Obstetric haemorrhage and risk of cardiovascular disease after three decades: a population-based cohort study.

OBJECTIVE: To investigate the association between obstetric haemorrhage and cardiovascular disease up to three decades after pregnancy. DESIGN: Population-based cohort study. SETTING AND POPULATION: All women who delivered between 1989 and 2016 in Quebec, Canada. METHODS: Using hospital admissions data, 1 224 975 women were followed from their first delivery until March 2018. The main exposure measures were antenatal (placenta praevia, placental abruption, peripartum haemorrhage) or postpartum haemorrhage, with or without transfusion. Adjusted Cox regression models were used to assess the association between obstetric haemorrhage and future cardiovascular disease. MAIN OUTCOME MEASURE: Cardiovascular hospitalisation. RESULTS: Among 104 291 (8.5%) women with haemorrhage, 4612 (4.4%) required transfusion. Women with haemorrhage had a higher incidence of cardiovascular hospitalisation than women without haemorrhage (15.5 versus 14.1 per 10 000 person-years; 2437 versus 28 432 events). Risk of cardiovascular hospitalisation was higher for obstetric haemorrhage, with or without transfusion, compared with no haemorrhage (adjusted hazard ratio [aHR] 1.06, 95% CI 1.02-1.10). Women with haemorrhage and transfusion had a substantially greater risk of cardiovascular hospitalisation (aHR 1.47, 95% CI 1.23-1.76). Among transfused women, placental abruption (aHR 1.79, 95% CI 1.06-3.00) and postpartum haemorrhage (aHR 1.38, 95% CI 1.13-1.68) were both associated with risk of cardiovascular hospitalisation. Antenatal haemorrhage with transfusion was associated with 2.46 times the risk of cardiovascular hospitalisation at 5 years (95% CI 1.59-3.80) and 2.14 times the risk at 10 years (95% CI 1.47-3.12). CONCLUSIONS: Obstetric haemorrhage requiring transfusion is associated with maternal cardiovascular disease. The benefit of cardiovascular risk prevention in pregnant women with obstetric haemorrhage requires further investigation. TWEETABLE ABSTRACT: Risk of future cardiovascular disease is increased for women with obstetric haemorrhage who require transfusion.

Chronicling changes to the chronic disease prevention landscape in Canada's public health system 2004-2010.

The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short.

Eating behaviour in obese patients with melanocortin-4 receptor mutations: a literature review.

Melanocortin-4 receptor (MC4R) mutations are the most common known cause of monogenic obesity and an important contributor to polygenic obesity. MC4R mutations with partial or total loss of function, as well as the variant rs17782313 mapped near MC4R, are positively associated with obesity. MC4R is involved in the leptin-melanocortin signalling system, located in hypothalamic nuclei, that controls food intake via both anorexigenic or orexigenic signals. Impairment in this receptor might affect eating behaviours. Thus, in the case of MC4R mutation carriers, obesity could be related, at least partly, to inadequate control over eating behaviours. Many published studies address eating behaviours in MC4R mutation carriers. Most studies focus on binge eating disorder, whereas others examine various aspects of intake and motivation. Up to now, no evaluation of this literature has been performed. In this review, we examine the available literature on eating behaviours in carriers of MC4R mutations and variant rs17782313 near MC4R gene. We address binge eating disorder, bulimia nervosa, mealtime hyperphagia, snacking, psychological factors, satiety responsiveness and intake of energy and macro/micronutrient. In a small number of studies, MC4R mutations seem to impair eating behaviours or motivation, but no clear causal effects can be found in the balance of the evidence presented. Improvements in methodologies will be necessary to clarify the behavioural effects of MC4R mutations.

Body mass index versus waist circumference as predictors of mortality in Canadian adults.

BACKGROUND: Elevated body mass index (BMI) and waist circumference (WC) are associated with increased mortality risk, but it is unclear which anthropometric measurement most highly relates to mortality. We examined single and combined associations between BMI, WC, waist-hip ratio (WHR) and all-cause, cardiovascular disease (CVD) and cancer mortality. METHODS: We used Cox proportional hazard regression models to estimate relative risks of all-cause, CVD and cancer mortality in 8061 adults (aged 18-74 years) in the Canadian Heart Health Follow-Up Study (1986-2004). Models controlled for age, sex, exam year, smoking, alcohol use and education. RESULTS: There were 887 deaths over a mean 13 (SD 3.1) years follow-up. Increased risk of death from all-causes, CVD and cancer were associated with elevated BMI, WC and WHR (P<0.05). Risk of death was consistently higher from elevated WC versus BMI or WHR. Ascending tertiles of each anthropometric measure predicted increased CVD mortality risk. In contrast, all-cause mortality risk was only predicted by ascending WC and WHR tertiles and cancer mortality risk by ascending WC tertiles. Higher risk of all-cause death was associated with WC in overweight and obese adults and with WHR in obese adults. Compared with non-obese adults with a low WC, adults with high WC had higher all-cause mortality risk regardless of BMI status. CONCLUSION: [corrected] BMI and WC predicted higher all-cause and cause-specific mortality, and WC predicted the highest risk for death overall and among overweight and obese adults. Elevated WC has clinical significance in predicting mortality risk beyond BMI.

