Perceived healthiness of food items and the traffic light front of pack nutrition labelling: choice-based conjoint analysis and cross-sectional survey.

BACKGROUND: Although traffic light labelling (TLL) is designed to aid the selection of healthier choices, consumers often have to make trade-offs between (un)desirable attributes. With the current emphasis of public health on sugar reduction, the present study aimed to investigate the relative influence of sugar on the perceived healthiness of products. METHODS: A choice-based conjoint analysis (CBC) survey was designed to assess the relative importance of the macronutrients commonly used in TLL, as well as the rescaled utilities of three attribute levels (red, amber and green), which involved 858 participants aged ≥18 years, who were recruited from the general population of Nottingham. An additional cross-sectional online survey was completed by another 901 participants to assess public knowledge about the intake recommendations underpinning the TLL. RESULTS: Usable data for CBC analysis showed that, when deciding upon the healthiness of items, sugar was significantly the most important macronutrient (mean 0.34, 95% confidence interval = 0.32-0.35) among the 641 participants. Red labelling was significantly more influential than green across macronutrients. In the substudy, 13.3% of participants correctly identify the maximum recommended intake of free sugars. Moreover, 42.8% of the total sample could not identify whether the sugar information on TLL refers to the total or free sugar content. CONCLUSIONS: Despite a lack of knowledge about the recommendations underpinning the TLL criteria, decisions made by participants concerning the healthfulness of food products were significantly influenced by sugar content. TLL appears to guide consumer beliefs in the absence of deep knowledge. The dominance of sugar in decision making is unsurprising in the current public health climate.

Polymorphisms within the neuronal cadherin (CDH2) gene are associated with obsessive-compulsive disorder (OCD) in a South African cohort.

OCD is characterised by recurrent obsessions and compulsions that result in severe distress and increased risk for comorbidity. Recently published findings have indicated that the neuronal cadherin gene (CDH2) plays a role in the development of canine OCD, and led us to investigate the human ortholog, CDH2, in a human OCD cohort. Seven CDH2 polymorphisms were selected and genotyped in a South African Caucasian cohort of 234 OCD patients and 180 healthy controls using TaqMan assays. Polymorphisms were analysed in a single-locus and haplotypic context. Of the seven polymorphisms, two reached statistical significance for OCD under additive and codominant models of inheritance (rs1120154 and rs12605662). CDH2 SNP, rs1120154, C-allele carriers were found to be significantly associated with lower risk to develop OCD compared to TT-homozygotes (OR = 0.49; 95% CI: 0.32-0.75; p < 0.001), and rs12605662 G-allele carriers were significantly associated with reduced risk OCD compared to TT-homozygotes (OR = 0.46; 95% CI: 0.30-0.71; p < 0.001), Furthermore, a single haplotype was found to infer an increased risk for OCD diagnosis (*rs8087457-rs1148374: A-T). Polymorphisms within the CDH2 gene are associated with susceptibility to OCD in a South African cohort.

Genome-wide association study of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common, debilitating neuropsychiatric illness with complex genetic etiology. The International OCD Foundation Genetics Collaborative (IOCDF-GC) is a multi-national collaboration established to discover the genetic variation predisposing to OCD. A set of individuals affected with DSM-IV OCD, a subset of their parents, and unselected controls, were genotyped with several different Illumina SNP microarrays. After extensive data cleaning, 1465 cases, 5557 ancestry-matched controls and 400 complete trios remained, with a common set of 469,410 autosomal and 9657 X-chromosome single nucleotide polymorphisms (SNPs). Ancestry-stratified case-control association analyses were conducted for three genetically-defined subpopulations and combined in two meta-analyses, with and without the trio-based analysis. In the case-control analysis, the lowest two P-values were located within DLGAP1 (P=2.49 × 10(-6) and P=3.44 × 10(-6)), a member of the neuronal postsynaptic density complex. In the trio analysis, rs6131295, near BTBD3, exceeded the genome-wide significance threshold with a P-value=3.84 × 10(-8). However, when trios were meta-analyzed with the case-control samples, the P-value for this variant was 3.62 × 10(-5), losing genome-wide significance. Although no SNPs were identified to be associated with OCD at a genome-wide significant level in the combined trio-case-control sample, a significant enrichment of methylation QTLs (P<0.001) and frontal lobe expression quantitative trait loci (eQTLs) (P=0.001) was observed within the top-ranked SNPs (P<0.01) from the trio-case-control analysis, suggesting these top signals may have a broad role in gene expression in the brain, and possibly in the etiology of OCD.

