Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015.

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.

Reactive oxygen species production, induced by atmospheric modification, alter conidial quality of Beauveria bassiana.

AIM: The aim of this study was to determine the relationship between reactive oxygen species (ROS) production and conidial infectivity in Beauveria bassiana. METHODS AND RESULTS: Beauveria bassiana Bb 882.5 was cultured in solid-state culture (SSC) using rice under three oxygen conditions (21%, or pulses at 16 and 26%). Hydrophobicity was determined using exclusion phase assay. Bioassays with larvae or adults of Tenebrio molitor allowed the measurements of infectivity parameters. A fluorometric method was used for ROS quantification (superoxide and total peroxides). NADPH oxidase (NOX) activity was determined by specific inhibition. Conidial hydrophobicity decreased by O2 pulses. Mortality of larvae was only achieved with conidia harvested from cultures under 21% O2 ; whereas for adult insects, the infectivity parameters deteriorated in conidia obtained after pulses at 16 and 26% O2 . At day 7, ROS production increased after 16 and 26% O2 treatments. NOX activity induced ROS production at early stages of the culture. CONCLUSION: Modification of atmospheric oxygen increases ROS production, reducing conidial quality and infectivity. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study in which conidial infectivity and ROS production in B. bassiana has been related, enhancing the knowledge of the effect of O2 pulses in B. bassiana.

Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study.

In a 24-month prospective, randomized, multicenter, open-label study, de novo liver transplant patients were randomized at 30 days to everolimus (EVR) + Reduced tacrolimus (TAC; n = 245), TAC Control (n = 243) or TAC Elimination (n = 231). Randomization to TAC Elimination was stopped prematurely due to a significantly higher rate of treated biopsy-proven acute rejection (tBPAR). The incidence of the primary efficacy endpoint, composite efficacy failure rate of tBPAR, graft loss or death postrandomization was similar with EVR + Reduced TAC (10.3%) or TAC Control (12.5%) at month 24 (difference -2.2%, 97.5% confidence interval [CI] -8.8%, 4.4%). BPAR was less frequent in the EVR + Reduced TAC group (6.1% vs. 13.3% in TAC Control, p = 0.010). Adjusted change in estimated glomerular filtration rate (eGFR) from randomization to month 24 was superior with EVR + Reduced TAC versus TAC Control: difference 6.7 mL/min/1.73 m(2) (97.5% CI 1.9, 11.4 mL/min/1.73 m(2), p = 0.002). Among patients who remained on treatment, mean (SD) eGFR at month 24 was 77.6 (26.5) mL/min/1.73 m(2) in the EVR + Reduced TAC group and 66.1 (19.3) mL/min/1.73 m(2) in the TAC Control group (p < 0.001). Study medication was discontinued due to adverse events in 28.6% of EVR + Reduced TAC and 18.2% of TAC Control patients. Early introduction of everolimus with reduced-exposure tacrolimus at 1 month after liver transplantation provided a significant and clinically relevant benefit for renal function at 2 years posttransplant.

[Practical considerations for implementing health outcomes measurement projects within a healthcare organization: Delphi Expert Consensus Study]. / Consideraciones prácticas para la implementación de proyectos de medición de resultados en salud en una organización sanitaria: Estudio Delphi de consenso de expertos.

INTRODUCTION: Measuring health outcomes and costs per patient is an essential element of value-based healthcare (VBHC). The aim of the study was to generate expert consensus on the activities required to implement it. METHODS: A two-round modified Delphi study with healthcare professionals, quality and clinical management methodologists and managers with academic and/or practical experience in outcome measurement projects. A median equal to or greater than 4 and a relative interquartile range (RIQR) equal to or greater than 25% were established as consensus criteria. RESULTS: Consensus was obtained on 91% of the items (N=74/81). In terms of feasibility, the items that received the highest score and consensus were the existence of data protection guarantees (median=5; mean=4.8; RIQR=0%), the vision and motivation of healthcare professionals (median=5; mean=4.7; RIQR=20%), the existence and availability of ICT tools (or systems) for data recording (median=5; mean=4.5; RIQR=20%), and having sufficient funding to undertake the project (median=5; mean=4.2; RIQR=20%). The most highly rated factors adding complexity were the number of units or departments involved in the care process for the clinical condition (median=5; mean=4.4; RIQR=20%), having an accepted set of monitoring indicators for the condition (median=5; mean=4.4; RIQR=20%), and the involvement of several levels of care in the project (median=5; mean=4.3; RIQR=20%). CONCLUSIONS: We describe practical aspects for the application of systematic outcomes measurement in routine clinical practice. These results can serve as a tool for prioritising, sizing, resource planning, and estimating implementation costs.

