Concurrence of inflammatory bowel disease with multiple sclerosis or Hodgkin lymphoma.

BACKGROUND AND AIMS: Epidemiologic evidence suggests that Hodgkin lymphoma (HL) and multiple sclerosis (MS) share a common set of risk factors with Crohn's disease (CD) and ulcerative colitis (UC). It was hypothesized that such shared risk factors would lead to clustering of the 4 diagnoses in the same patients. METHODS: All patients with HL, MS, CD, or UC were identified in the veterans population from 2016-2020 and the Medicare population from 1986 to 1989. In a case-control study, the observed concurrences amongst these 4 diagnoses were compared with their expected frequencies in the overall veterans or Medicare population during the same time period by calculating odds ratios (OR) with their 95% confidence intervals (CI). RESULTS: The study included 6 million veterans and 35 million Medicare patients. In the veterans population, inflammatory bowel disease (IBD) was significantly associated with a concurrent diagnosis of HL (OR: 1.40, 95% CI: 1.15-1.71) and MS (1.34, 1.19-1.50). In the Medicare population, IBD was also significantly associated with HL (1.84, 1.07-3.17) and MS (2.31, 1.59-3.35). Similar trends were observed in CD or UC when analyzed separately in both datasets. In the veterans population, adjustment for the potentially confounding influence of ethnicity, sex, and age left all OR values largely unaffected and statistically significant. CONCLUSION: The concurrence of IBD with HL or MS could reflect on a common pathway in the etiology or pathogenesis of these 4 diseases.

Farm to elementary school programming increases access to fruits and vegetables and increases their consumption among those with low intake.

OBJECTIVE: To assess the effectiveness of Wisconsin Farm to School (F2S) programs in increasing students' fruit and vegetable (FV) intake. DESIGN: Quasi-experimental baseline and follow-up assessments: knowledge and attitudes survey, food frequency questionnaire (FFQ), and lunch tray photo observation. SETTING: Wisconsin elementary schools: 1 urban and 8 rural. PARTICIPANTS: Children, grades 3-5 (n = 1,117; 53% male, 19% non-Caucasian). INTERVENTION(S): Farm to School programming ranging from Harvest of the Month alone to comprehensive, including school garden, locally sourced produce in school meals, and classroom lessons. MAIN OUTCOME MEASURES: Knowledge, attitudes, exposure, liking, willingness; FFQ-derived (total), and photo-derived school lunch FV intake. ANALYSIS: t tests and mixed modeling to assess baseline differences and academic-year change. RESULTS: Higher willingness to try FV (+1%; P < .001) and knowledge of nutrition/agriculture (+1%; P < .001) (n = 888), and lunch FV availability (+6% to 17%; P ≤ .001) (n = 4,451 trays), both with increasing prior F2S program exposure and across the year. There was no effect on overall dietary patterns (FFQ; n = 305) but FV consumption increased among those with the lowest intakes (FFQ, baseline very low fruit intake, +135%, P < .001; photos: percentage of trays with no FV consumption for continuing programs decreased 3% to 10%, P ≤ .05). CONCLUSIONS AND IMPLICATIONS: Farm to School programming improved mediators of FV consumption and decreased the proportion of children with unfavorable FV behaviors at school lunch. Longer-term data are needed to further assess F2S programs.

Preliminary findings from an evaluation of the USDA Fresh Fruit and Vegetable Program in Wisconsin schools.

