylhydrazine–induced colon carcinogenesis in rats

Summary Background Total polyphenolic extracts from red wine protect against azoxymethane (AOM)–induced colon carcinogenesis in rats. Since red wine contains more than 200 different polyphenolic compounds, it is still unclear which substances are responsible for this effect. Aim of the study We investigated the effect of high molecular weight polyphenols (HMWP), low molecular weight polyphenols (LMWP) and total polyphenolic extracts from red wine (WE) on colon carcinogenesis. We also tested the effect of 4–OH–coumaric acid, a potent phenolic antioxidant present in wine and fruit. Methods F344 rats were treated weekly with 1,2–dimethylhydrazine (DMH) (30 mg/kg b.w. subcutaneously x 10 times). One week after the final DMH injection rats were divided into five groups and fed: a) a high fat (HF) diet containing 23% corn oil (w/w), as control or the same basal diet supplemented with b) 0.11 % (w/w) WE; c) 0.027% (w/w) HMWP d) 0.083% (w/w) LMWP or e) 0.1 % (w/w) 4–OH–coumaric acid. The dietary treatments continued until sacrifice, 16 weeks after the last DMH injection. Results WE treated rats had significantly fewer (p < 0.05) colorectal adenomas than controls, while rats in other treatment groups did not differ significantly from controls (colorectal adenomas/rat were: 2.2 ± 0.3; 1.4 ± 0.2; 2.9 ± 0.5; 2.6 ± 0.4; 2.3 ± 0.3; in controls, WE, HMWP, LMWP and 4–OH–coumaric acid groups, respectively; means ± SE). The mean number of colorectal carcinomas per rat was similar among all experimental groups. Proliferative activity in the normal colon mucosa did not vary among experimental groups. Conclusions Total polyphenolic extracts (WE) from red wine, but neither the HMWP nor the LMWP, have some inhibitory effect on the process of colon carcinogenesis by DMH reducing the number of adenomas.     

Research Trends in Mother–Child Healthcare, 1966–1995

Objective: To explore trends in mother–child healthcare (MCHC) research over the past 30 years. Methods: Classifications of Medline articles were made at 5-year intervals using Medical Subject Headings (MeSH) as classifiers. Papers were classified in mutually and non-mutually exclusive categories by subject (mother and four age groups of children) and type of research (clinical, basic, epidemiologic, and unclassified) and its various combinations. Results: The number of MCHC papers increased from 34,110 in 1966 to 65,028 in 1995, but the proportion of all Medline articles (18–21%) was relatively stable. There were remarkable long-term temporal stabilities in the proportions of MCHC papers of mothers and the four age groups of children. Most papers dealt with child (46%) and adolescents (45%), and only 11% studied mother and children together. Regression analysis indicated that a linear increase in number of MCHC papers in Medline (1053/year) was represented largely by single-age and combinations of age children, especially adolescence. However, the slope for mother-plus-children papers (113/year) was substantially higher than for mothers alone (64/year). Clinical papers (52%) were the dominant type of MCHC research, but the proportions of basic and epidemiologic papers and their combinations with clinical papers have increased substantially in the past decade. Conclusions: There has been a dominance of clinical and child-related papers in MCHC research, which may be a reflection of restricted outlooks of specialists in the area. This may change soon if the tendency toward increasing numbers of basic and epidemiologic papers holds.     

Nutritional–pharmacological combinations

Summary Background Recent studies have suggested that n–9 fatty acids in olive oil prevent colon carcinogenesis while n–6 PUFA seems to activate this process. Aims To evaluate the effects of nutritional–pharmacological combinations made up of olive or soy oilbased diets and the drug sulindac, on colon cancer incidence in a chemically induced (1,2–dimethylhydrazine, DMH) rat cancer model. Methods Male rats were assigned to two different dietary regimes based on a standard murine defined diet (AIN–76A) containing either a low (4%) or high (15 %) concentration of olive or soy oil. Some groups also received sulindac in their food (80 mg/kg food) starting from the ninth week following the first DMH or vehicle administration. Results Oleic and linoleic acid reached higher levels in plasma and liver lipids when rats were fed high concentrations of olive or soy oil, respectively. Rats fed a low or high soy oil–based diet showed no significant difference in the number of aberrant crypt foci (ACF) in proximal or distal colon specimens. In contrast, rats fed a higher olive oil–based diet developed a significantly lower number of ACF than rats fed a low concentration of olive oil. Addition of sulindac reduced the number of ACF in rats fed the 4%, but not the 15%, soy oil diet. In contrast, the effect of sulindac was significant when combined with both the low and high concentrations of olive oil. High soy oilbased diet or DMH treatment upregulated colon expression of Bcl–2, but not that of cyclooxygenase–2 (COX–2). In contrast, olive oil dose–dependently downregulated the expression of both Bcl–2 and COX–2 in colonic mucosa and also abrogated the upregulation of Bcl–2 by DMH. Olive oil/sulindac combinations were effective in downregulating colonic mucosa Bcl–2 expression (with the 4% oil diet) and COX–2 expression (with the 15% oil diet). These effects were not observed in rats fed the soy oil/sulindac combinations. Caspase–3 activity in colonic mucosa was unaffected by soy oil or soy oil/sulindac combinations. The addition of olive oil, on the other hand, significantly enhanced colonic caspase–3 activity. Conclusions Diets containing high levels of olive oil exert a significant protective effect from tumor development that is additive with the inhibitory effect of sulindac. These inhibitory effects are mediated by regulating the expression and activity of key proteins involved in prostaglandin–biosynthesis and apoptosis–induction pathways. It may be concluded that appropriate dietary–pharmacological combination can improve anti–tumor efficacy over either dietary or pharmacological intervention alone.     