[Team-based care involving pharmacists and nurses to improve the management of hypertension]. / Améliorer la prise en charge de l'hypertension arterielle en favorisant la collaboration avec les pharmaciens et les infirmières.

Only half of hypertensive patients has controlled blood pressure. Chronic kidney disease (CKD) is also associated with low blood pressure control, 25-30% of CKD patients achieving adequate blood pressure. The Community Preventive Services Task Force has recently recommended team-based care to improve blood pressure control. Team-based care of hypertension involves facilitating coordination of care among physician, pharmacist and nurse and requires sharing clinical data, laboratory results, and medications, e.g., electronically or by fax. Based on recent studies, development and evaluation of team-based care of hypertensive patients should be done in the Swiss healthcare system.

High prevalence of smoking among patients with suspected tuberculosis in South Africa.

There is growing evidence that tobacco smoking is an important risk factor for tuberculosis (TB). There are no data validating the accuracy of self-reported smoking in TB patients and limited data about the prevalence of smoking in TB patients from high-burden settings. We performed a cross-sectional analysis of 500 patients with suspected TB in Cape Town, South Africa. All underwent comprehensive diagnostic testing. The accuracy of their self-reported smoking status was determined against serum cotinine levels. Of the 424 patients included in the study, 56 and 60% of those with active and latent TB infection (LTBI), respectively, were current smokers. Using plasma cotinine as a reference standard, the sensitivity of self-reported smoking was 89%. No statistically significant association could be found between smoking and active TB or LTBI. In Cape Town, the prevalence of smoking among patients with suspected and confirmed TB was much higher than in the general South African population. Self-reporting is an accurate measure of smoking status. These results suggest the need to actively incorporate tobacco cessation programmes into TB services in South Africa.

The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials.

BACKGROUND: Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive. OBJECTIVE: To conduct a meta-analysis of RCTs examining counselling in pregnant smokers. SEARCH STRATEGY: We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling. SELECTION CRITERIA: We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date. DATA COLLECTION AND ANALYSIS: Overall estimates were derived using random effects meta-analysis models. MAIN RESULTS: Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type. CONCLUSIONS: Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.

Dye efflux studies suggest that hematopoietic stem cells expressing low or undetectable levels of CD34 antigen exist in multiple species.

We previously described a method for isolating murine hematopoietic stem cells capable of reconstituting lethally irradiated recipients, which depends solely on dual-wavelength flow cytometric analysis of murine bone marrow cells stained with the fluorescent DNA-binding dye Hoechst 33342. This method, which appears to rely on the differential ability of stem cells to efflux the Hoechst dye, defines an extremely small and homogeneous population of cells (termed SP cells). We show here that dual-wavelength analysis of Hoechst dye-stained human, rhesus and miniature swine bone marrow cells reveals a small, distinct population of cells that efflux the dye in a manner identical to murine SP cells. Like the murine SP cells, both human and rhesus SP cells are primarily CD34-negative and lineage marker-negative. In vitro culture studies demonstrated that rhesus SP cells are highly enriched for long-term culture-initiating cells (LTC-ICs), an indicator of primitive hematopoietic cells, and have the capacity for differentiation into T cells. Although rhesus SP cells do not initially possess any hematopoietic colony-forming capability, they acquire the ability to form colonies after long-term culture on bone marrow stroma, coincident with their conversion to a CD34-positive phenotype. These studies suggest the existence of a hitherto unrecognized population of hematopoietic stem cells that lack the CD34 surface marker classically associated with primitive hematopoietic cells.

Isolation and functional properties of murine hematopoietic stem cells that are replicating in vivo.