INTRODUCTION: In 2002, the US Department of Agriculture (USDA) created the Fresh Fruit and Vegetable Program (FFVP) to improve nutrition and help reduce the prevalence of childhood overweight and obesity. The FFVP provides funding for students from selected schools in each participating state to receive a free fresh fruit or vegetable snack daily for an academic year. In November 2005, Wisconsin was added to this program. In this study, we evaluate whether the Wisconsin FFVP resulted in positive changes in children's attitudes and behavior related to eating fruits and vegetables. METHODS: In 2006, 25 Wisconsin schools were selected by the Wisconsin Department of Public Instruction for FFVP participation. Study measures included a pre-test and post-test survey given to 4th, 7th, and 9th graders in the intervention and controls schools. Post-test data from all 25 intervention schools were not yet available for analysis. Our sample, therefore, consisted of 1127 participants: 784 students in 10 intervention schools and 343 students in 10 control schools. Independent samples t tests and multivariate probit regression analyses were used to examine attitudinal and behavioral program effects. RESULTS: Compared to controls, intervention students reported an increased willingness to try new fruits (24.8% versus 12.8%, P<0.01) and vegetables (25.1% versus 18.4%, P=0.01) at school. CONCLUSIONS: Findings indicate positive changes in attitudes and behavior among children participating in the Wisconsin FFVP.

Calories from newspaper dessert recipes are associated with community obesity rates.

INTRODUCTION: The purpose of this study was to determine if the nutrient content of recipes available in newspapers is related to community obesity rates. METHODS: All recipes published in the major newspapers for 3 cities with populations of 400,000 or more from 4 geographic areas within the United States the last week of August 2000 were accessed. The recipes were grouped as entree, dessert, accompaniment, snack, appetizer, or beverage, and the nutrient content per serving for each recipe was calculated. The nutrient content was correlated with data on self-reported obesity rates in these same cities. RESULTS: Total mean kcalories per dessert serving ranged from 180.0 to 599.0 (mean=315.5) and total mean kcalories per entree serving ranged from 265.4 to 567.3 (mean=436.7). Obesity rates for the 12 cities ranged from 16.8% to 28.2% (mean=21.1%). The average total caloric content of dessert recipes was significantly associated with the percent obese in the metropolitan cities (correlation=0.76, P-value=0.011). The total caloric content of entrée recipes was not significantly associated with the obesity rate (P=0.59). DISCUSSION: While these data cannot be interpreted as causal, they are intriguing and suggest that newspapers may play a greater role in promoting or preventing obesity than previously recognized.

Use of an electronic medical record for the identification of research subjects with diabetes mellitus.

Diabetes mellitus is a rapidly increasing and costly public health problem. Large studies are needed to understand the complex gene-environment interactions that lead to diabetes and its complications. The Marshfield Clinic Personalized Medicine Research Project (PMRP) represents one of the largest population-based DNA biobanks in the United States. As part of an effort to begin phenotyping common diseases within the PMRP, we now report on the construction of a diabetes case-finding algorithm using electronic medical record data from adult subjects aged > or =50 years living in one of the target PMRP ZIP codes. Based upon diabetic diagnostic codes alone, we observed a false positive case rate ranging from 3.0% (in subjects with the highest glycosylated hemoglobin values) to 44.4% (in subjects with the lowest glycosylated hemoglobin values). We therefore developed an improved case finding algorithm that utilizes diabetic diagnostic codes in combination with clinical laboratory data and medication history. This algorithm yielded an estimated prevalence of 24.2% for diabetes mellitus in adult subjects aged > or =50 years.

Six year incidence and progression of diabetic retinopathy: results from the Mauritius diabetes complication study.

AIMS: To determine the incidence, progression and risk factors for diabetic retinopathy in the multiethnic population of Mauritius. METHOD: A longitudinal, population-based study was conducted in Mauritius, during 1987, 1992 and 1998. Participants identified through the study as having diabetes (both known and newly diagnosed, by self-report and oral glucose tolerance test) and one in four participants with impaired glucose tolerance (IGT) underwent complications screening in 1992 and 1998. Retinal photographs were taken using a TRC-50VT retinal camera in three fields of the right eye (centred on the optic disc; macula (temporal to the optic disc); and nasal to disc). Photographs were graded according to a simplified version of the Wisconsin grading system. RESULTS: The 6-year incidence of diabetic retinopathy was 23.8% (sight-threatening in 0.4%). Among those with known diabetes mellitus (KDM) and free of retinopathy at baseline the incidence of non-proliferative diabetic retinopathy (NPDR) was 29.2% and proliferative diabetic retinopathy (PDR) was 1.0%. Among those with newly diagnosed diabetes mellitus (NDM) at baseline the incidence of NPDR was 19.1% (no incident cases of PDR were found). Independent risk factors for retinopathy using the baseline population characteristics were duration of diabetes and fasting plasma glucose. CONCLUSIONS: This is one of the few recent population-based studies of diabetic retinopathy undertaken in a developing nation. The incidence of retinopathy in Mauritius was high among those with NDM at baseline, with one in five developing retinopathy over 6 years. These results support the concept that screening for diabetes is important.

