Cone-beam CT versus Multidetector CT in Postoperative Cochlear Implant Imaging: Evaluation of Image Quality and Radiation Dose.

BACKGROUND AND PURPOSE: Cone-beam CT is being increasingly used in head and neck imaging. We compared cone-beam CT with multidetector CT to assess postoperative implant placement and delineate finer anatomic structures, image quality, and radiation dose used. MATERIALS AND METHODS: This retrospective multicenter study included 51 patients with cochlear implants and postoperative imaging via temporal bone cone-beam CT (n = 32 ears) or multidetector CT (n = 19 ears) between 2012 and 2017. We evaluated the visualization quality of single electrode contacts, the scalar position of the electrodes, cochlear walls, mastoid facial canal, metallic artifacts (using a 4-level visual score), and the ability to measure the insertion angle of the electrodes. The signal-to-noise ratio and radiation dose were also evaluated. RESULTS: Cone-beam CT was more sensitive for visualizing the scalar position of the electrodes (P = .046), cochlear outer wall (P = .001), single electrode contacts (P < .001), and osseous spiral lamina (P = .004) and had fewer metallic artifacts (P < .001). However, there were no significant differences between both methods in visualization of the modiolus (P = .37), cochlear inner wall (P > .99), and mastoid facial canal wall (P = .07) and the ability to measure the insertion angle of the electrodes (P > .99). The conebeam CT group had significantly lower dose-length product (P < .001), but multidetector CT showed a higher signal-to-noise ratio in both bone and air (P = .22 and P = .001). CONCLUSIONS: Cone-beam CT in patients with cochlear implants provides images with higher spatial resolution and fewer metallic artifacts than multidetector CT at a relatively lower radiation dose.

Information exposure and growth monitoring favour child nutrition in rural Indonesia.

BACKGROUND AND OBJECTIVES: Malnutrition is a health problem among under-five children in Indonesia. The mothers' knowledge on nutrition and health in addition to growth monitoring program are essential components that may influence nutritional status of children under-five. The objective was to observe the importance of maternal information exposure along with growth monitoring program to the nutritional status of children in rural areas. METHODS AND STUDY DESIGN: A cross sectional study of 233 randomly selected mothers of under-five children from different geographical rural settings in Indonesia were interviewed and observed as to their exposure to nutrition and health information, growth monitoring program and nutritional status of the children. RESULTS: The prevalence of underweight, stunting, and wasting was 50.5%, 18.0%, and 28.4%, respectively. The mean of height-for-age z score was similar across villages, however, the mean of weight-for-age (p=0.039) and weightfor- height (p=0.047) were significantly lower in Kenduren compared with Karangrejo village. The possession of a growth monitoring card in Kenduren was significantly lower compared with Karangrejo (p<0.001) or Buko villages (p<0.001). The prevalence of underweight (p=0.001) or stunting (p=0.021) was higher among children who did not possess a growth monitoring card. The prevalence of stunting was higher among children who did not routinely go to Posyandu (Integrated Health Post) in the last 3 months (p=0.018). CONCLUSION: Maternal exposure to nutrition and health information, along with growth monitoring programs, contribute to the prevalence of underweight and stunting among rural children who are under-five years old.

Propagação vegetativa de Aloysia triphylla (L'Hér. ) Britton em função da concentração de AIB e do comprimento das estacas / Vegetative propagation of Aloysia triphylla (L'Hér. ) Britton according to IBA and length of cuttings

A Aloysia triphylla (L'Hér.) Britton é uma planta medicinal de porte arbustivo com folhas aromáticas que possuem óleo essencial rico em citral. A crescente demanda da indústria farmacêutica e cosmética pelo óleo essencial de A. triphylla promoveram grande interesse sobre o cultivo dessa espécie. A estaquia é um dos principais métodos de propagação devido à dificuldade em obter sementes, e também pela vantagem dos descendentes serem iguais à planta-matriz. O objetivo do trabalho foi avaliar o efeito de diferentes concentrações de AIB e do comprimento das estacas no enraizamento de estacas de A. triphylla. O experimento foi conduzido em ambiente protegido no período de Novembro de 2010 a Janeiro de 2011. O delineamento experimental foi inteiramente casualizado em esquema fatorial onde os fatores foram cinco concentrações de ácido indol butírico (AIB) (mg L-1): 0, 250, 500, 1000 e 1500, e quatro comprimentos de estaca: 4, 6, 8 e 10 cm. As estacas tiveram a base imersa em solução de AIB e foram colocadas para enraizar em substrato comercial Mecplant®. As variáveis analisadas foram: comprimento do sistema radicular, percentagem de estacas enraizadas (%), número de brotações, massa fresca e seca da parte aérea, e massa seca das raízes. Nas condições em que o estudo foi realizado os resultados mostraram que o comprimento das estacas e concentração de AIB afetam o desenvolvimento das estacas, apresentando ajuste quadrático e linear para as variáveis analisadas. As mudas obtidas a partir de estacas com 10 cm e concentração de 1500 mg L-1 de AIB apresentaram a maior percentagem de enraizamento e as maiores médias para o comprimento do sistema radicular, número de brotações, massa fresca e seca da parte aérea.