Dopamine transporter binding in social anxiety disorder: the effect of treatment with escitalopram.

Social anxiety disorder (SAD) is characterised by fear of social or performance situations where the individual is exposed to unfamiliar people or to possible scrutiny by others. The literature on dopamine ligands and dopamine genotypes in SAD is however inconsistent. In this study we measured the effects of SSRI pharmacotherapy on dopamine transporter (DAT) binding in patients with SAD, also addressing variability in DAT genotype. Adult subjects meeting DSM-IV criteria for generalised SAD were studied before and after 12 weeks of pharmacotherapy with the selective serotonin reuptake inhibitor (SSRI) escitalopram. DAT single photon emission computed tomography (SPECT) using (123)I-FP-CIT was performed at baseline, and repeated at 12 weeks. Striatal DAT binding was analysed for changes following therapy, and for correlations with clinical efficacy, in the whole group as well as for a subgroup with the A10/A10 DAT genotype. The study included 14 subjects (9 male, 5 female) with a mean (SD) age of 41 (±13) years. The subjects' Liebowitz Social Anxiety Scale (LSAS) score was significantly decreased following pharmacotherapy. In the combined group the left caudate and left putamen showed clusters of increased DAT binding after therapy. The left caudate changes were also observed in the subgroup of 9 A10/A10 homozygotes. However no correlation was found between improved symptoms and DAT binding. The changes found in DAT binding in the caudate and putamen may be due to serotonergic activation of dopamine function by SSRI therapy. This is consistent with previous work indicating decreased DAT binding in SAD, and increased DAT binding after SSRI administration.

Attitudes among South African university staff and students towards disclosing secondary genetic findings.

The present study represents an initial step in understanding diverse academic perspectives on the disclosure of secondary findings (SFs) from genetic research conducted in Africa. Using an online survey completed by 674 university students and academic staff in South Africa, we elicited attitudes towards the return of SFs. Latent class analysis (LCA) was performed to classify sub-groups of participants according to their overall attitudes to returning SFs. We did not find substantial differences in attitudes towards the return of findings between staff and students. Overall, respondents were in favour of the return of SFs in genetics research, depending on the type. The majority of survey respondents (80%) indicated that research participants should be given the option of deciding whether to have genetic SFs returned. LCA revealed that the largest group (53%) comprised individuals with more favourable attitudes to the return of SFs in genetics research. Those with less favourable attitudes comprised only 4% of the sample. This study provides important insights that may, together with further empirical evidence, inform the development of research guidelines and policy to assist healthcare professionals and researchers.

A translational approach to the genetics of anxiety disorders.

There have been important advances in our understanding of the genetic architecture of anxiety disorders. At the same time, relatively few genes have reached genome wide significance in anxiety disorders, and there is relatively little work on how exposure to an adverse environment impacts on gene expression in either animal models or human clinical populations. Here we assessed differential expression of genes of the dorsal striatum involved in synaptic transmission in an animal models of early adversity (maternal separation followed by restraint stress), and investigated whether variants in these genes were associated with risk for anxiety disorders, particularly in the presence of environmental stressors. Fifty-two male Sprague Dawley rats underwent maternal separation, and gene expression was studied using array technology. The human homologues of the differentially expressed genes were screened and analysed in a DSM-IV anxiety disorders cohort, and healthy controls (patients, n = 92; controls, n = 194), using blood. Two candidate genes (Mmp9 and Bdnf) were aberrantly expressed in the experimental rodent group relative to controls. Four single nucleotide polymorphisms (SNPs) in the human homologues of these genes were significantly associated with susceptibility for anxiety disorders (MMP9: rs3918242 and BDNF: rs6265, rs10835210 and rs11030107). Three of these (BDNF: rs6265, rs10835210, rs11030107) were found to interact significantly with childhood trauma severity resulting in increased likelihood of an anxiety disorder diagnosis. This study provides insights into the utility of rat models for identifying molecular candidates for anxiety disorders in humans.

Human myiasis in western Jamaica: five years after the implementation of a screwworm eradication programme.