Use of Multivariable Mendelian Randomization to Address Biases Due to Competing Risk Before Recruitment.

Background: Mendelian randomization (MR) provides unconfounded estimates. MR is open to selection bias when the underlying sample is selected on surviving to recruitment on the genetically instrumented exposure and competing risk of the outcome. Few methods to address this bias exist. Methods: We show that this selection bias can sometimes be addressed by adjusting for common causes of survival and outcome. We use multivariable MR to obtain a corrected MR estimate for statins on stroke. Statins affect survival, and stroke typically occurs later in life than ischemic heart disease (IHD), making estimates for stroke open to bias from competing risk. Results: In univariable MR in the UK Biobank, genetically instrumented statins did not protect against stroke [odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.20] but did in multivariable MR (OR 0.81, 95% CI 0.68-0.98) adjusted for major causes of survival and stroke [blood pressure, body mass index (BMI), and smoking initiation] with a multivariable Q-statistic indicating absence of selection bias. However, the MR estimate for statins on stroke using MEGASTROKE remained positive and the Q statistic indicated pleiotropy. Conclusion: MR studies of harmful exposures on late-onset diseases with shared etiology need to be conceptualized within a mechanistic understanding so as to identify any potential bias due to survival to recruitment on both genetically instrumented exposure and competing risk of the outcome, which may then be investigated using multivariable MR or estimated analytically and results interpreted accordingly.

Response of the growth plate of uremic rats to human growth hormone and corticosteroids.

Children with chronic renal failure in general present growth retardation that is aggravated by corticosteroids. We describe here the effects of methylprednisolone (MP) and recombinant human growth hormone (rhGH) on the growth plate (GP) of uremic rats. Uremia was induced by subtotal nephrectomy in 30-day-old rats, followed by 20 IU kg-1 day-1 rhGH (N = 7) or 3 mg kg-1 day-1 MP (N = 7) or 20 IU kg-1 day-1 rhGH + 3 mg kg-1 day-1 MP (N = 7) treatment for 10 days. Control rats with intact renal function were sham-operated and treated with 3 mg kg-1 day-1 MP (N = 7) or vehicle (N = 7). Uremic rats (N = 7) were used as untreated control animals. Structural alterations in the GP and the expression of anti-proliferating cell nuclear antigen (PCNA) and anti-insulin-like growth factor I (IGF-I) by epiphyseal chondrocytes were evaluated. Uremic MP rats displayed a reduction in the proliferative zone height (59.08 +/- 4.54 vs 68.07 +/- 7.5 microm, P < 0.05) and modifications in the microarchitecture of the GP. MP and uremia had an additive inhibitory effect on the proliferative activity of GP chondrocytes, lowering the expression of PCNA (19.48 +/- 11.13 vs 68.64 +/- 7.9% in control, P < 0.0005) and IGF-I (58.53 +/- 0.96 vs 84.78 +/- 2.93% in control, P < 0.0001), that was counteracted by rhGH. These findings suggest that in uremic rats rhGH therapy improves longitudinal growth by increasing IGF-I synthesis in the GP and by stimulating chondrocyte proliferation.

Systematic review: evidence-based management of hepatocellular carcinoma--an updated analysis of randomized controlled trials.

The treatment strategy of hepatocellular carcinoma applied following scientific guidelines is only supported by 77 randomized controlled trials published so far, a figure that clearly pinpoints hepatocellular carcinoma as an 'orphan' cancer in terms of clinical research when compared with other high-prevalent cancers worldwide. A systematic review analysing 61 randomized controlled trials (1978-2002) showed a modest survival benefit from chemoembolization in patients with intermediate tumours, and the lack of an effective first-line treatment option for patients with advanced disease. These conclusions have been endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. The present updated evidence-based approach includes 16 randomized controlled trials published from 2002 to 2005 assessing percutaneous ablation (seven), other loco-regional therapies (three) and systemic therapies (six). Eight showed high-quality methodological profiles. Four randomized controlled trials demonstrated a better local hepatocellular carcinoma control in tumours larger than 2 cm treated by radiofrequency ablation compared with ethanol injection. No survival advantages were obtained from systemic treatments in patients with advanced hepatocellular carcinoma, an area that is an unmet need. Therefore, there is an urgent request to conduct well-designed phase III investigations in hepatocellular carcinoma patients.

[An analysis of complaints received in a Neurology Service]. / Análisis de reclamaciones en un servicio de neurología.