The yin–yang of followership–leadership in public health

Aim  

To examine an innovative leadership model for public health professionals and for public health systems.     

Risk of febrile seizure after measles–mumps–rubella–varicella vaccine: A systematic review and meta-analysis

BackgroundConsidering the febrile seizure rate, there is no longer a clear preference for use of measles–mumps–rubella–varicella (MMRV) vaccine over separate measles–mumps–rubella (MMR) and varicella (V) vaccine. This work was undertaken to assess the risk of febrile seizure after MMRV vaccine in children.MethodsWe searched PubMed, Embase, BIOSIS Previews, Scopus, Web of Science, Cochrane Library and other databases through 12 December 2014. Meta-analysis was conducted using R version 3.1.2 and Stata version 12.0.ResultsA total of thirty-nine studies were included. Thirty-one published or unpublished clinical trials involving about 40,000 subjects did not show significant differences in incidence of febrile seizure or vaccine related febrile seizure between MMRV and MMR with or without varicella vaccine after any doses, in the risk windows of 0–28, 0–42 or 0–56 days and 7–10 days. In addition, these studies showed that the receipt of concomitant use of MMRV and other pediatric vaccines was not a significant predictor of febrile seizure. Eight post-marketing observations involving more than 3,200,000 subjects were included. No evidence suggested elevated risk of febrile seizure associated with MMRV vaccine among children aged 4–6 years old during 7–10 days or 0–42 days after vaccination. However, an approximately 2-fold increase in risk of seizure or febrile seizure during 7–10 days or 5–12 days after MMRV vaccination was found among children aged 10–24 months, although the highest incidence of seizure was still lower than 2.95‰.ConclusionsFirst MMRV vaccine dose in children aged 10–24 months was associated with an elevated risk of seizure or febrile seizure. Further post-marketing restudies based on more rigorous study design are needed to confirm the findings.     

Safety and immunogenicity of a hexavalent diphtheria–tetanus–acellular pertussis–inactivated poliovirus–Haemophilus influenzae b conjugate–hepatitis B vaccine at 2, 3, 4, and 12–14 months of age

Combination vaccines improve parental and provider satisfaction and schedule compliance by decreasing the number of injections. In a Phase 2, randomized, double-blind, multicenter study, we compared four formulations of a liquid, hexavalent diphtheria–tetanus–acellular pertussis–inactivated poliovirus–Haemophilus influenzae b conjugate–hepatitis B virus (DTaP–IPV–Hib–HBV) vaccine in 708 infants immunized at 2, 3, 4, and 12–14 months of age. The formulations contained identical DTaP and IPV components, differing in the contents of Hib polyribosylribitol phosphate (PRP) conjugate component (tetanus-toxoid [PRP-T, 12 μg] or Neisseria meningitidis outer-membrane-protein-complex [PRP-OMPC, 3 μg or 6 μg]), and in hepatitis B surface antigen (HBsAg, 10 μg or 15 μg). A minimum acceptable postdose 3 antibody response rate was defined by the lower limit of the 95% confidence interval exceeding a prespecified target. Rates of adverse events (AEs) were similar among groups, with a trend for increased solicited injection-site reactions (pain, redness, swelling) with increasing PRP-OMPC and HBsAg concentration. Serious AEs reported by eight subjects were not considered to be vaccine related. All PRP-OMPC formulations met prespecified acceptability criteria for postdose 3 immunogenicity for all antigens: PRP, HBsAg, pertussis, diphtheria, tetanus and polio. Apart from the Hib response, the postdose 3 responses obtained with the PRP-T formulation met the acceptability criterion for each antigen. Postdose 4 responses were acceptable for all antigens in all formulations. All vaccine formulations were well tolerated. The three PRP-OMPC formulations met prespecified immunogenicity criteria, and the one with the lowest PRP-OMPC concentration was selected for further optimization of immunogenicity.     