OBJECTIVE: To determine the distribution of cases of human myiasis admitted to the Cornwall Regional Hospital (CRH), Jamaica, between 1999 and 2003, following the inception of the National Screwworm Eradication Programme (NSEP) in 1998, and the risk factors associated with the condition. METHOD: A total of 144 cases of myiasis were retrieved from the database of the department of Medical Records at the CRH for the years 1999 to 2003. A data extraction form was devised to review the circumstances of each case. The data were analyzed using EpiInfo version 6. RESULTS: Of 144 cases, 54.9% were female and 45.1% male. The largest groups were < 10 years, 52.8% [76/144 (M-21, F-55)] and 60years and over, 18.8% [27/144 (M-16, F-I)] (p < 0.001). Case distribution for the years 1999-2003 showed 16, 39, 31, 30, and 28 cases respectively. Three-quarters (74.6%) of all cases affected the scalp/head one-fifth (20.3%) affected the lower limbs. Ninety-six per cent of those < 10 years had scalp/head myiasis (p < 0.001; OR = 23.29; CI: 6.14 < OR < 104.11). Two-thirds (66.6%) of those 60 years and over had lower limb myiasis (p < 0.001; OR = 19.09; CI: 6.20 < OR < 61.12). Mean duration of treatment was 3.5 days (SD = 1.4 days) and 69.7% required hospitalization for seven or more days. There was no difference in duration of treatment for myiasis or in length of hospitalization in relation to method used to eliminate maggots. Risk factors identified included Tinea capitis for myiasis of the scalp/head (p < 0.001) and diabetes mellitus for lower limb myiasis (p < 0.001; OR = 14.48; CI: 2.37 < OR < 133.25). CONCLUSION: Human myiasis remains a public health issue in western Jamaica with no significant decreasing trend in the number of cases admitted to the CRH since 1999. It is recommended that this zoonosis become a Class 1 notifiable disease to the Ministries of Health and Agriculture because of the existing NSEP.

Six years experience of angioedema at the University Hospital of the West Indies.

Angioedema (AE) is a problem that all doctors inclusive of emergency room physicians and the otolaryngologists are often asked to treat. We present a six-year experience with this disorder. In this series, angiotensin-converting enzyme inhibitors (ACEIs) were related to 60% of admissions for angioedema. Lip and tongue swelling was the most common manifestation. The discontinuation of ACEI therapy and supportive management are the recommended approaches to treatment and prevention of unfavourable outcomes. The authors strongly recommend medic alert bracelets for all patients with this disorder. The use and side effects of ACEI therapy in our population which is predominantly of African descent warrants further investigations.

The Big Role of Small RNAs in Anxiety and Stress-Related Disorders.

In the study of complex, heterogeneous disorders, such as anxiety and stress-related disorders, epigenetic factors provide an additional level of heritable complexity. MicroRNAs (miRNAs) are a class of small, noncoding RNAs that function as epigenetic modulators of gene expression by binding to target messenger RNAs (mRNAs) and subsequently blocking translation or accelerating their degradation. In light of their abundance in the central nervous system (CNS) and their involvement in synaptic plasticity and neuronal differentiation, miRNAs represent an exciting frontier to be explored in the etiology and treatment of anxiety and stress-related disorders. This chapter will present a thorough review of miRNAs, their functions, and mRNA targets in the CNS, focusing on their role in anxiety and stress-related disorders as described by studies performed in animals and human subjects.

MicroRNA Expression Varies according to Glucose Tolerance, Measurement Platform, and Biological Source.

Dysregulated microRNA (miRNA) expression is observed during type 2 diabetes (T2D), although the consistency of miRNA expression across measurement platform and biological source is uncertain. Here we report miRNA profiling in the whole blood and serum of South African women with different levels of glucose tolerance, using next generation sequencing (NGS) and quantitative real time PCR (qRT-PCR). Whole blood-derived miRNAs from women with newly diagnosed T2D (n = 4), impaired glucose tolerance (IGT) (n = 4), and normal glucose tolerance (NGT) (n = 4) were subjected to NGS, whereafter transcript levels of selected miRNAs were quantified in the whole blood and serum of these women using qRT-PCR. Of the five significantly differentially expressed miRNAs identified by NGS, only the directional increase of miR-27b in women with IGT compared to NGT was confirmed in whole blood and serum, using qRT-PCR. Functional enrichment of miR-27b gene targets identified biological pathways associated with glucose transport and insulin regulation. In conclusion, this study showed poor correlation in miRNA expression profiled using NGS and qRT-PCR and in whole blood and serum. The consistent increased expression of miR-27b in women with IGT compared to NGT across measurement platform and biological source holds potential as a biomarker for risk stratification in our population.

Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review.

