Evolution of depression during rehabilitation program in patients with cardiovascular diseases.

Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.

Effect of l-theanine tablets in reducing stress-related emotional signs in cats: an open-label field study.

BACKGROUND: L-theanine is an aminoacid found in tea leaves which has relaxing effects in humans and animals. It is a structural analogue of glutamate which can bind glutamate receptors. Although the relaxing action of L-theanine has been shown in humans, laboratory animals and dogs, it has never been published in cats. The goal of this open-label, multicentre and prospective trial was to determine whether an L-theanine based oral supplement (Anxitane®, Virbac, France) could attenuate manifestations of stress in cats under field conditions. CASE PRESENTATION: Thirty-three privately owned cats presenting signs associated with stress or fear (inappropriate urination/defecation, fear-induced aggressiveness, hypervigilance/tenseness or physical/functional manifestations of stress) for at least 1 month, were included in the study. They were given L-theanine (Anxitane®, 25 mg twice a day) for 30 days and 20 stress-related parameters were scored at Days 0, 15 and 30. The evolution of some parameters was also rated relative to Day 0. All median scores of the 20 parameters were significantly reduced at D30, and 30/33 cats (91%) had a reduced global score at the end of the study, including 21/33 with ≥50% score reduction. The median (IQR) global scores went from 18 (13-23) at D0 to 11 (8-13) at D15 and 5 (3-12) at D30 (p < 0.0001; Friedman test; significant reduction starting from D15). All the stress-related signs were significantly improved compared to D0, according to the owners, especially inappropriate elimination. Tablet palatability was judged good or very good in 94% of cases with spontaneous intake by cats when given by hand or in food. Tolerance was satisfactory as well, and no side effects were reported, so that most owners (27/33; 82%) were satisfied with the product. CONCLUSIONS: Despite the lack of a placebo group, it can be concluded that L-theanine (Anxitane®) helped to improve the undesirable manifestations of stress in cats in as soon as 15 days, though better results could be seen after 30 days of administration. These encouraging results show that L-theanine can help manage stress-related behaviour, but additional trials with a placebo group should be run to confirm this effect.

Examination of emotion-induced changes in eating: A latent profile analysis of the Emotional Appetite Questionnaire.

It is now recognized that emotions can influence food intake. While some people report eating less when distressed, others report either no change of eating or eating more in the same condition. The question whether this interindividual variability also occurs in response to positive emotions has been overlooked in most studies on Emotional Eating (EE). Using the Emotional Appetite Questionnaire (EMAQ) and Latent Profile Analysis, this study aimed to examine the existence of latent emotion-induced changes in eating profiles, and explore how these profiles differ by testing their relations with 1) age and sex, 2) BMI and risk for eating disorders (ED) and 3) factors that are known to be associated with EE such as perceived positive/negative feelings, depression, anxiety, stress symptoms and impulsivity. Among 401 university students (245 females) who completed the EMAQ, 3 profiles emerged (P1:11.2%, P2:60.1%, P3:28.7%), with distinct patterns of eating behaviors in response to negative emotions and situations but few differences regarding positive ones. Negative emotional overeaters (P1) and negative emotional undereaters (P3) reported similar levels of emotional distress and positive feelings, and were at greater risk for ED. However, the people in the former profile i) reported decreasing their food intake in a positive context, ii) were in majority females, iii) had higher BMI and iv) were more prone to report acting rashly when experiencing negative emotions. Our findings suggest that a person-centred analysis of the EMAQ scores offers a promising way to capture the inter-individual variability of emotionally-driven eating behaviors. These observations also add to the growing literature underscoring the importance of further investigating the role of different facets of impulsivity in triggering overeating and to develop more targeted interventions of EE.

Association between electronic health records and health care utilization.

BACKGROUND: The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. OBJECTIVE: To determine any association between EHRs and health care utilization. METHODS: We conducted a cohort study (2008-2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. RESULTS: Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. CONCLUSIONS: Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.

