Iodine status of breastfed infants and their mothers' breast milk iodine concentration

Iodine is an essential nutrient for growth and development during infancy. Data on iodine status of exclusively (EBF) and partially breastfed (PBF) infants as well as breast milk iodine concentration (BMIC) are scarce. We aimed to assess (a) infant iodine nutrition at the age of 5.5 months by measuring urinary iodine concentration (UIC) in EBF (n = 32) and PBF (n = 28) infants and (b) mothers' breast milk iodine concentration (n = 57). Sixty mother–infant pairs from three primary health care centres in Reykjavik and vicinities provided urine and breast milk samples for iodine analysis and information on mothers' habitual diet. The mother–infant pairs were participants of the IceAge2 study, which focuses on factors contributing to infant growth and development, including body composition and breast‐milk energy content. The median (25th–75th percentiles) UIC was 152 (79–239) μg/L, with no significant difference between EBF and PBF infants. The estimated median iodine intake ranged from 52 to 86 μg/day, based on urinary data (assuming an average urine volume of 300–500 ml/day and UIC from the present study). The median (25th–75th percentiles) BMIC was 84 (48–114) μg/L. It is difficult to conclude whether iodine status is adequate in the present study, as no ranges for median UIC reflecting optimal iodine nutrition exist for infants. However, the results add important information to the relatively sparse literature on UIC, BMIC, and iodine intake of breastfed infants.     

Training interventions for healthcare providers offering group-based patient education. A scoping review

ObjectivesTo provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education.MethodsA systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis.ResultsTwenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers’ reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers’ experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support.ConclusionsFurther evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation.Practice implicationsEfficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.     

Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha)

Ohne Zusammenfassung Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR) in Zusammenarbeit mit der Deutschen Gesellschaft für Rehabilitationswissenschaften e.V. (DGRW) und der Deutschen Gesellschaft für Sportmedizin und Pr?vention e.V. (DGSP) Unter Mitarbeit von: Stephan B?hmen Kardiologische Abteilung, Reha-Zentrum Oldenburg, Oldenburg Gerd B?nner · Christian Holubarsch MEDIAN Kliniken Bad Krozingen, Klinik Lazariterhof/Klinik Baden – Privatklinik, Bad Krozingen Curt Diehm Innere Medizin, Klinikum Karlsbad-Langensteinbach, Karlsbad Hermann Faller Institut für Psychotherapie und medizinische Psychologie, Universit?t Würzburg Helmut Gohlke · Christa Gohlke-B?rwolf Wolfgang Langosch Herzzentrum Bad Krozingen, Bad Krozingen Gesine Grande Hochschule für Technik, Wirtschaft und Kultur (HTWK), Leipzig Klaus G?tzmann Postfach 468, Waldkirch bei Freiburg Harry Hahmann Klinik Schwabenland, Isny-Neutrauchburg Rainer Hambrecht Klinik für Kardiologie, Klinikum Links der Weser, Bremen Christoph Herrmann-Lingen Klinik für Psychosomatische Medizin und Psychotherapie, Universit?t Marburg Stephan Jacob Forum für Vaskul?re Medizin, Brombeerweg 6, Villingen-Schwenningen Ulrich Keil Institut für Epidemiologie und Sozialmedizin, Universit?tsklinikum Münster Ellen Kuhlmann Zentrum für Sozialpolitik, Abt. Geschlechterpolitik im Wohlfahrtsstaat, Uni Bremen Wolfgang Mayer-Berger Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, Leichlingen Olaf Schulz Kardiologische Praxisgemeinschaft am Klinikum Spandau, Berlin Joachim Thiery Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universit?tsklinikum Leipzig, Leipzig Diethelm Tsch?pe Herz- und Diabeteszentrum NRW, Bad Oeynhausen Helmut Teschler Abt. Pneumologie, Ruhrlandklinik – Universit?tsklinik, Essen Claudia Wilhelm Klinik Falkenburg, Bad Herrenalb Alfred Wirth Teutoburger-Wald-Klinik, Bad Rothenfelde Horst Zebe Am Unterscheid 2, Bad Wildungen Redaktionelle Assistenz: Kristina Korinth · Erika Winterhalter Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V., DGPR     

A Comparison of Pharmacokinetics and Pharmacodynamics of Biphasic Insulin Aspart 30, 50, 70 and Pure Insulin Aspart: A Randomized,Quadruple Crossover Study

Abstract: The purpose of this study was to evaluate pharmacokinetic and pharmacodynamic profiles of pure insulin aspart and three different formulations of insulin aspart and protaminated insulin aspart: biphasic insulin aspart 30 (BIAsp30), biphasic insulin aspart 50 (BIAsp50) and biphasic insulin aspart 70 (BIAsp70). Nineteen type 1 diabetes patients received individually identical doses of the four different insulin aspart preparations on 4 separate days in this randomized crossover study. Having achieved overnight stable blood glucose control by intravenous infusions of human insulin, one of the trial insulins was injected subcutaneously and a standard meal was given in the morning. Plasma glucose and serum insulin aspart were recorded the following 12 hr. During the first 4 hr after injection with the trial insulin, the area under the curve for levels of insulin aspart (AUC_ins) was significantly higher during insulin aspart treatment as compared to the other three insulin treatments, followed by BIAsp70, BIAsp50 and BIAsp30 (P < 0.05). Over the last 4 hr, the AUC_ins for BIAsp30 was significantly higher as compared to the other insulin preparations (P < 0.05). By contrast, during the initial 4 hr, the area under the curve for levels of glucose (AUC_glu) was highest after injection with BIAsp30 compared to the other three treatments (P < 0.05), while during the last 4 hr the highest AUC_glu was seen following insulin aspart (P < 0.05). We conclude that when insulin aspart is pure or formulated with protamine in three different ratios, the pharmacokinetic profiles are readily distinguishable. These differences in pharmacokinetics are reflected in the pharmacodynamic profiles.     

