Knowledge about dietary fibres (KADF): development and validation of an evaluation instrument through structural equation modelling (SEM).

OBJECTIVES: Because there is scientific evidence that an appropriate intake of dietary fibre should be part of a healthy diet, given its importance in promoting health, the present study aimed to develop and validate an instrument to evaluate the knowledge of the general population about dietary fibres. STUDY DESIGN: The present study was a cross sectional study. METHODS: The methodological study of psychometric validation was conducted with 6010 participants, residing in 10 countries from three continents. The instrument is a questionnaire of self-response, aimed at collecting information on knowledge about food fibres. Exploratory factor analysis (EFA) was chosen as the analysis of the main components using varimax orthogonal rotation and eigenvalues greater than 1. In confirmatory factor analysis by structural equation modelling (SEM) was considered the covariance matrix and adopted the maximum likelihood estimation algorithm for parameter estimation. RESULTS: Exploratory factor analysis retained two factors. The first was called dietary fibre and promotion of health (DFPH) and included seven questions that explained 33.94% of total variance (α = 0.852). The second was named sources of dietary fibre (SDF) and included four questions that explained 22.46% of total variance (α = 0.786). The model was tested by SEM giving a final solution with four questions in each factor. This model showed a very good fit in practically all the indexes considered, except for the ratio χ(2)/df. The values of average variance extracted (0.458 and 0.483) demonstrate the existence of convergent validity; the results also prove the existence of discriminant validity of the factors (r(2) = 0.028) and finally good internal consistency was confirmed by the values of composite reliability (0.854 and 0.787). CONCLUSIONS: This study allowed validating the KADF scale, increasing the degree of confidence in the information obtained through this instrument in this and in future studies.

Knowledge about sources of dietary fibres and health effects using a validated scale: a cross-country study.

OBJECTIVES: Dietary fibre (DF) is one of the components of diet that strongly contributes to health improvements, particularly on the gastrointestinal system. Hence, this work intended to evaluate the relations between some sociodemographic variables such as age, gender, level of education, living environment or country on the levels of knowledge about dietary fibre (KADF), its sources and its effects on human health, using a validated scale. STUDY DESIGN: The present study was a cross-sectional study. METHODS: A methodological study was conducted with 6010 participants, residing in 10 countries from different continents (Europe, America, Africa). The instrument was a questionnaire of self-response, aimed at collecting information on knowledge about food fibres. The instrument was used to validate a scale (KADF) which model was used in the present work to identify the best predictors of knowledge. The statistical tools used were as follows: basic descriptive statistics, decision trees, inferential analysis (t-test for independent samples with Levene test and one-way ANOVA with multiple comparisons post hoc tests). RESULTS: The results showed that the best predictor for the three types of knowledge evaluated (about DF, about its sources and about its effects on human health) was always the country, meaning that the social, cultural and/or political conditions greatly determine the level of knowledge. On the other hand, the tests also showed that statistically significant differences were encountered regarding the three types of knowledge for all sociodemographic variables evaluated: age, gender, level of education, living environment and country. CONCLUSIONS: The results showed that to improve the level of knowledge the actions planned should not be delineated in general as to reach all sectors of the populations, and that in addressing different people, different methodologies must be designed so as to provide an effective health education.

Invasive inflammatory pseudotumor of the pelvis: a case report with review of the literature.

Inflammatory pseudotumor (IPT) is a rare benign lesion of unknown etiology, which mimics malignant neoplasm and may arise from various organs. A 53-year-old woman was submitted to diagnostic evaluation because of bilateral, hydroureteronephrosis and oedema of the left leg after a 3-month history of fever of unknown origin. On bimanual vaginal and rectal examination, a mass was involving the uterus, parametria and mostly left adnexa, while the cervix appeared normal. Computed tomographic (CT) scan revealed a 13x10.5 cm mass in the pelvis, mostly at the place of the left adnexa, uterus and both parametria, also involving the surrounding tissues and producing bilateral hydroureteronephrosis. At laparotomy, a grey solid mass was seen, mainly involving the reproductive system. As no radical operation could be performed, the mass was only biopsied and histology showed an inflammatory pseudotumor. Antibiotic therapy was given for one month. Follow-up CT 4 and 8 months after laparotomy showed local regression of IPT. The last follow-up CT, 20 months after laparotomy, revealed no evidence of tumor.