BACKGROUND: To update and expand on a 2012 systematic review of the prevalence and risk of violence and the prevalence and risk of physical, mental and sexual health problems among trafficked people. METHOD: Systematic review and meta-analysis. Searches of 15 electronic databases of peer-reviewed articles and doctoral theses were supplemented by reference screening, citation tracking of included articles and expert recommendations. Studies were included if they reported on the prevalence or risk of violence while trafficked, or the prevalence or risk of physical, mental or sexual health outcomes among people who have been trafficked. Two reviewers independently screened papers for eligibility and appraised the quality of included studies. RESULTS: Thirty-seven papers reporting on 31 studies were identified. The majority of studies were conducted in low and middle-income countries with women and girls trafficked into the sex industry. There is limited but emerging evidence on the health of trafficked men and the health consequences of trafficking into different forms of exploitation. Studies indicate that trafficked women, men and children experience high levels of violence and report significant levels of physical health symptoms, including headaches, stomach pain and back pain. Most commonly reported mental health problems include depression, anxiety and post-traumatic stress disorder. Although serological data on sexually transmitted infections are limited, women and girls trafficked for sexual exploitation self-report symptoms suggestive of a high prevalence of infections. Limitations of the review include methodological weaknesses of primary studies and some differences in definition and operationalisation of trafficking, which hinder comparability and generalisability of the results. CONCLUSIONS: There is increasing evidence human trafficking is associated with high prevalence and increased risk of violence and a range of physical and mental health problems. Although more studies have emerged in recent years reporting on the health of trafficked men and people trafficked for forms of exploitation other than in the sex industry, further research is needed in this area. Appropriate interventions and support services to address the multiple and serious medical needs, especially mental health, of trafficked people are urgently needed.

Modification of the association between early adversity and obsessive-compulsive disorder by polymorphisms in the MAOA, MAOB and COMT genes.

The monoamine oxidases (MAOA/B) and catechol-O-methyltransferase (COMT) enzymes break down regulatory components within serotonin and dopamine pathways, and polymorphisms within these genes are candidates for OCD susceptibility. Childhood trauma has been linked OCD psychopathology, but little attention has been paid to the interactions between genes and environment in OCD aetiology. This pilot study investigated gene-by-environment interactions between childhood trauma and polymorphisms in the MAOA, MAOB and COMT genes in OCD. Ten polymorphisms (MAOA: 3 variants, MAOB: 4 variants, COMT: 3 variants) were genotyped in a cohort of OCD patients and controls. Early-life trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Gene-by-gene (GxG) and gene-by-environment interactions (GxE) of the variants and childhood trauma were assessed using logistic regression models. Significant GxG interactions were found between rs362204 (COMT) and two independent polymorphisms in the MAOB gene (rs1799836 and rs6651806). Haplotype associations for OCD susceptibility were found for MAOB. Investigation of GxE interactions indicated that the sexual abuse sub-category was significantly associated with all three genes in haplotype x environment interaction analyses. Preliminary findings indicate that polymorphisms within the MAOB and COMT genes interact resulting in risk for OCD. Childhood trauma interacts with haplotypes in COMT, MAOA and MAOB, increasing risk for OCD.

Neonatal STZ model of type II diabetes mellitus in the Fischer 344 rat: characteristics and assessment of the status of the hepatic adrenergic receptors.

The Fischer 344 rat was found to be extremely sensitive to the diabetogenic effects of neonatally injected streptozotocin (STZ): injection of 40-100 mg/kg STZ at 1.5 days postnatal produced in the adult graded levels of hyperglycemia in males but not the females. The optimal dose in the 1.5 day old male was 80 mg/kg: it produced hyperglycemia without affecting growth or thyroid status in the adult. The neonatally STZ-injected adult rat displayed characteristics consistent with type II diabetes: mild hyperglycemia accentuated by fasting or consumption of a high fat diet; little change in insulin levels; slight elevation in glucagon levels; no alterations in ketones. Using radioligand binding techniques to isolated rat liver plasma membranes, compared to the control state, the type II diabetic state was found to have: no effect on either alpha(2)- or beta-adrenergic receptor binding; a decrease in the major dominant alpha(1)-adrenergic receptor, reflecting a decrease in receptor numbers but not their affinity; an increase in the plasma membrane calcium transport system, potentially depleting intracellular calcium stores essential for producing an alpha(1)-adrenergic receptor response. Since the alpha(1)-adrenergic receptor-calcium effector system is critical for the actions of catecholamines in the rat, these results suggest that the liver in the type II diabetic state may be refractory to the actions of catecholamines. We propose that the diabetes-evoked decrease in the dominant adrenergic receptor-effector system through which catecholamines act may be the cellular expression of defective glucocounterregulation in the diabetic state.