AIMS: To determine the number of complaints received by the Neurology Service in one year, to carry out a qualitative analysis, and to examine how they are dealt with in order to provide patients with a solution. MATERIALS AND METHODS: The work involved a retrospective study of the complaints from patients in the Neurology Service throughout the year 2004, using the information provided by the Patient Advice and Liaison Service. The following quality indicators were used to evaluate how these claims were managed: the percentage of complaints that were attended in less than 30 days after being received and the percentage of complaints that were resolved. RESULTS: Throughout the period under study a total of 183 complaints were received: 1/478 hospital admissions (0.21%), 71/43,841 medical visits (0.16%), 110/5,522 neurophysiological studies (2%) and 3 due to other reasons. It was found that 90.2% of all complaints had to do with waiting lists, 3.3% were related to dealings with staff and the rest were due to other causes. 86.3% of the complaints were resolved, 10.2% were dismissed and the others were passed on or shelved. 77.5% of the claims were attended within 30 days (quality parameter), the mean delay being 21.3 days (standard deviation: 11.3). CONCLUSIONS: Our rate of complaints is low, although improvements must be introduced both quantitatively and in their management. Practically no data has been published to date concerning these aspects of clinical management in neurology services.

Histological evaluation of brain damage caused by crude quinolizidine alkaloid extracts from lupines.

The effects of the intracerebroventricular (ICV) administration of crude extracts of lupin quinolizidine alkaloids (LQAs) were studied in adult rat brain tissue. Mature L. exaltatus and L. montanus seeds were collected in western Mexico, and the LQAs from these seeds were extracted and analyzed by capillary gas chromatography. This LQA extract was administered to the right lateral ventricle of adult rats through a stainless steel cannula on five consecutive days. While control animals received 10 microl of sesame oil daily (vehicle), the experimental rats (10 per group) received 20 ng of LQA from either L. exaltatus or from L. montanus. All the animals were sacrificed 40 h after receiving the last dose of alkaloids, and their brains were removed, fixed and coronal paraffin sections were stained with haematoxylin and eosin. Immediately after the administration of LQA the animals began grooming and suffered tachycardia, tachypnea, piloerection, tail erection, muscular contractions, loss of equilibrium, excitation, and unsteady walk. In the brains of the animals treated with LQA damaged neurons were identified. The most frequent abnormalities observed in this brain tissue were "red neurons" with shrunken eosinophilic cytoplasm, strongly stained pyknotic nuclei, neuronal swelling, spongiform neuropil, "ghost cells" (hypochromasia), and abundant neuronophagic figures in numerous brain areas. While some alterations in neurons were observed in control tissues, unlike those found in the animals treated with LQA these were not significant. Thus, the histopathological changes observed can be principally attributed to the administration of sparteine and lupanine present in the alkaloid extracts.

The neurons of class ALD mediate thermotaxis in the parasitic nematode, Strongyloides stercoralis.

Strongyloides stercoralis, a skin-penetrating nematode parasite of homeotherms, migrates to warmth. In nematodes, the amphids, anteriorly positioned, paired sensilla, each contain a bundle of sensory neurons. In the amphids of the free-living nematode Caenorhabditis elegans, a pair of neurons, each of which ends in a cluster of microvilli-like projections, are known to be the primary thermoreceptors, and have been named the finger cells (class AFD). A similar neuron pair in the amphids of the parasite Haemonchus contortus is also known to be thermosensory. Strongyloides stercoralis lacks finger cells but, in its amphids, it has a pair of neurons whose dendrites end in a multi-layered complex of lamellae, the so-called lamellar cells (class ALD). Consequently, it was hypothesised that these lamellar cells might mediate thermotaxis by the skin-penetrating infective larva of this species. To investigate this, first stage S. stercoralis larvae were anaesthetised and the paired ALD class neurons were ablated with a laser microbeam. The larvae were then cultured to the infective third stage (L3) and assayed for thermotaxis on a thermal gradient. L3 with ablated ALD class neuron pairs showed significantly reduced thermotaxis compared with control groups. The thermoreceptive function of the ALD class neurons (i) associates this neuron pair with the host-finding process of S. stercoralis and (ii) demonstrates a functional similarity with the neurons of class AFD in C. elegans. The structural and positional characteristics of the ALD neurons suggest that these neurons may, in fact, be homologous with one pair of flattened dendritic processes known as wing cells (AWC) in C. elegans, while their florid development and thermosensory function suggest homology with the finger cells (AFD) of that nematode.

Growth of the genital primordium as a marker to describe a time course for the heterogonic larval development in Strongyloides stercoralis.