The Marshfield Youth Health Study: design, objectives and cohort characteristics.

PROBLEM: The Marshfield Youth (MY) Health Study was designed to identify parental and infant factors associated with childhood and adolescent overweight. METHODS: The study examined 867 children (age 5-17 years) from the Marshfield Public Schools. Heights and weights were measured by standard methods. Age- and gender-specific body mass index (BMI) percentiles and z-scores were determined. Definitions of overweight from the Centers for Disease Control and Prevention were applied. Family characteristics were self-reported by questionnaire and included parents' BMI, employment, education, smoking, physical activity; and child's daycare attendance, and television/computer use. Maternal and child medical records were reviewed. RESULTS: The MY Health cohort included 361 families. The mean +/- SD age of the children was 12.1 +/- 3.0 yrs; 511 (59%) were born in Marshfield, Wis. Of the children studied, 70% had a healthy body weight (BMI >5th and <85th percentile); 14.4% were at risk of overweight (BMI > or = 85th and <95th percentile) and 13% were overweight (BMI > or = 95th percentile). There were no differences in gender or weight status between the study cohort and all Marshfield school children (n=2782). CONCLUSIONS: Children in the MY Health Study are representative of all school-age children in Marshfield. This cohort will be studied to identify factors associated with overweight among children.

Prevalence and associations of epiretinal membranes in the visual impairment project.

PURPOSE: To determine the prevalence and factors associated with epiretinal membranes in a random sample of the population aged 40 years and older in Victoria, Australia. DESIGN: Population-based cross-sectional study. METHODS: Detailed eye examinations, including retinal photographs, were conducted in 1992 and 1997 in 3271 people (83% of the eligible) in Melbourne and 1473 (92% of the eligible) in rural Victoria. Eyes present with either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) were classified as having epiretinal membranes. Eyes with both CMR and PMF present were classified as having PMF. Age-standardized prevalence rates and 95% confidence limits were calculated by the direct methods using Segi's world population. RESULTS: Epiretinal membranes were observed in 253 of 4313 participants (6.0%; 95% confidence interval [CI] 5.2 to 6.7), bilaterally in 19%. Prevalence increased significantly by age group (0.5% for 40 to 49 years, 2.6% for 50 to 59 years, 9.4% for 60 to 69 years, 15.1% for 70 to 79 years, and 11.3% for 80 years and older). Prevalence was similar in males and females after adjusting for age. The overall age- and gender-standardized prevalence of CMR was 4.8% (95% CI 4.0 to 5.6) and PMF was 1.7% (95% CI 1.2 to 2.3). A decrease in visual acuity (<6/6) was significantly associated with idiopathic PMF (odds ratio [OR] 1.9; 95% CI 1.0 to 3.6) and CMR (OR 1.5; 95% CI 1.1 to 2.0) after adjusting for age. CONCLUSIONS: The prevalence of epiretinal membranes was similar to that reported in other population-based studies. Population shifts in the age distribution to older ages could lead to an increase in mild visual impairment caused by epiretinal membranes.

Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes.