Gambling and Attention Deficit Hyperactivity Disorders (ADHD) in a Population of French Students.

Attention deficit disorder with or without hyperactivity (ADD/ADHD) is a neurodevelopmental disorder that can be exacerbated by psychosocial factors. Various studies confirm that the severity of a psychiatric disorder, particularly when it comes to ADHD, is strongly correlated with the amount of use. This study (1) evaluated the association between ADHD and gambling among young students; (2) determined which symptom among ADHD's three symptoms (attention deficit, hyperactivity, or impulsivity) had the strongest association with video game addiction and gambling; and (3) determined the impact of the association between ADHD and video game addiction and gambling on self-esteem and academic performance of students. A total of 720 students (445 males and 274 females) were recruited from eight higher educational institutions of Ile de France. They all completed a battery of questionnaire consisting of Canadian Problem Gambling Index, UPPS Impulsive Behavior Scale, Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS) and Rosenberg scales, and socio-demographic data. 13.33% of the participants had symptoms of ADHD during childhood (WURS scale score) and 40.41% of them have symptoms of ADHD in adulthood (ASRS score). Finally, among the participants, 37.5% had excessive gambling addiction, have positive results on WURS and ASRS scales, thus having a probable ADHD, whereas 14.55% had no gambling addiction. The results demonstrated that adult ADHD was associated with gambling addiction. Significant associations were observed between ADHD and impulsivity, academic difficulties and gambling addiction. The association between ADHD and gambling seems to be common among vulnerable populations such as adolescents and could be related to variables such as self-esteem, which appears to potentially worsen the prognosis. Further research on this relationship is needed to optimize prevention strategies and effective treatment.

[A cyberbullying study: Analysis of cyberbullying, comorbidities and coping mechanisms]. / Étude sur la « cyber-intimidation ¼ : cyberbullying, comorbidités et mécanismes d'adaptations.

INTRODUCTION: Cyberbullying is a relatively new form of bullying. This bullying is committed by means of an electronic act, the transmission of a communication by message, text, sound, or image by means of an electronic device, including but limited to, a computer phone, wireless telephone, or other wireless communication device, computer, games console or pager. Cyberbullying is characterized by deliberately threatening, harassing, intimidating, or ridiculing an individual or group of individuals; placing an individual in reasonable fear of harm; posting sensitive, private information about another person without his/her permission; breaking into another person's account and/or assuming another individual's identity in order to damage that person's reputation or friendships. LITERATURE FINDING: A review of the literature shows that between 6 and 40% of all youths have experienced cyberbullying at least once in their lives. Several cyberbullying definitions have been offered in the literature, many of which are derived from definitions of traditional bullying. In our study we asked clear definition of cyberbullying. Few studies explicate the psychosocial determinants of cyberbullying, and coping mechanisms. The authors of the literature recommend developing resiliency, but without analyzing the resilience factor. OBJECTIVES: The first aim of this study was to determine the prevalence of adolescents and adults engaged in cyberbullying. The second aim was to examine the coping mechanisms and comorbidity factors associated with the cyberbullied people. METHODOLOGY: The sample was composed of 272 adolescents (from a high school) and adults (mean age=16.44 ± 1). The Olweus Bully/Victim Questionnaire was used to identify profiles of cyberbullying. Coping mechanisms were investigated using the Hurt Disposition Scale (HDS) and the Brief Resilience Scale (BRS). Comorbidities were assessed using the Hospital Anxiety and Depression Scale (HAD), Liebowitz's Social Anxiety Scale (LSAS), and the Bermond-Vorst Alexithymia Questionnaire (BVAQ). RESULTS: Almost one student in three was involved in cyberbullying (34.9% as cyber-victim, 16.9 as cyberbully); 4.8% of our sample was concerned by bullying as a victim. The victims of bullying were also victims of cyberbullying. The mean age of victims of cyberbullying was 17.84 ± 5.9 years, and the mean age of victims of bullying was 16.3 ± 4.5 years. Correlation coefficient was significant for HAD, LSAS, BVAQ scales with CQ. The retaliatory variable of HDS scale was not significant. Finally, the coping strategies of students who reported victimization were explored. These strategies include coping, telling someone, figuring out the situation, and avoidant coping. The results showed for the victims of cyberbullying, that they take longer to recover from a stressful event, compared to victims of bullying. CONCLUSION: Results have indicated the importance of further study of cyberbullying because its association with comorbidities was distinct from traditional forms of bullying. The biggest risk factor for the adolescents is the severity of the consequences. These are: the adoption of the avoidance coping strategy, the occurrence of offline bullying during the situation, the adoption of the self-control coping strategy, the variety of cyberbullying acts, the victim's level of self-blame, the victim's perception of the duration of the situation, and the frequency of cyberbullying victimization.

