Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis.

AIMS: To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms. METHODS: We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission. RESULTS: A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21-0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24-0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26-0.34) vs. 18 % (95 % Cl 0.14-0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13-0.33). CONCLUSIONS: Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.

Toxicological transcriptome of human airway constructs after exposure to indoor air particulate matter: In search of relevant pathways of moisture damage-associated health effects.

BACKGROUND: Multiple health effects are associated with moisture damage in buildings. Studies explaining these associations and cell-level mechanisms behind the observed health effects are urgently called for. OBJECTIVES: We focused on characterizing gene expression in human airway epithelium after exposure to indoor air particulate matter (PM) sampled from houses with and without moisture damage, alongside determination of general toxicological markers. METHODS: We performed detailed technical building inspections in 25 residential houses and categorized them based on the detection of moisture damages and the probability of occupant exposure. PM sampling was complemented by microbiological and volatile organic compound assessment. We exposed human airway constructs to three dilutions (1:16, 1:8, 1:4) of collected PM from moisture-damaged (index) and non-moisture-damaged (reference) houses and imaged selected constructs with electron microscopy. We analyzed general toxicological markers and the RNA of exposed constructs was sequenced targeting genes associated with toxicological pathways. We did groupwise comparisons between index and reference houses and pairwise comparisons in matched index/reference houses. RESULTS: In groupwise comparison, gene Cytochrome P450 Family 1 Subfamily A Member 1 (CYP1A1) was statistically significantly over-expressed in index houses at all dilutions of collected PM and Nuclear Factor Kappa B Subunit 1 (NFKB1) at dilution 1:4 of collected PM. In pairwise index/reference house comparison, several genes related to multiple toxicological pathways were activated, largest expression differences seen for CYP1A1. However, none of the genes was consistently expressed in all the matched pairs, and general toxicological markers did not differentiate index and reference houses. DISCUSSION: The exposure to PM from index houses activated toxicology -related genes in airway constructs. Differential expression was not consistent among all the index/reference pairs, possibly due to compositional differences of bioactive particles. Our study highlights CYP1A1 and NFKB1 as potential targets in moisture damage -associated cellular responses.

Microbial exposures in moisture-damaged schools and associations with respiratory symptoms in students: A multi-country environmental exposure study.

Moisture-damaged buildings are associated with respiratory symptoms and underlying diseases among building occupants, but the causative agent(s) remain a mystery. We first identified specific fungal and bacterial taxa in classrooms with moisture damage in Finnish and Dutch primary schools. We then investigated associations of the identified moisture damage indicators with respiratory symptoms in more than 2700 students. Finally, we explored whether exposure to specific taxa within the indoor microbiota may explain the association between moisture damage and respiratory health. Schools were assessed for moisture damage through detailed inspections, and the microbial composition of settled dust in electrostatic dustfall collectors was determined using marker-gene analysis. In Finland, there were several positive associations between particular microbial indicators (diversity, richness, individual taxa) and a respiratory symptom score, while in the Netherlands, the associations tended to be mostly inverse and statistically non-significant. In Finland, abundance of the Sphingomonas bacterial genus and endotoxin levels partially explained the associations between moisture damage and symptom score. A few microbial taxa explained part of the associations with health, but overall, the observed associations between damage-associated individual taxa and respiratory health were limited.

Indoor bacteria and asthma in adults: a multicentre case-control study within ECRHS II.

Both protective and adverse effects of indoor microbial exposure on asthma have been reported, but mostly in children. To date, no study in adults has used non-targeted methods for detection of indoor bacteria followed by quantitative confirmation.A cross-sectional study of 198 asthmatic and 199 controls was conducted within the European Community Respiratory Health Survey (ECRHS) II. DNA was extracted from mattress dust for bacterial analysis using denaturing gradient gel electrophoresis (DGGE). Selected bands were sequenced and associations with asthma confirmed with four quantitative PCR (qPCR) assays.15 out of 37 bands detected with DGGE, which had at least a suggestive association (p<0.25) with asthma, were sequenced. Of the four targeted qPCRs, Clostridium cluster XI confirmed the protective association with asthma. The association was dose dependent (aOR 0.43 (95% CI 0.22-0.84) for the fourth versus first quartile, p for trend 0.009) and independent of other microbial markers. Few significant associations were observed for the three other qPCRs used.In this large international study, the level of Clostridium cluster XI was independently associated with a lower risk of prevalent asthma. Results suggest the importance of environmental bacteria also in adult asthma, but need to be confirmed in future studies.