Organochlorine pesticides and PCBs (including dl-PCBs) in human milk samples collected from multiparae from Croatia and comparison with primiparae.

This study investigated the levels of 20 congeners of polychlorinated biphenyls (PCBs), including toxic dioxin-like PCBs and 7 organochlorine pesticides (OCPs) in 33 human milk samples collected in 2011 from multiparae living in Zadar, Croatia. Concentrations of ∑PCBs, ∑DDTs, ∑HCHs and HCB in samples ranged from 11.7 to 146.3, 8.7 to 89.2, 0.9 to 28.4, and

Acute and Late Genitourinary Toxicity after 72 Gy of Conventionally Fractionated Conformal Radiotherapy for Localised Prostate Cancer: Impact of Individual and Clinical Parameters.

AIM: Our aim was to estimate the incidence of acute and late genitourinary toxicity in patients treated with three-dimensional conformal radiotherapy (3DCRT) for localised prostate cancer and to estimate the possible influence of individual and clinical characteristics. MATERIALS AND METHODS: Between September 2009 and September 2013, 225 patients with localised prostate cancer were treated with 3DCRT. Ninety-four patients with an estimated risk of lymph node involvement ≤15%, according to the Roach formula, were evaluated in this study. All patients received a total dose of 72 Gy in 36 fractions. Acute and late genitourinary toxicity were graded according to the European Organization for Research and Treatment of Cancer radiation morbidity scoring scale. Characteristics such as age, smoking status, previous abdominal or pelvic surgery (PAPS), diabetes mellitus and the use of diuretics were analysed as possible predictive factors of toxicity. The median follow-up was 27 months. RESULTS: Grade ≥2 acute toxicity during 3DCRT developed in 25 of 94 patients (26.5%). Predictive factors of acute genitourinary toxicity grade ≥2 in the multivariate logistic regression analysis (MVA) were current smoking status (P = 0.003), PAPS (P = 0.012) and the use of diuretics (P = 0.017). The 2 and 3 year cumulative risk of late genitourinary toxicity grade ≥1 was 25.3% and 30.2%, respectively. In the MVA, acute genitourinary toxicity was significantly associated with late genitourinary toxicity (P = 0.024). CONCLUSION: Current smoking status, PAPS and the use of diuretics have a significant effect on the occurrence of acute genitourinary toxicity grade ≥2. The occurrence of any grade of acute genitourinary toxicity has a significant influence on the development of any grade of late genitourinary toxicity.

Identification of EhICP1, a chagasin-like cysteine protease inhibitor of Entamoeba histolytica.

Based on the Entamoeba histolytica genome project (www.sanger.ac.uk/Project/E_histolytical/) we have identified a cysteine protease inhibitor, EhICP1 (amoebiasin 1), with significant homology to chagasin. Recombinant EhICP1 inhibited the protease activity of papain and that of a trophozoite lysate with Ki's in the picomolar range. By immunocytology, we localized the endogenous approximately 13 kDa EhICP1 in a finely dotted subcellular distribution discrete from the vesicles containing the amoebic cysteine protease, EhCP1 (amoebapain). In an overlay assay, we observed binding of recombinant EhICP1 to EhCP1. As a heptapeptide (GNPTTGF) corresponding to the second conserved chagasin motif inhibited the protease activity of both papain (K) 1.5 microM) and trophozoite extract (Ki in sub-mM range), it may be a candidate for the rational development of anti-amoebiasis drugs.

Mitochondrial development in Trypanosoma brucei brucei transitional bloodstream forms.

