Dietary health and CVD: implications for dietary policy in England.

CVD is a major burden on the health system in the UK. On average, diets are not aligned with current dietary recommendations, including those for salt, saturated fat, fibre, fruit and vegetables. Obesity prevalence is high and the majority of the population is consuming more energy than required. Addressing these issues would reduce the burden of CVD and help reduce inequalities in health. There is currently a range of policy interventions in place in England designed to help improve diets and reduce obesity, which in turn should help reduce the risk of CVD. Further actions may be needed in the long term to deliver sustained improvements to diet and health.

High-energy, high-fat lifestyle challenges an Arctic apex predator, the polar bear.

Regional declines in polar bear (Ursus maritimus) populations have been attributed to changing sea ice conditions, but with limited information on the causative mechanisms. By simultaneously measuring field metabolic rates, daily activity patterns, body condition, and foraging success of polar bears moving on the spring sea ice, we found that high metabolic rates (1.6 times greater than previously assumed) coupled with low intake of fat-rich marine mammal prey resulted in an energy deficit for more than half of the bears examined. Activity and movement on the sea ice strongly influenced metabolic demands. Consequently, increases in mobility resulting from ongoing and forecasted declines in and fragmentation of sea ice are likely to increase energy demands and may be an important factor explaining observed declines in body condition and survival.

Wet degradation of keratin proteins: linking amino acid, elemental and isotopic composition.

RATIONALE: Archaeological keratin samples are increasingly the subject of palaeodietary, provenancing and dating studies. Keratin samples from wet archaeological contexts are microbiologically and chemically degraded, causing differential diagenesis of protein structures in hair fibres. The effects of these processes on the analytical parameters of interest are currently unknown. METHODS: This study examined the impact of degradation of wool fibres on isotopic (δ(13)C, δ(15)N, un-exchangeable δ(2)H and δ(18)O values) composition. It compared two models of archaeological protein degradation in wet burial environments: (1) short term (up to 8 years) experimental burial in three contrasting soil environments; and (2) laboratory wet conditions, in which elevated temperature (80 °C, 110 °C, and 140 °C) and pressure simulated longer exposure. Elemental and amino acid (AA) composition were also measured. RESULTS: In experimentally soil-buried samples, AA, elemental and isotopic composition changes were small, despite extensive macroscopic alteration. Isothermally heated samples showed preferential loss of hydrophilic AAs (Asx, Glx, Ser, Gly) from wool residues, with depletion in (2)H and (18)O at higher temperatures (up to -73‰ change in δ(2)H and -2.6‰ in δ(18)O values). The δ(13)C and δ(15)N values showed little change except in densely pigmented samples at low temperatures only. Samples dyed with madder/alum were better preserved than undyed samples. CONCLUSIONS: Diagenesis in experimentally soil-buried wool textiles was consistent with microbiological, non-protein-selective activity, in contrast to highly AA-selective hydrolytic behaviour under laboratory wet conditions. Changes in δ(2)H and δ(18)O values were correlated with degree of AA change, but the δ(13)C and δ(15)N values were not. The results contribute to a baseline for interpreting analytical data from archaeological hair samples preserved by burial in wet environments.

Metabolites of dietary 1,8-cineole in the male koala (Phascolarctos cinereus).

The in vivo metabolic fate of 1,8-cineole was investigated in six male koalas. Koalas were fed ad lib a diet of Eucalyptus cephalocarpa leaf with a 1,8-cineole concentration of 2.53+/-0.70% dry mass of leaf, corresponding to a 1,8-cineole intake of 2.4+/-1.1 mmol/kg (3.1+/-1.3 g). Urine and faeces were collected for 24 h and metabolites identified by GC-MS and LC-MS. Metabolites were quantified before and after hydrolysis with beta-glucuronidase to give free and total levels, respectively. Fractional recovery of ingested 1,8-cineole was 1.3+/-0.4 and 1.4+/-0.4 (mean+/-S.D.) for free and total measurements, respectively. Seven metabolites were identified and quantified: 9- and 7-hydroxycineole, 9- and 7-cineolic acid, 7-hydroxy-9-cineolic acid, 9-hydroxy-7-cineolic acid and 7,9-dicineolic acid. The hydroxycineolic acids dominated the metabolite profile (85%). 7,9-Dicineolic acid, a novel metabolite of 1,8-cineole, accounted for almost 10% of the recovered dose making it the second most abundant metabolite after 7-hydroxy-9-cineolic acid (77%). Together, the less oxidised metabolites, the hydroxycineoles and cineolic acid, accounted for only 5% of the cineole consumed. Significant conjugation only occurred with four minor, less oxidised, alcohol and carboxylic acid metabolites. We have shown that the koala detoxifies and eliminates 1,8-cineole primarily by extensive oxidation without utilising conjugation pathways.