Quantitative assessment of microbes from samples of indoor air and dust.

Different types of house dust samples are widely used as surrogates of airborne inhalation exposure in studies assessing health effects of indoor microbes. Here we studied-in a quantitative assessment-the representativeness of different house dust samples of indoor air (IA) and investigated seasonality and reproducibility of indoor samples. Microbial exposure was measured five times over 1 year in four rural and five urban Finnish homes. Six sampling methods were used: button inhalable aerosol sampler (actively collected personal and indoor air sampling), settled dust, floor dust, mattress dust and vacuum cleaner dust bag dust; the latter three referred to herein as "reservoir dust samples". Using quantitative PCR, we quantified the fungal species Cladosporium herbarum, the fungal group Penicillium/Aspergillus/Paecilomyces variotii, total fungal DNA, and Gram-positive and Gram-negative bacteria. We observed significant differences in microbial levels between rural and urban homes, most pronounced for personal air samples. Fungal species and groups but not total fungal DNA in indoor air correlated moderately to well with reservoir dust and with personal air samples. For bacterial groups, the correlations between air and dust were generally lower. Samples of indoor air and settled dust reflected similarly seasonal variation in microbial levels and were also similar compositionally, as assessed by ratios of qPCR markers. In general, determinations from mattress dust and other reservoir samples were better reproducible in repeated assessments over time than from indoor air or settled dust. This study indicates that settled dust reflects the microbial composition of indoor air and responds similarly to environmental determinants. Reservoir dusts tend to predict better microbial levels in indoor air and are more reproducible. Sampling strategies in indoor studies need to be developed based on the study questions and may need to rely on more than one type of sample.

Toxicity of airborne dust as an indicator of moisture problems in school buildings.

Moisture-damaged indoor environments are thought to increase the toxicity of indoor air particulate matter (PM), indicating that a toxicological assay could be used as a method for recognizing buildings with indoor air problems. We aimed to test if our approach of analyzing the toxicity of actively collected indoor air PM in vitro differentiates moisture-damaged from non-damaged school buildings. We collected active air samples with NIOSH Bioaerosol Cyclone Samplers from moisture-damaged (index) and non-damaged (reference) school buildings (4 + 4). The teachers and pupils of the schools were administered a symptom questionnaire. Five samples of two size fractions [Stage 1 (>1.9 µm) and Stage 2 (1-1.9 µm)] were collected from each school. Mouse RAW264.7 macrophages were exposed to the collected PM for 24 h and subsequently analyzed for changes in cell metabolic activity, production of nitric oxide (NO), tumor necrosis factor (TNF)-α and interleukin (IL)-6. The teachers working in the moisture-damaged schools reported respiratory symptoms such as cough (p = 0.01) and shortness of breath (p = 0.01) more often than teachers from reference schools. Toxicity of the PM sample as such did not differentiate index from reference building,s but the toxicity adjusted for the amount of the particles tended to be higher in moisture-damaged schools. Further development of the method will require identification of other confounding factors in addition to the necessity to adjust for differences in particle counts between samples.

Evaluation of sampling methods for toxicological testing of indoor air particulate matter.

There is a need for toxicity tests capable of recognizing indoor environments with compromised air quality, especially in the context of moisture damage. One of the key issues is sampling, which should both provide meaningful material for analyses and fulfill requirements imposed by practitioners using toxicity tests for health risk assessment. We aimed to evaluate different existing methods of sampling indoor particulate matter (PM) to develop a suitable sampling strategy for a toxicological assay. During three sampling campaigns in moisture-damaged and non-damaged school buildings, we evaluated one passive and three active sampling methods: the Settled Dust Box (SDB), the Button Aerosol Sampler, the Harvard Impactor and the National Institute for Occupational Safety and Health (NIOSH) Bioaerosol Cyclone Sampler. Mouse RAW264.7 macrophages were exposed to particle suspensions and cell metabolic activity (CMA), production of nitric oxide (NO) and tumor necrosis factor (TNFα) were determined after 24 h of exposure. The repeatability of the toxicological analyses was very good for all tested sampler types. Variability within the schools was found to be high especially between different classrooms in the moisture-damaged school. Passively collected settled dust and PM collected actively with the NIOSH Sampler (Stage 1) caused a clear response in exposed cells. The results suggested the higher relative immunotoxicological activity of dust from the moisture-damaged school. The NIOSH Sampler is a promising candidate for the collection of size-fractionated PM to be used in toxicity testing. The applicability of such sampling strategy in grading moisture damage severity in buildings needs to be developed further in a larger cohort of buildings.