State funding for health information technology and selected ambulatory healthcare quality measures.

BACKGROUND: Previous studies on the effects of health information technology (health IT) on ambulatory quality have had mixed results. New York State has invested heavily in health IT throughout the State, creating a unique opportunity to assess effects on health care quality across multiple communities. OBJECTIVE: To determine any association between primary care providers' receipt of funding from New York State's Healthcare Efficiency and Affordability Law for New Yorkers Program (HEAL NY) and ambulatory quality of care. METHODS: A statewide, longitudinal cohort study of primary care physicians in New York State was conducted. Data regarding which primary care physicians received funding through the HEAL NY program (Phase 5 or Phase 10) in 2008 or 2009 were obtained from the New York State Department of Health. Health care quality in 2010 was measured using claims data that had been aggregated across 7 commercial health plans across the state. Physicians were divided into 2 groups, based on receipt of HEAL funding (yes/no). Any association was measured between study group and each of 7 quality measures, all of which appear in the Stage 1 federal Meaningful Use program. Negative binomial regression was used, adjusting for provider gender and specialty. RESULTS: The study included 3,988 primary care providers, of whom 863 (22%) had received HEAL NY funding. The HEAL-funded physicians provided higher quality of care on 5 of the 7 measures: breast cancer screening, eye exams in patients with diabetes, nephropathy screening in patients with diabetes, influenza vaccination and pneumococcal vaccination (p<0.0001 for all adjusted comparisons). The HEAL-funded group provided higher quality of care by an absolute 2 to 6 percentage points per measure for those 5 measures. CONCLUSION: Primary care physicians who received state funding for health IT provided higher quality of care than those who did not receive such funding.

Association between use of a health information exchange system and hospital admissions.

OBJECTIVE: Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED. METHODS: We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE's system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings. RESULTS: The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000. CONCLUSION: These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US.

[Mounier-Kuhn syndrome - a rare cause of recurrent bronchitis]. / Das Mounier-Kuhn-Syndrom - eine seltene Ursache rezidivierender Bronchitiden.

HISTORY AND ADMISSION FINDINGS: A 43-year-old man presented at our emergency room with progressive dyspnea and productive cough. He was in moderate respiratory distress. Symptomatic treatment had so far not led to clinical improvement. He had suffered from similar episodes since adolescence. INVESTIGATIONS: An intensive diagnostic investigation was started to evaluate the source of infection and dyspnea. CRP levels were elevated to 26 mg/l. Arterial blood gas analysis showed a moderate hypoxemia with a pO2 of 8.35kPa (63 mmHg) and a pCO2 of 3.84kPa (29 mmHg). DIAGNOSIS, TREATMENT AND COURSE: Computed tomography of the chest revealed the diagnosis of trachebobronchomegaly. This rare cause of recurrent bronchitis is named after Mounier-Kuhn who established this diagnosis for the first time. The patient improved under a course with antibiotics and inhaled bronchodilators. CONCLUSION: In patients with recurrent bronchitis, an underlying disease of the tracheobronchial system has to be suspected. The Mounier-Kuhn syndrome is only rarely diagnosed because the diagnosis cannot be established by conventional chest x-ray. Computed tomography is the gold standard for diagnosis. Mounier-Kuhn syndrome is likely to lead to severe venilatory failure and death, if untreated.