Hematopoietic stem cells (HSC) are multipotent cells that reside in the bone marrow and replenish all adult hematopoietic lineages throughout the lifetime of the animal. While experimenting with staining of murine bone marrow cells with the vital dye, Hoechst 33342, we discovered that display of Hoechst fluorescence simultaneously at two emission wavelengths revealed a small and distinct subset of whole bone marrow cells that had phenotypic markers of multipotential HSC. These cells were shown in competitive repopulation experiments to contain the vast majority of HSC activity from murine bone marrow and to be enriched at least 1,000-fold for in vivo reconstitution activity. Further, these Hoechst-stained side population (SP) cells were shown to protect recipients from lethal irradiation at low cell doses, and to contribute to both lymphoid and myeloid lineages. The formation of the Hoechst SP profile was blocked when staining was performed in the presence of verapamil, indicating that the distinctly low staining pattern of the SP cells is due to a multidrug resistance protein (mdr) or mdr-like mediated efflux of the dye from HSC. The ability to block the Hoechst efflux activity also allowed us to use Hoechst to determine the DNA content of the SP cells. Between 1 and 3% of the HSC were shown to be in S-G2M. This also enabled the purification of the G0-G1 and S-G2M HSC had a reconstitution capacity equivalent to quiescent stem cells. These findings have implications for models of hematopoietic cell development and for the development of genetic therapies for diseases involving hematopoietic cells.

The effect of magmatic activity on hydrothermal venting along the superfast-spreading East pacific rise.

A survey of hydrothermal activity along the superfast-spreading (approximately 150 millimeters per year) East Pacific Rise shows that hydrothermal plumes overlay approximately 60 percent of the ridge crest between 13 degrees 50' and 18 degrees 40'S, a plume abundance nearly twice that known from any other rige portion of comparable length. Plumes were most abundant where the axial cross section is inflated and an axial magma chamber is present. Plumes with high ratios of volatile ((3)He, CH(4), and H(2)S) to nonvolatile (Mn and Fe) species marked where hydrothermal circulation has been perturbed by recent magmatic activity. The high proportion of volatile-rich plumes observed implies that such episodes are more frequent here than on slower spreading ridges.

Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents.

OBJECTIVE: Obesity prevention in childhood is important. However, changing children's lifestyle behaviors to reduce overweight is a substantial challenge. Accurately perceiving oneself as overweight/obese has been linked to greater motivation to change lifestyle behaviors. Children and adolescents may be less likely to perceive themselves as overweight/obese if they are exposed to overweight/obese people in their immediate environments. This study examined whether youth who are exposed to overweight parents and schoolmates were more likely to misperceive their own weight status. DESIGN: The Quebec Child and Adolescent Health and Social Survey was a provincially representative, school-based survey of children and adolescents conducted between January and May 1999. SUBJECTS: 3665 children and adolescents (age 9, n=1267; age 13, n=1186; age 16, n=1212) from 178 schools. Mean body mass index (BMI) was 17.5, 20.6 and 22.2 kg/m(2), respectively. MEASUREMENTS: The misperception score was calculated as the standardized difference between self-perception of weight status (Stunkard Body Rating Scale) and actual BMI (from measured height and weight). Exposure to obesity was based on parent and schoolmate BMI. RESULTS: Overweight and obese youth were significantly more likely to misperceive their weight compared with non-overweight youth (P<0.001). Multilevel modeling indicated that greater parent and schoolmate BMI were significantly associated with greater misperception (underestimation) of weight status among children and adolescents. CONCLUSION: Children and adolescents who live in environments in which people they see on a daily basis, such as parents and schoolmates, are overweight/obese may develop inaccurate perceptions of what constitutes appropriate weight status. Targeting misperception may facilitate the adoption of healthy lifestyle behaviors and improve the effectiveness of obesity prevention interventions.

FACS-based isolation of slowly growing cells: double encapsulation of yeast in gel microdrops.

Isolating hyperproducing cells is important in biotechnology, but these cells usually grow slowly and can be overgrown by poorly producing cells. We describe a new method of isolating slowly growing cells from among rapidly growing cells, which has the potential for automation and high throughput (e.g., 100,000 cells/h). A model system is presented consisting of a mixed population of slowly growing mutant and rapidly growing wild-type yeast, which were encapsulated in double agarose gel microdrops (dGMDs); with most dGMDs initially containing single cells. Double encapsulation locates parent cells near dGMD centers, making microcolony measurement more accurate. After a 15-h incubation, fluorescent activated cell sorting was used to analyze and sort dGMDs with small microcolonies (slow growers) from dGMDs with large microcolonies (rapid growers). Successful isolation of slow growers from a mixed population of predominantly rapidly growing Saccharomyces cerevisiae cells was achieved.

Risk factors for tobacco dependence in adolescent smokers.