OBJECTIVE: The aim of this work was to study the frequency of examining for diabetic eye and foot complications in an Australian population and to study factors associated with regular screening. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. Participants identified as having previously diagnosed diabetes (n=475) were invited to participate in the complications study. Measures included foot examination, retinopathy photography, and self-report use of health care services. RESULTS: Seventy-seven percent of participants reported having an eye examination within the previous 2 years, and 50% reported having their feet examined by a health professional in the previous year. Type of diabetes treatment (odds ratio 1.46, 95% CI 0.85-2.50 for tablets versus diet alone and 4.17, 1.71-10.17 for insulin or insulin and tablets versus diet alone) and visiting a diabetes nurse educator in the previous 12 months (2.14, 1.18-3.87) were independent predictors of having had an eye examination. Duration of diabetes (1.33, 1.06-1.67 per year) and visiting a diabetes nurse educator in the previous 12 months (1.89, 1.20-2.95) were independent predictors of a foot examination. CONCLUSIONS: This study has shown that retinopathy screening is performed more frequently than foot screening in Australia. This may be due to the implementation of eye screening programs and awareness campaigns. Foot screening appears to be poor, with less than one-half of the population reporting a regular examination for foot complications. In Australia, diabetes nurse educators play a key role in promoting screening for diabetes complications.

In vivo effects of fluoroquinolones on rabbit corneas.

PURPOSE: The use of topical fluoroquinolones to treat microbial keratitis is associated with an increased incidence of corneal perforation compared to other standard treatments. This study examined the effects of topical fluoro-quinolones on corneal collagen and keratocytes in intact rabbit corneas and corneas with an epithelial defect. METHODS: Studies consisted of one group of intact corneas and one group of corneas where a 6-mm epithelial defect was created with a surgical scrape. Within each group, eyes were randomly assigned to one of four topical medications (0.3% ciprofloxacin, 0.3% ofloxacin, fortified antibiotics (1.36% tobramycin, 5% cefrazolin) or Tears Naturale (Alcon Laboratories, Frenchs Forest, NSW, Australia). Two drops were instilled hourly for 48 h and then 2-hourly for an additional 48 h. At 96 h the corneas were removed and processed for light microscopy, immunohistology for collagen IV, V and VI, and apoptosis staining. RESULTS: In intact rabbit corneas there was no demonstrable difference between treatment groups. In corneas with an epithelial defect, both fluoroquinolones delayed epithelial healing when compared to fortified antibiotics or tears. Keratocyte loss was seen in all groups and was greatest in the ofloxacin group. Median stromal thickness with keratocyte loss were: ofloxacin 30%; ciprofloxacin 10%; fortified antibiotics 7.5%; and tears 15% (ofloxacin vs tears, Mann-Whitney = 16.0, P = 0.09). Keratocyte loss did not correlate with the amount of demonstrable apoptosis. Collagens IV, V and VI showed no differences between treatments. CONCLUSIONS: These results suggest that ofloxacin is potentially cytotoxic to corneal keratocytes. Such an effect could lead to the observed increased incidence of corneal perforation in microbial keratitis.

Differences in preventive screening rates in Wisconsin farm and non-farm resident women.

PURPOSE: To determine the proportion of rural women who met screening recommendations for Pap smears, mammograms, blood cholesterol, and blood pressure measurements. METHODS: Women aged 25-75 were recruited for a population-based study of chronic diseases in rural residents. In addition to a self-administered health questionnaire and a brief examination, the most recent Pap smear, mammogram, blood pressure, and blood cholesterol measurements were documented from electronic medical records. RESULTS: The study population was comprised of 675 farm and 825 non-farm residents. Fifty-five women (3.7%) had no documentation in their medical records of having ever had a Pap smear, and 19.3% (95% CL 16.9, 21.7) of women aged 40 and older had no documentation of a mammogram. Ninety-two percent of the women (95% CL = 90.2, 93.7) had a blood pressure measurement in the previous 2 years and 74.9% (95% CL = 72.2, 77.6) had a blood cholesterol measurement in the previous 5 years. Age was inversely related to Pap smears and positively correlated with mammograms, blood pressure, and blood cholesterol measurements. Farm residents were significantly less likely to have Pap smears or blood pressure measurements at recommended time intervals. DISCUSSION: To increase the proportion of rural women in compliance with preventive screening recommendations, public health education efforts should target farm residents and younger women.