Physician specialty and variations in adoption of electronic health records.

OBJECTIVE: Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored. METHODS: We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree). RESULTS: Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine/general practitioners. After adjustment for covariates, these specialties were 44-94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty. CONCLUSIONS: Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties.

Health information exchange and ambulatory quality of care.

BACKGROUND: Health information exchange is a national priority, but there is limited evidence of its effectiveness. OBJECTIVE: We sought to determine the effect of health information exchange on ambulatory quality. METHODS: We conducted a retrospective cohort study over two years of 138 primary care physicians in small group practices in the Hudson Valley region of New York State. All physicians had access to an electronic portal, through which they could view clinical data (such as laboratory and radiology test results) for their patients over time, regardless of the ordering physician. We considered 15 quality measures that were being used by the community for a pay-for-performance program, as well as the subset of 8 measures expected to be affected by the portal. We adjusted for 11 physician characteristics (including health care quality at baseline). RESULTS: Nearly half (43%) of the physicians were portal users. Non-users performed at or above the regional benchmark on 48% of the measures at baseline and 49% of the measures at followup (p = 0.58). Users performed at or above the regional benchmark on 57% of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was independently associated with higher quality of care at follow-up for those measures expected to be affected by the portal (p = 0.01), but not for those not expected to be affected by the portal (p = 0.12). CONCLUSIONS: Use of an electronic portal for viewing clinical data was associated with modest improvements in ambulatory quality.

[Relationship between exercise dependence and big five personality]. / Relation entre la dépendance à l'exercice physique et les cinq dimensions de la personnalité

INTRODUCTION: Despite the increased interest in exercise dependence, there is limited research examining the personality characteristics of exercise dependent individuals. Furthermore, researchers examining the relationship between exercise dependence and personality have found inconsistent results. This maybe the result of the varying methods used by researchers to assess exercise dependence and personality. AIM OF THE STUDY: The purpose of this study was to examine the relationship between exercise dependence and personality, and that determine whether there is an addictive personality type. Participants were 484 university students (M=21.24, SD=3.03), and 322 sport leisure participants (M=30.08, Sd=13.58) who completed multidimensional assessments of exercise dependence and personality. INSTRUMENTS: to assess exercise dependence, the EDS-R (French version, Kern, L, 2007, Validation de l'adaptation française de l'échelle de dépendance à l'exercice physique : l'EDS-R Pratiques Psychologiques, 13, 4, 425-441) was undertaken. This scale is based on the DSM_IV criteria for substance dependence which are: withdrawal effects, intention effects, lack of control, time, reductions in other activities, continuance. The D5D was chosen to assess the big five personality dimensions (Rolland, J.-P., & Mogenet, J.-L. (1994). Manuel du système d5d. Paris: ECPA.). These dimensions are: Extraversion, Emotional Stability, Agreeableness, Conscientiousness, and Openness to Experience. To examine the predictive relationship of personality for exercise dependence symptoms, a series of multiple regressions was carried out. RESULTS: Results show that, according to the status of the people under scrutiny, it is either openness to experience and emotional stability or openness to experience and agreeableness which explain the greatest variance of exercise dependence. Then, the description of a personality type seemed very difficult to obtain. We feel it's important to know the personality type, but not sufficient; it is more pertinent to know the type of personality. Then, further research could examine the relationship between personality disorder and exercise dependence. In contrast with the literature, we did not find a relationship between exercise dependence and extraversion.

The differences of platelet response to snake venoms: a comparative study of children and adults.