Intermediate and short stumpy bloodstream forms of Trypanosoma brucei brucei are transitional stages in the differentiation of mammal-infective long slender bloodstream forms into the procyclic forms found in the midgut of the tsetse vector. Although the mitochondria of the proliferative long slender forms do not accumulate rhodamine 123, the mitochondria of the transitional forms attain this ability thus revealing the development of an electromotive force (EMF) across the inner mitochondrial membrane. The EMF is inhibited by 2,4-dinitrophenol, rotenone and salicylhydroxamic acid but not by antimycin A or cyanide. Consequently, NADH dehydrogenase, site I of oxidative phosphorylation, is the source of the EMF and the plant-like trypanosome alternative oxidase (TAO) supports the electron flow serving as the terminal oxidase of the chain. Although the TAO is present in the long slender forms as well, it serves only as the terminal oxidase for electrons from glycerol-3-phosphate dehydrogenase. The data presented here, combined with older data, lead to the conclusion that the mitochondria of transitional intermediate and short stumpy forms likely produce ATP. This putative production is either by F1F0 ATPase driven by the complex I proton pump or by mitochondrial substrate level phosphorylation, or most likely by both. These conclusions contrast with the previously held dogma that all bloodstream form mitochondria are incapable of ATP production.

Malignant tumours of the gastrointestinal tract in an area with an asbestos-cement plant.

Data on persons who died of cancer of the gastrointestinal tract in a Croatian coastal area with an asbestos-cement plant were analysed for the period 1970-1990. By poll method applied to the families of deceased subjects, additional data on occupation, lifestyle, educational level, length of resistance and cancer mortality among relatives were collected. The investigation showed that in the study area, but also in certain narrower locations within it (subarea settlements), some of the tumours studied occurred at higher rates than expected. Although not conclusive, these findings may indicate a role of environmental exposure to asbestos, particularly in the occurrence of peritoneal mesothelioma.

Malignant tumors of the liver and lungs in an area with a PVC industry.

The incidence of malignant tumors of the lung and bronchus and of cytologically confirmed primary malignant tumor of the liver was analyzed for a 4-yr period in a city with several factories, including a PVC industry. Prior to the study two cases of angio-sarcoma of the liver were diagnosed in workers employed in PVC production. The total incidence of analyzed tumors was only slightly higher than predicted. The tumors of the liver recorded did not show any dependence on place of work or residence. During the period of observation, malignant tumors of the bronchus (lung) were not recorded in the PVC industry. Their rate in the area in which the PVC industry is situated was approximately the same as that for the entire city area. The study does not indicate that the occurrence of malignant tumors other than angiosarcoma is associated with exposure to vinyl chloride.

Unusual eustachian valve function.

The eustachian valve directs oxygen-rich blood from the inferior vena cava toward the foramen ovale and away from the tricuspid valve during fetal development. Ordinarily, it does not prevent reflux of right atrial blood back into the inferior vena cava because it does not function as a true valve. Here we describe an unusual adult patient with severe tricuspid valve regurgitation in whom the eustachian valve did function as a true, albeit regurgitant, valve.

Pulmonary venous flow in large, uncomplicated atrial septal defect.

BACKGROUND: The pulmonary venous flow velocity pattern (PVFVP) in atrial septal defect (ASD) has not been previously studied in detail. Normally, PVFVP is primarily determined by the left heart performance. We hypothesized that the impact of left-sided heart dynamics on PVFVP is diminished in patients with ASD because of the presence of a left-to-right shunt into the low-resistance right side of the heart. METHODS AND RESULTS: Transesophageal echocardiography was performed in 19 adults and 3 children with a large, uncomplicated secundum ASD (maximum diameter 0.6 to 3.0 cm). All patients were in normal sinus rhythm with an average heart rate of 78 bpm in adults and 116 bpm in children. In 21 subjects the antegrade PVFVP lacked distinct systolic (S) and diastolic (D) waves. Instead, we observed a single continuous antegrade wave extending from the beginning of systole to the onset of atrial contraction. Furthermore, the amplitude of the atrial reversal (AR) wave was smaller than in historical controls. In 3 patients in whom ASD was surgically repaired, we observed an immediate return of distinct S and D waves postoperatively. This confirmed that PVFVP abnormality was indeed the result of the ASD. Also a large increase in the AR wave amplitude (46 + 15 cm/s) was noted postoperatively. CONCLUSIONS: This previously unrecognized PVFVP comprising a single continuous antegrade wave and a diminished AR wave sheds new light on the hemodynamics of ASDs. Its presence may also alert the echocardiographer to the possibility of an ASD when the septal defect cannot be visualized directly.

Application of self-organizing maps for the classification of chromatographic systems and prediction of values of chromatographic quantities.