Five-year incidence of diabetic retinopathy in the Melbourne Visual Impairment Project.

BACKGROUND: The purpose of the present paper was to describe the 5-year incidence and progression of diabetic retinopathy in the Melbourne Visual Impairment Project (VIP) cohort. METHODS: Baseline examinations were conducted from 1992 to 1994 and follow-up data were collected 5 years later. Data collected during the baseline and follow-up studies included medical history (including previous diagnosis of diabetes mellitus) and dilated fundus examination. Two 30 degrees stereoscopic fundus photographs were taken with a Topcon TRC fundus camera, one centred on the optic disc and the other centred on the fovea. Photographs from participants who reported having diabetes were graded for diabetic retinopathy based on an extension of the Modified Airlie House Classification. Grouping of participant data into retinopathy grades was based on the results of the worst eye. RESULTS: The follow-up survey included 82% (n = 121) of those with diabetes at baseline. Prevalence of any retinopathy was 35.7% and macular oedema was 13% at follow up. Diabetic retinopathy was newly detected in 8/73 (5-year incidence = 11.0%, 95% confidence interval (CI) = 3.8-18.1). Disease progression was seen in 9/31 participants (29.0%, 95%CI = 14.9-47.8) who had diabetic retinopathy at baseline. The 5-year incidence of proliferative diabetic retinopathy in people without proliferative diabetic retinopathy at baseline was 2.9% (3/104, 95%CI = 0-6.4). The 5-year incidence of macular oedema in people who did not have macular oedema at baseline was 8.0% (8/100, 95%CI = 2.7-13.3). All people with proliferative diabetic retinopathy at baseline had received laser treatment by the follow-up survey. Twenty-four per cent of people without diabetic retinopathy reported never having had a dilated fundus examination (excluding the VIP examinations). CONCLUSION: The 5-year incidence of diabetic retinopathy was 11% in the Melbourne Visual Impairment Project. Most people with proliferative diabetic retinopathy or macular oedema are receiving treatment. However, many people with diabetes are not having regular dilated fundus examinations.

Mutations in the amino terminus of ANKH in two US families with calcium pyrophosphate dihydrate crystal deposition disease.

OBJECTIVE: To analyze ANKH in families with calcium pyrophosphate dihydrate crystal deposition disease (CPPD) for disease-causing mutations. METHODS: Two US families (one of British ancestry and the other of German/Swiss ancestry) with autosomal-dominant CPPD, whose disease phenotypes were found to be linked to chromosome 5p15.1 (locus symbol CCAL2), were screened by direct sequencing for mutations in ANKH, a gene in the CCAL2 candidate interval that has been shown to harbor mutations in other families with CPPD. Observed sequence variants were confirmed by antisense sequencing, and expression of the mutant allele was verified by reverse transcriptase-polymerase chain reaction amplification of messenger RNA followed by direct sequencing. RESULTS: The two US families displayed the same mutation at position 5 of the ANKH gene product (P5T). All affected members were heterozygous for the P-to-T variant, and the mutation was not seen in 204 control alleles. The two families displayed distinct disease haplotypes, suggesting that they were unrelated to each other. CONCLUSION: These observations represent the fourth and fifth families with heritable CPPD whose disease phenotypes are linked to the CCAL2 locus and who have missense mutations in the amino terminus of ANKH. This same position (P5) was the site of a missense mutation in an Argentine family of northern Italian ancestry; however, the sequence variant in that family generated a P5L mutation. The distinct disease haplotypes among the 3 families with P5 mutations suggest that the mutations arose independently and that the evolutionarily conserved P5 position of ANKH may represent a hot spot for mutation in families with autosomal-dominant CPPD.