Platelets play a vital role in the coagulation, yet the potential for differences in platelet function, between adults and children, remains underexplored. This is despite the age-related variation in haemostatic proteins, that is encompassed by the term Developmental Haemostasis. Hemotoxins found in the venoms of Australian snakes mimic human blood coagulation factors. The effects of Australian snake venoms on platelets, as well as the possible differential response in adults and children were subject of this study.

Effect of S-adenosylmethionine tablets on the reduction of age-related mental decline in dogs: a double-blinded, placebo-controlled trial.

Oral S-adenosylmethionine (SAMe) tosylate supplementation (Novifit tablets, Virbac) was evaluated as a dietary aid for the management of age-related mental impairment in dogs. Thirty-six dogs older than 8 years that had displayed signs of cognitive dysfunction for at least 1 month were selected for the study. The dogs were administered 18 mg/kg SAMe tosylate (n=17) or identical placebo tablets (n=19) for 2 months. Concurrent behavioral treatment was forbidden. A 14-item standardized questionnaire evaluated behavior and locomotion difficulties. Compared with the placebo group, SAMe-treated dogs showed greater improvement in activity (41.7% versus 2.6% after 4 weeks, P<.0003; 57.1% versus 9.0% after 8 weeks, P<.003) and awareness (33.3% versus 17.9% after 4 weeks, P<.05; 59.5% versus 21.4% after 8 weeks, P<.01). The aggregate mental impairment score was reduced by more than 50% in 41.2% and 15.8% of dogs treated with SAMe and placebo, respectively, at week 8. SAMe tosylate tablets proved safe and effective in improving signs of age-related mental decline in dogs.

Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study.

INTRODUCTION: Previous studies have found inconsistent relationships of alcohol consumption with risk of hip fracture, and the importance of bone mineral density and risk of falls in mediating such a relationship has not been determined. METHODS: As part of the Cardiovascular Health Study, a population-based cohort study of adults aged 65 years and older from four U.S. communities, 5,865 participants reported their use of beer, wine, and liquor yearly. We identified cases of hip fracture unrelated to malignancy or motor vehicle accidents using hospitalization discharge diagnoses. A subgroup of 1,567 participants in two communities underwent dual-energy x-ray absorptiometry scans to assess bone mineral density. RESULTS: A total of 412 cases of hip fracture occurred during an average of 12 years of follow-up. There was a significant U-shaped relationship between alcohol intake and risk of hip fracture (p quadratic 0.02). Compared with long-term abstainers, the adjusted hazard ratios for hip fracture were 0.78 (95% confidence interval [CI], 0.61-1.00) among consumers of up to 14 drinks per week and 1.18 (95% CI, 0.77-1.81) among consumers of 14 or more drinks per week. Alcohol intake was associated with bone mineral density of the total hip and femoral neck in a stepwise manner, with approximately 5% (95% CI, 1%-9%) higher bone density among consumers of 14 or more drinks per week than among abstainers. These relationships were all similar among men and women. CONCLUSIONS: Among older adults, moderate alcohol consumption has a U-shaped relationship with risk of hip fracture, but a graded positive relationship with bone mineral density at the hip.

Evaluating selenium poisoning.

Selenium poisoning in humans is reviewed from the perspective of the clinical laboratory. While evaluation of selenium poisoning is straightforward when the analytic results are markedly elevated and the patient is acutely symptomatic, distinguishing toxic from non-toxic elevations is a more frequent issue and more challenging. A significant problem is that selenium is determined as its total concentration in spite of the fact that different chemical forms of selenium have different toxic potentials. In the published reports reviewed herein, serum selenium concentrations span the following ranges: 400-30,000 micro g/L associated with acute toxicity, 500-1400 micro g/L associated with chronic toxicity, and <1400 micro g/L free of toxicity; the category is determined by signs and symptoms in the patient. Most reports that describe acute selenium poisoning involve ingestion of inorganic compounds such as selenious acid, found in gun-bluing agents, and fatalities that occur within the first day are associated with postmortem blood selenium levels >1400 micro g/L. Tissue selenium levels show a complex pattern and significant elevations in organs such as kidney are not always indicative of toxicity. As with many trace elements, measuring selenium concentrations in body fluids and tissues tends to be easier than understanding what the results mean.