A time course for the heterogonic development of Strongyloides stercoralis is described and a method for distinguishing the early larval stages of this nematode is proposed. The number of cells in the developing gonad were counted at various time intervals of incubation, along with the percentage of larvae in molt at each interval. The time course of growth of the gonad follows a pattern comparable to that reported for body length in an idealized general nematode. A model for the heterogonic development of S. stercoralis is proposed, which, although similar to other nematode developmental models, is stage specific for S. stercoralis, allowing the otherwise morphologically similar rhabditiform stages (L1, L2) to be distinguished.

Casimiroa edulis seed extracts show anticonvulsive properties in rats.

A single dose of 5, 10 and 100 mg/kg of Casimiroa edulis aqueous extract (AQ); 10, 100 and 1000 mg/kg of C. edulis ethanolic extract (E-OH); in addition, 10, 30 and 12 mg/kg of propyleneglycol (Pg), phenytoin (Phen) and phenobarbital (Phb) was orally given to adult male Wistar rat groups. Thereafter, all groups were assayed for protection against maximal electroshock (MES) and pentylenetetrazole (METsc) seizure inducing tests at hourly intervals throughout 8 h. For MES, a maximal protection of 70% at the 2nd and 4th h with 10 mg/kg AQ and 100 mg/kg E-OH doses, occurred. That of Phen, Phb and Pg was 80, 90 and 10% at the 8th, 6th and 2nd h, respectively. The averaged values of the MES unprotected rats under 10 and 100 mg/kg of AQ and E-OH extracts, showed that a shortened reflex duration as well as a delayed latency and uprising times occurred. On the other hand, just an enlarged latency and no protection against METsc device in AQ and EOH was observed. Phen and Phb maximal protection was 80 and 100% at the 4th and 6th hour against METsc. Thus, AQ is tenfold more potent anticonvulsive extract than E-OH against MES.

In vitro inhibition of microbial methane production by 9,10-anthraquinone.

Monensin, 2,2-dichloroacetamide, and 9,10-anthraquinone were incubated for 24 h in ruminal fluid and buffer with 100:0, 50:50, and 10:90 forage-concentrate diets. Monensin (.5 ppm of the fluid) increased (P < .05) the molar proportion of propionate in the 50 and 100% forage diets but not in the high concentrate diet. At the same level of addition, 2,2-dichloroacetamide increased (P < .05) the molar proportion of propionate only in the 50:50 forage-concentrate diet. Relative to control cultures, monensin and 2,2-dichloroacetamide numerically decreased methane production in the 10 and 100% forage diets and decreased (P < .05) methane in the 50% forage diet. Hydrogen production was unaffected by treatment. Lack of an effect on fermentation end products in the high concentrate diet was probably a result of the low dose levels. In general, increasing levels of 9,10-anthraquinone (.5, 1.0, and 5.0 ppm) reduced total VFA concentration and the molar proportion of acetate, and increased propionate, butyrate and valerate. Increasing levels of 9,10-anthraquinone caused linear and quadratic decreases (P < .05) in methane production, and increases (P < .05) in hydrogen. There were no consistent effects on ammonia concentration in culture fluid from any of the compounds. In continuous culture of a 10:90 forage-concentrate diet, addition of 9,10-anthraquinone (10 ppm of the fluid/12 h) caused changes similar to those observed in batch culture with the exception of a decreased (P < .05) molar percentage of propionate, which may have been due to the high dose. The data are interpreted to indicate that 9,10-anthraquinone has the ability to alter in vitro microbial fermentation.

[Value of the lateral chest x-ray in the diagnosis of traumatic pleural effusions]. / Intérêt du cliché thoracique de profil dans le diagnostic des épanchements pleuraux traumatiques.

Forty patients were admitted to a hospital emergency department after closed chest injury. Chest X-rays, a-p and lateral, with low and high voltage, were performed in a supine position. The aim of the study was to show the interest of lateral films in the diagnosis of post-traumatic pneumo- and hemothoraces. A special technique, using a double-drawer plate holder, gave a good quality radiograph in emergency conditions without danger for patients with severe trauma. In 30 of the patients, chest radiographs confirmed pleural gas or blood collection. In ten of these, the diagnosis could only be made after radiographic examination. In nine other cases, radiographs showed an absence of hemo- or pneumothorax. Lateral views were very important in confirming a hemothorax and appreciating its volume, as well as in showing up partial pneumothoraces which could not be seen on a-p views. The interest of performing a lateral film in all the cases of chest injury is pointed out.

Black esophagus (acute esophageal necrosis) after spinal anesthesia.

Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

Effects of Hibiscus sabdariffa extract powder and preventive treatment (diet) on the lipid profiles of patients with metabolic syndrome (MeSy).

Insulin resistance, obesity, hypertension, and dyslipidemia are strongly associated with metabolic syndrome (MeSy), which is considered to be a reversible clinical stage before its evolution to coronary heart disease and diabetes. Currently, the antihypertensive and hypolipidemic properties of aqueous Hibiscus sabdariffa extracts (HSE) have been demonstrated in clinical trials and in vivo experiments. The aim of the present study was to evaluate the effects of a Hibiscus sabdariffa extract powder (HSEP) and a recognized preventive treatment (diet) on the lipid profiles of individuals with and without MeSy according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The protocol was a follow-up study carried out in a factorial, randomized design (T1=preventive treatment comprises Diet, T2=HSEP, T3=HSEP+preventive treatment (Diet) X MeSy, non-MeSy individuals). A total daily dose of 100 mg HSEP was orally administered in capsules for one month. The preventive treatment (diet) was selected according to NCEP-ATP III recommendations and adjusted individually. Total cholesterol, LDL-c, HDL-c, VLDL-c, triglycerides, glucose, urea, creatinine, AST, and ALT levels in the blood were determined in all individuals pre- and post-treatment. The MeSy patients treated with HSEP had significantly reduced glucose and total cholesterol levels, increased HDL-c levels, and an improved TAG/HDL-c ratio, a marker of insulin resistance (t-test p<0.05). Additionally, a triglyceride-lowering effect was observed in MeSy patients treated with HSEP plus diet, and in individuals without MeSy treated with HSEP. Significant differences in total cholesterol, HDL-c, and the TAG/HDL-c ratio were found when the means of absolute differences among treatments were compared (ANOVA p<0.02). Therefore, in addition to the well documented hypotensive effects of Hibiscus sabdariffa, we suggest the use of HSEP in individuals with dyslipidemia associated with MeSy.

[Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain]. / Opinión sobre la organización asistencial en el ictus. Encuesta a directores médicos hospitalarios en España.

INTRODUCTION: Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself. AIM: To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004. RESULTS: Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists. CONCLUSIONS: The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients.

Profiling isoflavone conjugates in different organs of Lupinus exaltatus Zucc.

The profiles of isoflavone conjugates in extracts obtained from different parts of Lupinus exaltatus Zucc. grown in Mexico were compared using HPLC-UV and HPLC-ESI/MSn. Collision-induced dissociation-MSn experiments were performed using an ion trap analyser during HPLC-ESI/MS analyses. Nineteen isoflavone conjugates were identified in samples obtained from air-dried roots, leaves, stems and inflorescences of lupin plants. It was possible to determine the structures of the studied compounds on the basis of the MS recorded. The compounds identified were di- and mono-glucosides of genistein and 2'-hydroxygenistein with a different pattern of C- and O-glycosylation. Some glucosides were acylated with malonic acid. It was not possible to establish the glycosylation sites on the basis of MS alone; however, it was possible to differentiate isoflavone C- and O-glucosides. The highest levels of isoflavones and their conjugates were detected in roots and the lowest in stems. Free aglycones were identified in roots and inflorescences but they were not found in stems and leaves.

Epidemiology of Down's syndrome in a Scottish city.

The aim of the study was to investigate aspects of the epidemiology of Down's syndrome (DS) in a population subjected to continuous surveillance. Data were obtained from the Glasgow Register of Congenital Anomalies. Over the period 1980-90, 173 cases of DS were identified (1.2 per 1000 births), of which 135 (78.1%) were livebirths, five (2.9%) were stillbirths and 33 (19.1%) were terminations following prenatal diagnosis. The increasing risk of DS with advancing maternal age was confirmed, although most DS pregnancies occurred in women aged under 35. While the birth prevalence of DS did not vary significantly over time, there was a significant increase in DS pregnancy prevalence. The proportion of all DS pregnancies terminated showed a statistically significant rise from 14% in 1980-87 to 31% in 1988-90 following the introduction of a new screening marker for DS risk. Almost half of DS pregnancies in women aged 35 and over ended in termination following prenatal diagnosis compared with only 7% in women under 35. There was a statistically significant excess risk of DS pregnancy in the more prosperous areas of the city; this excess persisted, but was not statistically significant, after standardising the rates for maternal age. These findings suggest that there is no scope for reducing service provision for DS children on the basis of the epidemiological trends, that the antenatal screening programme, while benefiting from the recent introduction of serum markers of risk, continues to have a greater impact on older women, and that further aetiological research using population based registries is required.