Evaluation of an optimal temperature for brain storage in delayed 2, 3,5-triphenyltetrazolium chloride staining.

This paper presents the determination of an optimal temperature for delayed 2,3,5-triphenyltetrazolium chloride (TTC) staining. Twenty-one rats were subjected to right middle cerebral artery embolic stroke and sacrificed 96 h following ischemia. The brains were harvested and stained immediately after sacrifice or stored for 8 h at 21-23 degrees C or 4 degrees C, respectively. The stained sections were scanned and infarct volume calculated. The quality of staining, distinction of borders between infarcted and non-ischemic tissue and ease of differentiating ischemic tissue in colored and grayscale images was assessed. The present study indicates that results of TTC obtained immediately after animal sacrifice, or delayed TTC staining while storing the brains at room temperature or 4 degrees C are comparable.

Tendency toward controlling behavior in adult children of problem drinkers: an experimental study.

Several clinicians have remarked on an obsessive need to control among adult children of alcoholics. In an experimental test of this hypothesis 30 adult children of problem drinkers and 31 control subjects performed a computer-simulated coin-tossing task. On half of the trials the outcome of the coin toss was open to control; the outcome was random on the remainder of the trials. The children of problem drinkers and the control group did not differ in their success on the task, but in comparison to control subjects the children of problem drinkers tended to perceive a greater difference between controllable and random trials in the coin-tossing task's openness to control. Of the two groups, the control subjects proved to be more realistic in their assessment of the control they had exercised during the task. These findings are discussed in terms of the theme of control in the lives of the adult children of alcoholics.

Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol.

BACKGROUND: Soft tissue injuries and tendinopathies account for large numbers of chronic musculoskeletal disorders. Extracorporeal shockwave therapy (ESWT) is popular, and effective in the management of chronic tendon conditions in the elbow, shoulder, and pain at and around the heel. METHODS/DESIGN: Ethical approval was granted from the South East London Research Ethics Committee to implement a database for the Assessment of Effectiveness of Extracorporeal Shock Wave Therapy for Soft Tissue Injuries (ASSERT) to prospectively collect information on the effectiveness of ESWT across the UK. All participants will give informed consent. All clinicians follow a standardised method of administration of the ESWT. The primary outcome measures are validated outcome measures specific to the condition being treated. A Visual Analogue Score for pain and the EuroQol will be completed alongside the condition specific outcome tool at baseline, 3, 6, 12 and 24 months post treatment. DISCUSSION: The development of the ASSERT database will enable the evaluation of the effectiveness of ESWT for patients suffering from chronic conditions (plantar fasciopathy, tennis elbow, Achilles tendinopathy, greater trochanter pain syndrome and patellar tendinopathy). The results will aid the clinicians in the decision making process when managing these patients.

Understanding posttraumatic stress disorder: insights from the methylome.

Genome-wide association studies (GWAS) have identified numerous disease-associated variants; however, these variants have a minor effect on disease and explain only a small amount of the heritability of complex disorders. The search for the missing heritability has shifted attention to rare variants, copy number variants, copy neutral variants and epigenetic modifications. The central role of epigenetics, and specifically DNA methylation, in disease susceptibility and progression has become more apparent in recent years. Epigenetic mechanisms facilitate the response to environmental changes and challenges by regulating gene expression. This makes the study of DNA methylation in psychiatric disorders such as posttraumatic stress disorder (PTSD) highly salient, as the environment plays such a vital role in disease aetiology. The epigenome is dynamic and can be modulated by numerous factors, including learning and memory, which are important in the context of PTSD. Numerous studies have shown the effects of early life events, such as maternal separation and traumas during adulthood, on DNA methylation patterns and subsequent gene expression profiles. Aberrations in adaptive DNA methylation contribute to disease susceptibility when an organism is unable to effectively respond to environmental demands. Epigenetic mechanisms are also involved in higher order brain functions. Dysregulation of methylation is associated with neurodevelopmental and neurodegenerative cognitive disorders, affective disorders, addictive behaviours and altered stress responses. A thorough understanding of how the environment, methylome and transcriptome interact and influence each other in the context of fear and anxiety is integral to our understanding and treatment of stress-related disorders such as PTSD.