Interpreting hair mercury levels in individual patients.

Evaluation of mercury exposure in an individual patient ideally includes the presenting history, physical examination, consideration of the differential diagnosis, and mercury analysis of blood and urine specimens. Analysis of mercury in hair specimens may supply useful supplemental information about exposure to organic compounds such as methylmercury, particularly to help reconstruct the pattern of prior exposure. The most appropriate specimen is generally terminal-type hair from the occipital-neck junction, clamped to maintain strand alignment, and oriented to the scalp. Hair from the initial 0.5 cm adjacent to the scalp represents on average 1-3 wk before collection, and consideration of the time frame represented by the specimen is an important part of the evaluation. Literature reports describe hair mercury levels as high as 2400 microg/g. Hair mercury level is usually <1 microg/g in individuals who do not eat fish but may be >30 microg/g in those who frequently consume fish with high mercury content. Hair mercury level is often not correlated with blood mercury concentration or symptoms of mercury toxicity, and reports of hair contamination by exogenous mercury are not uncommon. Hair mercury level is notoriously prone to misinterpretation and should be used with an understanding of its limitations.

Interpreting mercury in blood and urine of individual patients.

The effects of mercury exposure are determined by: (a) chemical form, (b) route of exposure, (c) dose, and (d) patient factors. Patient factors include age, genetics, environmental aspects, and nutritional status, and are responsible for different individual responses to similar doses. When blood and urine are collected to evaluate exposure, the results are influenced by (a) specimen collection, (b) analysis, and (c) the time elapsed from exposure. Interpretation is influenced by the patient's symptoms and is facilitated by comparison to published reports. The ranges reported in the literature are broad, with elevations as high as 16,000 microg/L in blood and 11,000 microg/L in urine. Interpretation is relatively straightforward when the results are massively elevated, but becomes increasingly difficult as concentrations approach the population norms (blood and urine mercury < 10-20 microg/L). Interpretation can be aided by biological markers (eg, urine porphyrins, beta2-microglobulin, and N-acetyl-beta-D-glucosaminidase).

Analysis of the estrogen regulation of the zebrafish estrogen receptor (ER) reveals distinct effects of ERalpha, ERbeta1 and ERbeta2.

We have previously cloned and characterized three estrogen receptors (ER) in the zebrafish (zfERalpha, zfERbeta1 and zfERbeta2). We have also shown that they are functional in vitro and exhibit a distinct expression pattern, although partially overlapping, in the brain of zebrafish. In this paper, we have shown that the hepatic expression of these zfER genes responds differently to estradiol (E2). In fact, a 48-h direct exposure of zebrafish to E2 resulted in a strong stimulation of zfERalpha gene expression while zfERbeta1 gene expression was markedly reduced and zfERbeta2 remained virtually unchanged. To establish the potential implication of each zfER in the E2 upregulation of the zfERalpha gene, the promoter region of this gene was isolated and characterized. Transfection experiments with promoter-luciferase reporter constructs together with different zfER expression vectors were carried out in different cell contexts. The data showed that in vivo E2 upregulation of the zfERalpha gene requires ERalpha itself and a conserved transcription unit sequence including at least an imperfect estrogen-responsive element (ERE) and an AP-1/ERE half site at the proximal transcription initiation site. Interestingly, although in the presence of E2 zfERalpha was the most potent at inducing the expression of its own gene, the effect of E2 mediated by zfERbeta2 represented 50% of the zfERalpha activity. In contrast, zfERbeta1 was unable to upregulate the zfERalpha gene whereas this receptor form was able to tightly bind E2 and activate a reporter plasmid containing a consensus ERE. Altogether, these results indicated that the two ERbeta forms recently characterized in teleost fish could have partially distinct and not redundant functions.