Genotoxicity of Acrylic Bone Cements

Abstract: The genotoxicity of conventional polymethylmethacrylate (PMMA) and a new formulation of bone cement: methylmethacrylate/n-decylmethacrylate/isobornylmethacrylate (MMA/DMA/IBMA) were tested by micronucleus test and reverse mutation assays of Salmonella typhimurium (Ames test). In extracts from cement pellets (37°, 72 hr) with water and water/ethanol the concentration of MMA was reduced by 13–1. times with the new formulation and the concentrations of accelerators were reduced by 4-5 times. New chemical constituents (DMA, IBMA, dihydroxy- propyl-p-toluidine) were found in negligible concentrations. In the micronucleus test all three cement brands were found non-mutagenic and in the Ames test scattered increased revertant ratios were found without differences between the three brands. The new formulation does not possess any increased risk of genotoxicity.     

Retinal vessel oxygen saturation in healthy individuals

Purpose. We measured oxygen saturation in retinal vessels of healthy eyes to determine the effects of age, sex, and cardiovascular parameters, as well as the reliability of the measurements and topographic differences. Methods. The Oxymap T1 retinal oximeter is based on a fundus camera. It simultaneously captures retinal images at two different wavelengths and estimates retinal vessel oxygen saturation. Mean saturation of main retinal arterioles and venules was measured in 120 healthy individuals aged 18-80 years (median 47 years). Of the 120 participants 44 (37%) were male (49 years) and 76 (63%) female (44 years). Results. Oxygen saturation was 92.2 ± 3.7% (mean ± SD) in retinal arterioles and 55.6 ± 6.3% in venules. No significant difference in oxygen saturation was found between left and right eyes. The inferotemporal quadrant had lower oxygen saturation in arterioles and venules (P < 0.0001). Arteriolar oxygen saturation was stable with age. Venular oxygen saturation in males decreased by 1.9 ± 0.6% (mean ± SEM) per 10 years of age (P = 0.003) and by 0.7 ± 0.4% in females (P = 0.068). Arteriovenous (AV) difference increased by 1.5 ± 0.5% per 10 years in males (P = 0.004) and 1.0 ± 0.4% (P = 0.007) in females. For every 10 mm Hg increase in ocular perfusion pressure, oxygen saturation in arterioles increased by 0.9 ± 0.4% (P = 0.024) and in venules by 1.2 ± 0.7% (P = 0.075). Conclusions. Retinal arteriolar oxygen saturation is stable in healthy individuals, while there is a significant decrease in venular oxygen saturation with age in males and a similar trend in females. AV difference increases significantly with age for both sexes. Our study provided normative data for spectrophotometric retinal oximetry in the Caucasian population.     

Who benefits from intervention in, as opposed to screening of, overweight and obese children?

AIMS: StEP TWO is a school- and family-based intervention consisting of extra lessons, healthy nutrition and physical education for overweight and obese children in primary schools, aimed at reducing body mass index by maintenance or reduction of weight, and improving motor abilities. We analysed differences in changes in anthropometric, cardiovascular and obesity parameters between children who underwent intervention, non-participants in intervention, and controls. METHODS: Anthropometric data and waist circumference were recorded for 1678 children; body mass index and body mass index-standard deviation score were calculated. Blood pressure was measured after 5 minutes at rest. 121 overweight and obese children enrolled at 3 schools involved in programmes of intervention were invited to take part; 40 of them completed the programme from November 2003 to July 2004. Of these overweight children, 74 were invited, but did not take part. As controls, we enrolled 155 overweight and obese children from 4 other schools. RESULTS: After the programme, the children involved in intervention showed a lower increase in the body mass index (0.3 plus or minus 1.3 versus 0.7 plus or minus 1.2 kilograms per metre squared) and an approximately three times higher diminution of the body mass index-standard deviation score in comparison with their controls (-0.15 plus or minus 0.26 versus 0.05 plus or minus 0.27). Systolic blood pressure was significantly lowered by 9.5 plus or minus 19.6 millimetres of mercury in those involved in intervention, but increased in the control group by 0.5 plus or minus 16.5 millimetres of mercury. Among those invited but not participating, the increase of the body mass index (0.5 plus or minus 1.3 kilograms per metre squared) was less, and the reduction of the body mass index-standard deviation score (-0.09 plus or minus 0.31) and systolic blood pressure (-5.3 plus or minus 15.6 millimetres of mercury) was higher than in the control group. Overweight but not obese children seem to benefit from a screening examination alone. CONCLUSIONS: Early preventive measures in schools are necessary and effective for overweight and obese primary school children. The screening itself seems also to have a minor positive effect, especially for overweight children. Sustainability of the observed improvements over a longer period remains to be confirmed.