The applicability of self-organizing maps (SOM) for the classification of chromatographic systems or components of chromatographic systems based on data taken from literature is shown. The SOM approach is compared to dendrogram and principal components analysis (PCA) approaches. It has been shown that the distance between classified objects could reveal linear correspondence with quantity to be optimized, e.g. resolution, so it can be applied in the chromatographic method development. SOMs can also be applied for prediction of chromatographic quantities. It is shown that SOM-based response surface modeling is comparable to triangular presentation of mobile phase composition response surfaces.

The once and future health system in the former Yugoslavia: myths and realities.

This paper debunks three widely believed myths about the former Yugoslavia's health care system: that it was characterized by: (1) social ownership of "self-managing" provider organizations; (2) a commitment to primary health care; and (3) a faith in what might be called the "march of progress"--the health system's continuous expansion and improvement. In contrast to this picture, we present an alternative view and conclude with a word of caution for American consultants and health care reformers in Eastern European countries and newly independent states: If universal health coverage is to be maintained, beware of reforms that do no more than substitute private for public organizational forms.

Binding of (+)- and (-)-isomers and racemate of etomoxir to human serum albumin and effect of stearic acid and stanozolol.

Binding of (+)- and (-)-isomers and the racemate of sodium 2[6-(4-chlorophenoxy)-hexyl]-oxiran-2-carboxylate dihydrat (etomoxir) to the human serum albumin (HSA) was studied by the gel filtration method. The experimental results are presented graphically using the method of Scatchard. Measurements revealed the following data on the binding: (a) for either of the isomers there are two independent and nonequivalent classes of binding sites on the HSA molecule; (b) the binding constants calculated for both isomers were of the same order of magnitude (K1/n approximately 20 x 10(5) L.mol-1 for the concentration range 3.48-4.0 x 10(-5) mol.L-1, and K2/n approximately 2 x 10(5) L.mol-1 for the concentration range 4.28-10 x 10(-5) mol.L-1, for the high and low affinity binding sites, respectively); (c) statistically significant difference (p < or = 0.05) between the low affinity binding constant estimated for the (+)-isomer K2 = 1.9 +/- 0.1 x 10(5) L.mol-1) compared with the constants evaluated for the (-)-isomer and racemic etomoxir (2.6 +/- 0.1 and 2.9 +/- 0.2 x 10(5) L.mol-1, respectively); and (d) both isomers are bound into a high extent to the HSA molecule (i.e., at a ligand concentration of 3.48 x 10(-5) mol.L-1, the percent of binding was approximately 95% for the compound tested. When plotting the percent binding (% Cb) against the total concentration (Ctot), a statistically significant difference (p < or = 0.05) was obtained between the slope of the straight line for the (+)-isomer and those for other two compounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibacterial and antifungal activities of isatin N-Mannich bases.

The antimicrobial and antifungal activities of 29 congeneric isatin N-Mannich bases were investigated by testing against standard test microorganisms and 21 pathogenic Gram-negative microorganisms. Considerable growth inhibition of Gram-negative bacteria and yeasts and slight inhibition of Gram-positive bacteria resulted when they were treated with the various N-Mannich bases of isatin and 5-nitroisatin, respectively.

Epidemiology of Balkan endemic nephropathy.

The first outbreak of Balkan endemic nephropathy (BEN) was reported between 1955 and 1957, initially in Serbia and soon afterwards in Croatia and in Bosnia and Herzegovina. The disease appears to be of a focal nature. In Yugoslavia at least six foci are known, generally along major rivers of the Danubian river basin, in areas that have often been flooded in the past and even today suffer from high ground waters. The prevalence rate of the disease is reported to be between 2 and 10%. In the endemic area of Croatia, a systematic survey of 'in-the-field' cases of the disease since 1975 has shown a prevalence between 0.5 and 4.4%. When suspected cases are also included the prevalence rises to 20% or more. Specific mortality (based on official statistics) during the period 1957-1984 averaged 1.54/1000 per annum, but some studies have shown that mortality is actually more than twice as high as this figure. More women are affected than men; women also more frequently die of BEN than men. Lethality is extremely high. A striking feature of BEN is the familial occurrence of the disease. Incidence does not seem to be connected with ethnic group differences. Immigrants into the endemic area may also contract the disease. An increased incidence of malignant tumours of the urinary tract has been recorded in populations living in endemic areas. Epidemiological characteristics suggest that the disease is contracted in the domestic situation, or possibly from other family members. Factors to be considered are food, water or long close contact. It is also possible that the disease is contracted outside the house, in connection with farming activities, since the affected persons are almost exclusively farmers.