Clinical outcomes following laser photocoagulation treatment for diabetic retinopathy at a large Australian ophthalmic hospital.

OBJECTIVE: To evaluate clinical outcomes of diabetic retinopathy laser treatment at a large Australian ophthalmic hospital. METHODS: A retrospective medical record review of all patients who had initial laser treatment for diabetic retinopathy at the Royal Victorian Eye and Ear Hospital from January 1997 to December 1998. RESULTS: The study included 322 eyes from 203 patients. The mean age was 65.8 years (range 18-89) and the mean follow up was 18 months (range 2-33). Focal photocoagulation treatment alone was performed in 238 eyes. Clinically significant macular oedema (CSME) resolved in 218 (91.6%) eyes. Vision was improved or maintained in 137 (57.6%) eyes. Moderate visual loss occurred in 49 (20.6%) eyes. Panretinal photocoagulation (PRP) was performed in 84 eyes, including 37 eyes with PRP alone and 47 eyes with PRP and focal together. Neovascularization regressed in 55 (65.5%) eyes. Vision was improved or maintained in 52 (61.9%) eyes. Moderate visual loss was observed in 20 (23.8%) eyes and severe visual loss was observed in 4 (4.8%) eyes. CONCLUSIONS: The clinical outcomes reported here are similar to those reported in other studies.

The prevalence of and factors associated with diabetic retinopathy in the Australian population.

OBJECTIVE: To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity and Lifestyle study (AusDiab) included 11,247 adults aged > or =25 years in 42 randomly selected areas of Australia. Retinopathy was assessed in participants identified as having diabetes (based on self-report and oral glucose tolerance test), impaired fasting glucose, and impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,177 participants. RESULTS: Overall, 15.3% of those with diabetes had retinopathy. The prevalence of retinopathy was 21.9% in those with known type 2 diabetes (KDM) and 6.2% in those newly diagnosed (NDM). The prevalence of proliferative diabetic retinopathy (PDR) was 2.1% in those with KDM. No cases of PDR were found in those with NDM. Untreated vision threatening retinopathy (presence of PDR or macular edema) was present in 1.2% (n = 4). Factors associated with retinopathy were duration of diabetes, HbA(1c), and systolic blood pressure. Using linear extrapolation of the prevalence of retinopathy with diabetes duration, the onset of diabetes in this population was approximately the time of diagnosis. CONCLUSIONS: This is one of the first national studies of diabetic retinopathy in a developed country. The prevalence of retinopathy was similar to that in other population-based studies. Vision threatening retinopathy was relatively rare; however, four untreated cases were identified. Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy.

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)--methods and response rates.

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) addresses the urgent need for data on diabetes prevalence, risk factors and associated conditions in Australia. Here we describe the methods used and the response rates obtained. AusDiab was a population-based cross-sectional survey of national diabetes mellitus prevalence and associated risk factors in people aged > or =25 years, conducted between May 1999 and December 2000 in the six states and the Northern Territory of Australia. The study involved an initial household interview, followed by a biomedical examination that included an oral glucose tolerance test (OGTT), standard anthropometric tests, blood pressure measurements and the administration of questionnaires. Of the 20347 eligible people (aged > or =25 years and resident at the address for > or =6 months) who completed a household interview, 11247 (55.3%) attended for the biomedical examination. Of those who completed the biomedical examination 55.1% were female. Comparisons with the 1998 Australian population estimates showed that younger age responders were under-represented at the biomedical examination, while the middle-aged and older age groups were over-represented. Weighting of the AusDiab data for age and gender have corrected for this bias. AusDiab, which is the largest national diabetes prevalence study undertaken in a developed nation to have used an OGTT, provides a valuable national resource for the study of the prevalence and possible causes of diabetes, as well as identifying possible risk factors that may lead to diabetes. Furthermore, it generates the baseline data for a prospective 5-year cohort study. The data will be important for national and regional public health and lifestyle education and health promotion programs.