Dampness, bacterial and fungal components in dust in primary schools and respiratory health in schoolchildren across Europe.

BACKGROUND: Respiratory health effects of damp housing are well recognised, but less is known about the effect of dampness and water damage in schools. The HITEA study previously reported a higher prevalence of respiratory symptoms in pupils from moisture damaged schools, but the role of specific microbial exposures remained unclear. OBJECTIVES: To study associations between school dampness, levels of fungal and bacterial markers, respiratory symptoms and lung function in children. METHODS: Primary schools in Spain, the Netherlands and Finland were selected on the basis of the observed presence (n=15) or absence (n=10) of moisture, dampness and/or mould. Settled dust was repeatedly sampled in 232 classrooms and levels of 14 different microbial markers and groups of microbes were determined. Parental reports of respiratory symptoms were available from 3843 children aged 6-12 years, of whom 2736 provided acceptable forced spirometry testing. Country-specific associations between exposure and respiratory health were evaluated by multilevel mixed-effects logistic and linear regression models and combined using random-effects meta-analysis. RESULTS: The prevalence of respiratory symptoms was higher in moisture damaged schools, being more pronounced in Finnish pupils. Effects on lung function were not apparent. Levels of microbial markers were generally higher in moisture damaged schools, varied by season and were lower in Finnish schools. Wheeze tended to be inversely associated with microbial levels. All other respiratory symptoms were not consistently associated with microbial marker levels. CONCLUSIONS: Health effects of moisture and microbial exposures may vary between countries, but this requires further study.

Information sources used by women in Finland who use hormonal contraceptives.

OBJECTIVE: The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women's attitudes and perceptions in 2001 and 2007. SETTING: The questionnaires were distributed from university pharmacies in 12 large cities across Finland. METHOD: The data were collected with two questionnaire surveys among women who used hormonal contraceptives in 2001 and 2007. In the 2001 survey the response rate was 53% (n = 264) and in the 2007 survey 55% (n = 436). RESULTS: The number of respondents who considered professional information sources the most important information sources was markedly bigger in 2007 than in 2001 (P = 0.005). The most common source of information concerning the benefits of hormonal contraceptives was a physician (2001: 43%, 2007: 53%). The most common source of information concerning the risks of hormonal contraceptives was friends and relatives (43%) in 2001 and physician in 2007 (35%). Only a few percent of the respondents considered a pharmacy the most important information source both the 2001 and 2007 surveys. CONCLUSION: The importance of health care professionals as sources of information concerning hormonal contraceptives has increased. However, role of pharmacists as information source was surprisingly small. Women who use hormonal contraceptives need more information from professional sources to alleviate possible fears associated with use.

Hormonal contraceptive users' self-reported benefits, adverse reactions, and fears in 2001 and 2007.

BACKGROUND: Hormonal contraceptives (HCs) are the most common contraceptive method in western countries. The fears and problems experienced by users of HCs can have an impact on their quality of life, and lead to abortions and unwanted pregnancies. OBJECTIVE: To investigate whether experiences and perceptions of HC users in Finland have changed from 2001 to 2007. METHODS: Data were collected using questionnaire surveys of women using HCs in 2001 and 2007. In Finland, HCs are available with a physician's prescription, and are only supplied in community and university pharmacies. University pharmacies in 12 large cities across Finland were selected to distribute the questionnaires. The response rate was 53% (n = 264) in 2001 and 55% (n = 436) in 2007. The average age of the respondents was 26 years in both surveys. The surveys measured self-reported benefits and adverse reactions, preconceptions, fears, knowledge, and opinions. RESULTS: The number of HC users reporting fears increased from 2001 to 2007 (p = 0.002), whereas the number of HC users reporting adverse reactions decreased (p = 0.013). In both surveys, the most common fear was infertility after HC use (17% vs 26% for 2001 and 2007, respectively). In both surveys, the most common benefits were efficacy and regular menstrual cycle, and the most common adverse reactions were mood swings, lowered libido, and weight gain. CONCLUSIONS: Our study suggests that, although women using HCs were convinced about their benefits, and the number of users reporting adverse reactions had decreased from 2001 to 2007, the number of users reporting fears had increased. Healthcare professionals need to provide counseling in order to alleviate women's fears and to correct false perceptions of HCs.