Adverse events, including death, associated with the use of 1,4-butanediol.

BACKGROUND: 1,4-Butanediol is an industrial solvent that, when ingested, is converted to gamma-hydroxybutyrate, a drug of abuse with depressant effects, primarily on the central nervous system. After reports of toxic effects of gamma-hydroxybutyrate and its resultant regulation by the federal government, 1,4-butanediol and gamma-butyrolactone, another precursor of gamma-hydroxybutyrate and an industrial solvent, began to be marketed as dietary supplements. We investigated reports of toxic effects due to the ingestion of 1,4-butanediol and reviewed the related health risks. METHODS: From June 1999 through December 1999, we identified cases of toxic effects of 1,4-butanediol involving patients who presented to our emergency departments with a clinical syndrome suggesting toxic effects of gamma-hydroxybutyrate and a history of ingesting 1,4-butanediol and patients discovered through public health officials and family members. We used gas chromatography-mass spectrometry to measure 1,4-butanediol or its metabolite, gamma-hydroxybutyrate, in urine, serum, or blood. RESULTS: We identified nine episodes of toxic effects in eight patients who had ingested 1,4-butanediol recreationally, to enhance bodybuilding, or to treat depression or insomnia. One patient presented twice with toxic effects and had withdrawal symptoms after her second presentation. Clinical findings and adverse events included vomiting, urinary and fecal incontinence, agitation, combativeness, a labile level of consciousness, respiratory depression, and death. No additional intoxicants were identified in six patients, including the two who died. The doses of 1,4-butanediol ingested ranged from 5.4 to 20 g in the patients who died and ranged from 1 to 14 g in the nonfatal cases. CONCLUSIONS: The health risks of 1,4-butanediol are similar to those of its counterparts, gamma-hydroxybutyrate and gamma-butyrolactone. These include acute toxic effects, which may be fatal, and addiction and withdrawal.

Escherichia coli O157:H7: etiology, clinical features, complications, and treatment.

In recent years, Escherichia coli (E. coli) O157:H7 has developed into an emerging cause of foodborne illness. It has been identified as the leading cause of post-diarrheal hemolytic-uremic syndrome (HUS) and acute renal failure in infancy and childhood. This article examines, the etiology, clinical features, complications, and treatment of this illness. Prevention strategies are also presented as well as a disaster management case study.

Clinical practice guidelines for maintaining adequate iron status with intravenous iron dextran in hemodialysis patients.

While oral iron can be used to manage iron stores in some hemodialysis patients, most require intravenous iron supplementation. Maintenance of iron balance in these patients is critical, since patients with end stage renal disease often suffer from anemia caused by inadequate production of red blood cells and iron deficiency resulting from chronic blood loss. Using guidelines that include maintenance dosing ensures sustained adequate iron stores and maximizes the effects of rHuEPO therapy. Easy-to-administer clinical practice guidelines for repletion and maintenance of iron stores are presented here.

Drug resistant organisms and their implications for the outpatient dialysis setting.

Ever since antibiotics have been used to combat infection, resistance to them has also developed. The elderly and immunosuppressed populations found in today's dialysis facility comprise a group at risk for acquiring infection caused by drug resistant organisms. By utilizing antibiotics prudently and developing infection control strategies based on the disease/organism epidemiology, mode of transmission and individualized needs of the patient as well as the care setting, the proliferation of drug resistant organisms may be curtailed.

The high prevalence of unsafe sexual behaviors among acute psychiatric inpatients. Implications for AIDS prevention.

We conducted a study to determine the prevalence and sociodemographic distribution of unsafe sexual behaviors among psychiatric inpatients and to investigate an association between crack cocaine use and these behaviors. Two hundred thirty-nine patients admitted to two Philadelphia hospitals during a 12-month period were interviewed to obtain a detailed sexual history and substance abuse history. A history of multiple sex partners was reported by 42.6% of male patients and 13.0% of female patients (p < .01). A history of receptive anal intercourse in the past 6 months was reported by 11.6% of females and 2.1% of males (p < .05). Only about half the study subjects who were sexually active reported ever using a condom during the past 6 months. Crack cocaine use among males and cocaine use among females was statistically significantly associated with a history of having sex with a high risk partner. This study draws attention to the role of crack cocaine and other types of cocaine in the spread of human immunodeficiency virus infection in this population and the need for intensive acquired immunodeficiency syndrome prevention programs on inpatient psychiatric units.