Comparison of measured and predicted ventilatory volumes in selected groups of industrial workers.

A follow-up study of ventilatory volumes [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0) and maximum expiratory flow at 50% of the FVC (MEF50)] was conducted for selected groups of workers from two plants involving the electrolytic extraction of aluminum (two groups with 95 and 38 workers, respectively), a cement industry (50 workers with chronic bronchitis and 96 healthy workers)and a shipyard (38 workers) during a period of 3 or 4 a. In the workers from the aluminum plant, particularly in those who were older and exposed longer to respiratory irritants, the fall in FVC was much higher than expected. Cement workers also showed a tendency towards more decreased FVC values than expected, and the fall in MEF50 was particularly pronounced. The cement workers with chronic bronchitis had a slightly higher annual fall in the ventilatory volumes than the healthy cement workers. The observed fall in the MEF50 of the shipyard workers without a specific occupational exposure to dusts or respiratory irritants was unexpectedly high. An analysis of the relative values of the ventilatory volumes within the groups indicated individual differences among the exposed workers in regard to a possible chronic effect of occupational exposure to respiratory irritants. A drop in the ventilatory volumes during the follow-up period was not found to be directly dependent on the initial volume values. In the evaluation of the results, selection factors and ambient exposure to irritants were taken into account.

Optimization of TLC analysis of flavonoids and phenolic acids of Helleborus atrorubens Waldst. et Kit.

Numerical methods for the evaluation of the separation power of thirteen thin-layer chromatographic systems for splitting a methanolic extract of leaves of Helleborus atrorubens Waldst. et Kit. into 15 compounds (flavonoids and phenolic acids) have been investigated. For this purpose, the following mathematical approaches have been applied: calculation of the information content (I), determination of discriminating power (DP) and formation of clusters and dendrogram. The most suitable chromatographic system for the separation of investigated compounds is ethyl acetate-formic acid-water (65:15:20, v/v/v).

Environmental exposure to manganese and combined exposure to gaseous upper respiratory irritants: mechanism of action and adverse health effects.

This review relates to possible explanations of the often-observed findings that exposure to certain air pollutants or their mixture results in an increased rate of acute respiratory diseases. Epidemiological investigations have shown that exposure to manganese (MnO2) concentrations only 10 to 50 times higher than the normal urban concentrations of 0.01 to 0.03 microgram/m3 air might have an adverse health effect on respiratory organs. The assumption that one possible mechanism of action could be that manganese at such exposure levels disturbs certain protective functions in the lung--thus making the organism more susceptible to infections--is supported by toxicological studies. In vitro studies have demonstrated the cytotoxic action of manganese, including the inhibition of activities of alveolar macrophages. Animal experiments showed a decrease in resistance toward respiratory infections that were caused by simultaneous exposure to MnO2 and pathogenic bacteria. In cases of combined exposure to gaseous upper respiratory tract irritants and suspended particles, the involvement of adsorption of gaseous compounds on solid particles as carriers has been suggested. The assumption is that through such a mechanism, water-soluble gaseous irritants can be transported deep into air passages, which such irritants normally do not reach. As the adsorption is reversible, the gaseous compounds can later be released from the particles, inducing a local irritating effect in the small airways and alveoli.

Occupational airway diseases.

In this review we describe characteristics of occupational airway diseases, as well as physical and chemical characteristics of agents inducing airway disease. Occupational airway diseases include industrial bronchitis, reactive airway dysfunction syndrome, bronchiolitis obliterans, and occupational asthma. High- and low-molecular weight substances associated with occupational airway disease are listed. The importance of host factors is stressed. Diagnostic approaches, particularly indicators for specific challenge testing with occupational materials, are described. Preventive and control measures are presented.