OBJECTIVE: To study the incidence of conversion to tobacco dependence (TD) and the prevalence of the TD state in relation to several potential determinants in a sample of adolescent smokers. METHODS: Questionnaires were administered every 3-4 months to document TD symptoms, amount of cigarette consumption, and depression symptoms in a prospective cohort of 1293 grade 7 students in a convenience sample of 10 schools. RESULTS: Over 54 months of follow-up, 113 of 344 novice smokers converted to TD. The referent series for the analysis of incidence comprised 823 person-surveys. The prevalence series included 1673 person-surveys, contributed by 429 smokers. Conversion to TD and TD status were associated with the intensity of recent (that is, past 3-month) cigarette consumption (adjusted incidence rate ratio (aIRR) 1.63 (95% confidence interval (CI) 1.36 to 1.97) and adjusted prevalence odds ratio (aPOR) 1.35 (95% CI 1.23 to 2.48) per 100 cigarettes per month), slowest CYP2A6 activity (aIRR 4.19 (95% CI 1.38 to 12.76) and aPOR 2.30 (95% CI 1.29 to 4.09)), depression score (aIRR 1.61 (95% CI 1.17 to 2.21) and aPOR 1.47 (95% CI 1.22, 1.75) per 1-unit change). Additional determinants included, for conversion to TD, time since onset of cigarette use (aIRR 0.76 (95% CI 0.58 to 1.00) per year) and, for the TD state, positive TD status six months ago (aPOR 3.53 (95% CI 2.41 to 5.19)). CONCLUSIONS: TD risk in adolescents is associated with intensity of recent cigarette consumption, while the role of more distant cigarette consumption appears small; subjects with slow nicotine metabolism and those with more depression symptoms are at increased risk of becoming tobacco dependent. The risk of being tobacco dependent is considerably higher in subjects who had previously developed the TD state.

Phosphorylation of ribosomal proteins during the cell cycle of Physarum polycephalum.

Physarum polycephalum has been used as a model system to study the phosphorylation of ribosomal proteins during the cell cycle. The results showed that the phosphate content of S3, the major ribosomal phosphoprotein in this organism, was constant during all phases of the cell cycle. No additional ribosomal phosphoproteins were observed. These results differ significantly from those reported earlier by Rupp, R.G., Humphrey, R.M. and Shaeffer, J.R. (Biochim. Biophys. Acta (1976) 418, 81-92) and suggest that the use of thymidine or hydroxyurea to synchronize cell population may affect the phosphorylation of ribosomal proteins. The results are discussed in relation to protein synthesis and cAMP level during the cell cycle.

Phosphorylation of ribosomal proteins S3, L1 and L24 during spherulation in Physarum polycephalum.

The phosphate content of ribosomal proteins S3, L1 and L24 has been determined in the course of spherulation of Physarum polycephalum. The major phosphoprotein, S3, was completely dephosphorylated after 4 h of differentiation. The phosphate content of L1 and L24 was not altered during the differentiation. The cellular level of ATP remained constant for at least 5 h. A 3-fold reduction of cyclic AMP concentration occurred in the first hour, followed by a slow increase to a final value of twice the level observed in growing cells. The results showed that the phosphorylation of ribosomal proteins is regulated by at least two different mechanisms and that the dephosphorylation of S3 is not induced by a lack of cellular ATP. Although cyclic AMP might trigger the dephosphorylation of S3, the phosphate content of this protein remained at a very low value even when the cellular concentration of cyclic AMP rose significantly. Since the polysome level remains constant during the first 24 h of spherulation, the phosphorylation of S3 is not necessary for active protein synthesis and the phosphorylation of L1 and L24 is not involved in ribosome inactivation, which occurs after 24 h.

High level of expression in the prostate of a human glandular kallikrein mRNA related to prostate-specific antigen.

Using a synthetic oligonucleotide primer complementary to human prostate-specific antigen mRNA, we found that an additional sequence possibly similar to human glandular kallikrein-1 could be read by a primer-extension sequencing technique. We were able to confirm the identity of that additional sequence with another oligonucleotide primer complementary to a specific region of the human glandular kallikrein-1 mRNA sequence. Northern blot analysis with 2 oligonucleotide probes respectively specific for prostate-specific antigen and human glandular kallikrein-1 mRNAs showed that the length of both mRNAs was similar at 1.5 kb. The level of human glandular kallikrein-1 mRNA relative to that of prostate-specific antigen could be estimated as approx. 10-20%. This study constitutes the first evidence that the human glandular kallikrein-1 gene is expressed at a high level in a human tissue.

Prevalence and correlates of early smoking among elementary schoolchildren in multiethnic, low-income inner-city neighborhoods.