Influenza-Associated Hospitalizations,Singapore, 2004–2008 and 2010–2012

Studies of influenza-associated hospitalizations in tropical settings are lacking. To increase understanding of the effect of influenza in Singapore, we estimated the age-specific influenza-associated hospitalizations for pneumonia and influenza during 2004–2008 and 2010–2012. The rate of hospitalization was 28.3/100,000 person-years during 2004–2008 and 29.6/100,000 person-years during 2010–2012. The age-specific influenza-associated hospitalization rates followed a J-shaped pattern: rates in persons >75 years of age and in children <6 months of age were >47 times and >26 times higher, respectively, than those for persons 25–44 years of age. Across all ages during these 2 study periods, ≈12% of the hospitalizations for pneumonia and influenza were attributable to influenza. The rates and proportions of hospitalizations for influenza, particularly among the very young and the elderly, are considerable in Singapore and highlight the importance of vaccination in protecting populations at risk.     

The French National Nutrition and Health Program: 2001–2006–2010

Summary Objectives: Established in 2001–2005 then extended to 2010, the French National Nutrition and Health Program (PNNS) is a nutrition policy whose objective is to improve the health status of the population by acting on one of its major determinants, nutrition. Methods: Nine priority objectives focusing on diet, physical activity and nutritional status were determined. Program strategies are based on fundamental principles including food culture, pleasure, and gastronomy. This multidisciplinary program involves stakeholders from ministries, research and educational institutions, food industry, healthcare, and consumers. Results: More than 75 % of the public health actions planned were accomplished or in progress by the end of 2005, particularly those concerning nutrition communication, education, research and nutritional surveillance. Dietary guidelines were established and are now considered the official reference in France. Actions focusing on the healthcare system, economic actors and players and specific population groups need further development. Conclusions: The success of a public health program like the PNNS requires a combination of synergistic and complementary actions, measures, regulations and laws. A national study at the end of the PNNS will determine if objectives were achieved. Submitted: 28 February 2007; Revised: 05 July 2007, 10 December 2007; Accepted: 21 December 2007     

Effect of folate–binding protein on intestinal transport of folic acid and 5–methyltetrahydrofolate across Caco–2 cells

Summary Background Milk products are a potential matrix for fortification with synthetic folic acid or natural 5-methyltetrahydrofolate (5–CH₃–H₄folate) to enhance the daily folate intake. In milk, folate occurs bound to folatebinding proteins (FBP). Our previous studies with an in vitro gastrointestinal model showed that 70% of the initial FBP content of the milk product was retained in the duodenal lumen. While folic acid remained bound to FBP after gastric passage, 5–CH₃–H₄folate was mainly present as free folate in the duodenal lumen. Aim of the study To investigate the effect of FBP on the absorption of folic acid and 5–CH₃–H₄folate from the intestinal lumen. Methods The transport of [³H]–folic acid and [¹⁴C]–5–CH₃–H₄folate across enterocytes was studied in the presence or absence of bovine FBP using monolayers of Caco–2 cells grown on semi–permeable inserts in a two–compartment model. The apparent permeability coefficients (P_app) of folic acid and 5–CH₃–H₄folate were determined and compared with the permeability of reference compounds for low (mannitol) and high (caffeine) permeability. Results The transport from the apical to the basolateral side of the Caco–2 cells was higher (P < 0.05) for folic acid (P_app = 1.7*10^–6 cm/s) than for 5– CH₃–H₄folate (P_app = 1.4*10^–6 cm/s) after 2 h incubation to 1 µM folic acid or 5–CH₃–H₄folate test solutions (pH 7). The permeability of folic acid and 5–CH₃–H₄folate across Caco–2 monolayers appeared to be higher (P < 0.05) than that of mannitol (P_app = 0.5*10^–6 cm/s) but lower (P < 0.05) than that of caffeine (P_app = 34*10^–6 cm/s). The addition of FBP to the medium led to a lower (P < 0.05) intestinal transport and cellular accumulation of folic acid and 5–CH₃–H₄folate. Conclusions Compared to the reference compounds, folic acid and 5–CH₃–H₄folate showed a moderate permeability across Caco–2 cells, which indicates that folate absorption from the intestinal lumen is not likely to be complete. The intestinal transport of folic acid and 5–CH₃–H₄folate was found to be dependent on the extent of binding to FBP at the luminal side of the cells.     

Prediction of Environmental Properties in Water–Soil–Air Systems for Phthalates

In this paper, environmentally key properties including aqueous solubilities (S _W), vapor pressures (V _P), sorption coefficients (K _OC), octanol–water (K _OW), octanol–air (K _OA) and air–water (K _AW) partition coefficients of 53 phthalates are studied by the quantitative structure-property relationship models by means of previously proposed Lu index. Reliable models are obtained to estimate Log S _W, solubility in air (Log S _A), Log K _OC and Log K _OW for phthalates with the correlation coefficients of estimations (R) being 0.9869, 0.9461, 0.8880 and 0.9836, and the standard errors being 0.44, 0.27, 0.52 and 0.40, respectively. The predictive ability of the constructed models is demonstrated by the correlation coefficients (R _CV) in the leave-one-out cross validation procedures being 0.9709, 0.9218, 0.8089 and 0.9784, and the corresponding standard errors (s _CV) being 0.47, 0.34, 0.67 and 0.47, respectively. The properties of K _AO and K _AW for the phthalates are calculated by the predicted S _W, S _A, and K _OW values.