[Application of the Smoking Scale for Primary Care (ETAP) in clinical practice]. / Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica.

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure.

Inverse association between serum resistin and insulin resistance in humans.

AIM: To determine how serum concentrations of resistin are distributed in humans in relation to insulin resistance, type 2 diabetes, and obesity. METHODS: Cross-sectional, descriptive study carried out in a random sample (n=713, 43% men, 18-75 years) of general population of inhabitants of the Canary Islands (Spain). Serum resistin concentration, HOMA2-IR, anthropometric parameters, drug consumption and physical activity were recorded. RESULTS: There were no differences in resistin concentration between participants with and without diabetes (3.1+/-0.2 vs. 3.2+/-0.1ng/mL; p=0.566), or between obese and non-obese participants (3.1+/-0.1 vs. 3.2+/-0.1ng/mL; p=0.803). Individuals with abdominal obesity (waist-hip ratio [WHR] >or=1 in men or >or=0.9 in women) had lower concentrations of resistin (3.0+/-0.13 vs. 3.4+/-0.1ng/mL; p<0.001). The correlations between resistin and HOMA2-IR (r=-0.231; p<0.001) and between resistin and WHR (r=-0.202; p<0.001) were inverse. Multivariate analysis corroborated the inverse association of this cytokine with HOMA2-IR, WHR and, in women, also retained in the model the direct association between resistin and physical activity and the inverse association between resistin and antihypertensive agents. CONCLUSIONS: In this population resistin is inversely associated with insulin resistance and abdominal obesity.

Serum resistin and polymorphisms of androgen receptor GAGn and GGNn and aromatase TTTAn.

There is evidence that androgens are regulators of insulin resistance (IR), and may be involved in the regulation of resistin, a cytokine that has been related with IR. Earlier studies found that androgen receptor length polymorphisms CAGn and GGNn and the aromatase polymorphism TTTAn may influence receptor or enzyme activity and serum concentrations of androgens. This study was designed to determine whether polymorphism length was related to serum resistin concentration and to other variables related with IR. In 1,580 persons chosen randomly from the general population of the Canary Islands (Spain), we measured polymorphism length, waist circumference, waist/hip ratio, BMI, and serum glucose concentration. In smaller subgroups, we also measured C-peptide (n = 677), resistin (n = 583), and leptin concentration (n = 754) and estimated IR (homeostasis model assessment-IR (HOMA2-IR)). In men, polymorphism length correlated with resistin concentration (CAGn, r = 0.13, P = 0.031; TTTAn, r = 0.15, P = 0.005; GGNn, r = -0.15, P = 0.026), and the correlations were confirmed in multivariate regression models. The length of CAGn and TTTAn correlated inversely with C-peptide (r = -0.13, P = 0.016 and r = -0.21, P < 0.001, respectively) and with estimated IR (r = -0.12, P = 0.032 and r = -0.19, P = 0.001, respectively). In men, length of the CAGn, GGNn, and TTTAn was associated with serum resistin concentration. These results support the hypothesis that androgens may be involved in the regulation of resistin. Resistin may be a link between IR and androgens.

Effects of protein malnutrition and the administration of cortisol on the reflexologic development in rats.

The use of neurological tests in various states of undernutrition has confirmed the presence of delays in reflex ontogeny. Glucocorticoid administration in conditions of normal nutrition produces diminished growth and alterations in brain development similar to those observed in malnutrition, but there is not enough evidence about its effect on reflex development. In addition, some facts lead us to think that the use of permissive doses of these hormones during gestation could alleviate some of the effects of protein malnutrition on the development of pups. In the present study the ages at which certain reflexes appeared in the offspring of Wistar rats (Rattus norvegicus) fed a 20% (N) or 10% (M) protein diet from a week before conception to the end of lactation were observed. Each dietary group was subdivided into two: mothers receiving a daily injection during gestation either of a 0.9% NaCl (S) solution or of a 0.5 mg/100 g weight hydrocortisone acetate (C) solution. Results showed that the NS group of pups generally presented earlier ages of appearance of the variables under study than the remaining groups. Pups of the NC group presented delays in the age of appearance of reflexes. Finally, protein malnutrition delayed the appearance of reflexes and this effect seemed to be attenuated by treatment with hydrocortisone. Thus, hydrocortisone administration in protein malnutrition conditions seems to be beneficial although the results are harmful when administered under normal nutritional conditions.

The effects of protein malnutrition and cortisol treatment on motor activity of rats.

Virgin female Wistar rats were randomly assigned to one of three isocaloric diets (20, 11 and 6.7% protein content). From a week prior to mating and during gestation and suckling periods they were fed ad lib. At the beginning of gestation period each dietary group was subdivided into two groups according to the treatment with a daily injection of either hydrocortisone acetate solution or saline solution they were to receive until delivery. After weaning, only the male pups were selected and fed ad lib with the same diet as their mothers. They were weighed and evaluated in an open field test every 10 days for 70 days. The body weight of the animals diminished as protein content in diet decreased. The 6.7% group was hyperactive and less emotional than the other dietary groups. The 11% group showed more vertical activity than the 20 and 6.7% groups. Cortisol administration during gestation decreased motor activity in the 20% group, but had no effect on the two malnourished groups.