PURPOSE: The prevalence and correlates of early smoking were investigated among schoolchildren in grades 4-6 living in multiethnic, low-income neighborhoods in Montreal. METHODS: As part of the evaluation of a school-based heart health promotion program, baseline data on the prevalence of early smoking were collected from 2285 students aged 9-13 years in 24 inner-city elementary schools during May-June 1993. RESULTS: Overall, 28.7% of boys and 20.3% of girls had smoked. Girls began trying later than boys, but by age 13 the prevalence of experimental or regular smoking by girls overtook that of boys. Univariately, ever smoking varied considerably by family origin, from 2.1% among Vietnamese girls, to 35.8% among Portuguese boys. In multivariate analysis, age, perceived smoking habits of friends, and smoking by family members, were strong correlates of smoking. Being of Asian family origin was negatively associated with smoking. None of the indicators of social class were significantly associated with ever smoking. CONCLUSIONS: Smoking prevention should begin with children even younger than age 9 in multiethnic, low-income, inner-city neighborhoods. With the exception of a lower prevalence of smoking among Asian children, ethnicity and social class were not strong influences on early smoking behavior in this population.

Reliability of proxy reports of parental smoking by elementary schoolchildren.

PURPOSE: To investigate the reliability of reports of parental smoking by elementary schoolchildren aged 9-13 years, and to identify the correlates of disagreement between student proxy and parent self-reports. METHODS: As part of the evaluation of a school-based heart health promotion program, data on parental smoking status were collected from 1240 student-mother pairs and 898 student-father pairs. RESULTS: Agreement for parental smoking status was 93.1% among student-mother pairs and 86.4% among student-father pairs. Among student-mother pairs, reports by students aged 9 years were more likely to disagree with mothers' self-reports than those of older children (odds ratio (OR) = 3.1). Among student-father pairs, the only significant correlate of disagreement was living in a single-parent family headed by the mother (OR = 2.6). CONCLUSIONS: Children 10-years or older can provide reliable reports of the smoking status of cohabiting parents.

Prevalence and correlates of physical activity behaviors among elementary schoolchildren in multiethnic, low income, inner-city neighborhoods in Montreal, Canada.

PURPOSE: To describe the prevalence and correlates of physical inactivity and of participation in organized sports at and outside school among elementary schoolchildren in multiethnic, low income, urban neighborhoods in Montreal, Canada. METHODS: As part of the evaluation of a school-based heart health promotion program, baseline data on physical activity behaviors and potential correlates of these behaviors, were collected from 2285 students aged 9-13 in all 130 grade 4 to 6 classes in 24 inner-city elementary schools from May to June 1993. RESULTS: One-fifth of boys (20.5%) and 24.4% of girls were inactive; 40.0% and 33.3% of boys and girls respectively, participated in school sports teams; 82.5% and 74.7% participated in organized sports outside school. Declines in activity levels with age were apparent in both genders. Children who participated in organized sports programs at and outside school, those with higher perceived self-efficacy for physical activity, and those with more parental support for engaging in physical activity were more active. Children of Asian family origin were less active. Socioeconomic status was related to participation in organized sports outside school. CONCLUSIONS: To reach children in socio-economically disadvantaged areas and to prevent age-related declines in activity levels, interventions promoting physical activity should focus on increasing availability and access to community-based organized sports programs at and outside school. Also they should include components to increase parental support and to improve perceived self-efficacy for physical activity.

Prevalence and correlates of overweight among elementary schoolchildren in multiethnic, low income, inner-city neighbourhoods in Montreal, Canada.

PURPOSE: Increased understanding of the early determinants of obesity is essential because of the increasing prevalence of obesity in many industrialized countries. METHOD: As part of the evaluation of a school-based heart health promotion intervention, we measured height, weight, and triceps skinfold thickness at baseline in 2108 students aged 9-12 years (80.5% of eligible students) in 24 inner-city elementary schools located in multiethnic, low income neighbourhoods in Montreal, Canada. Data on student's socio-demographic and lifestyle characteristics were collected in classroom-administered questionnaires, and parents completed an at-home self-administered questionnaire. RESULTS: Overall, 35.2% of boys and 33.0% of girls were overweight (> or = 85th age and gender-specific percentiles from NHANES 11, for body mass index and triceps skinfold thickness); 15.1% of boys and 13.3% of girls were obese (> or = 95th age and gender-specific percentiles for body mass index and triceps skinfold thickness). Younger age, having lived all one's life in Canada, and being of European or Central American/Caribbean family origin were independent correlates of obesity in boys. Younger age, ever smoked, mother obese and father obese were independent correlates of obesity in girls. Girls of Asian family origin were protected. CONCLUSIONS: The very high prevalence of overweight students in this low income, multiethnic population suggests an important need for preventive intervention.