Aloysia triphylla (L'Hér.) Britton is a medicinal plant shrub with aromatic leaves, which have essential oil rich in citral. The increasing demand of the pharmaceutical and cosmetic industries for the A. triphyllaessential oil provided a greater interest in the cultivation of this species. Cutting is one of the main methods of propagation, due to the difficulty in obtaining seeds and also for the benefit of descendants being equal to the parent plant. The objective of this study was to evaluate the effect of different concentrations of IBA and length of cuttings in the rooting of A. triphylla. The experiment was carried out in a protected environment in the period from November 2010 to January 2011. The experimental design was completely randomized using the factorial design where the factors were five concentrations of indole butyric acid (IBA) (mg L-1): 0, 250, 500, 1000 and 1500, and four lengthsforthe cuttings: 4, 6, 8 and 10 cm. The cutting base was immersed in a solution of IBA and placed into the rooting Mecplant ® commercial substrate. The variables analyzed were: root length, percentage of rooted cuttings (%), number of shoots, fresh and dry weight of the shoots, and dry weight of the roots. Under the conditions in which the study was conducted, the results showed that the length of the cuttings and IBA concentration affect the development of the cuttings, with linear and quadratic adjustment for the variables analyzed. The seedlings of cuttings with 10cm and the concentration of 1500 mg L-1 IBA showed the highest percentage of rooting and the highest averages for length of the root system, number of shoots, fresh and dry weight of the shoots.

Towards improved hardware component attenuation correction in PET/MR hybrid imaging.

In positron emission tomography/computed tomography (PET/CT) hybrid imaging attenuation correction (AC) of the patient tissue and patient table is performed by converting the CT-based Hounsfield units (HU) to linear attenuation coefficients (LAC) of PET. When applied to the new field of hardware component AC in PET/magnetic resonance (MR) hybrid imaging, this conversion method may result in local overcorrection of PET activity values. The aim of this study thus was to optimize the conversion parameters for CT-based AC of hardware components in PET/MR. Systematic evaluation and optimization of the HU to LAC conversion parameters has been performed for the hardware component attenuation map (µ-map) of a flexible radiofrequency (RF) coil used in PET/MR imaging. Furthermore, spatial misregistration of this RF coil to its µ-map was simulated by shifting the µ-map in different directions and the effect on PET quantification was evaluated. Measurements of a PET NEMA standard emission phantom were performed on an integrated hybrid PET/MR system. Various CT parameters were used to calculate different µ-maps for the flexible RF coil and to evaluate the impact on the PET activity concentration. A 511 keV transmission scan of the local RF coil was used as standard of reference to adapt the slope of the conversion from HUs to LACs at 511 keV. The average underestimation of the PET activity concentration due to the non-attenuation corrected RF coil in place was calculated to be 5.0% in the overall phantom. When considering attenuation only in the upper volume of the phantom, the average difference to the reference scan without RF coil is 11.0%. When the PET/CT conversion is applied, an average overestimation of 3.1% (without extended CT scale) and 4.2% (with extended CT scale) is observed in the top volume of the NEMA phantom. Using the adapted conversion resulting from this study, the deviation in the top volume of the phantom is reduced to -0.5% and shows the lowest standard deviation inside the phantom in comparison to all other conversions. Simulation of a µ-map misregistration shows acceptable results for shifts below 5 mm for the flexible surface RF coil. The adapted conversion from HUs to LAC at 511 keV within this study can improve hardware component AC in PET/MR hybrid imaging as shown for a flexible RF surface coil. Furthermore, these results have a direct impact on the improvement of the hardware component AC of the examined flexible RF coil in conjunction with position determination.

Avaliação de substratos orgânicos na produção de mudas de hortelã (Mentha gracilis R. Br. e Mentha x villosa Huds.) / Evaluation of organic substrates on mint (Mentha gracilis R. Br. and Mentha x villosa Huds.) seedling production

A determinação de substratos alternativos viáveis para a produção de mudas de plantas medicinais é de grande relevância, pois o aproveitamento de resíduos de atividades agrícolas representa alternativa para problemas ambientais e sociais. Os experimentos foram realizados em ambiente protegido e a campo, na Universidade Tecnológica Federal do Paraná, Campus Dois Vizinhos, com o objetivo de avaliar substratos orgânicos para produção de mudas de hortelã para cultivo a campo. O delineamento experimental foi blocos casualizados, com três repetições, em esquema fatorial, sendo avaliados quatro substratos [esterco bovino + vermiculita + areia (1:1:1), esterco bovino + areia + solo (1:1:1), solo + vermiculita + cama-de-aviário (1:1:1) e substrato organo-mineral Plantmax® HA] e duas espécies de menta (Mentha gracilis e Mentha x villosa). Foram analisadas a altura da plantas e o número de folhas aos 07, 14 e 21 dias após o transplantio, índice de mortalidade, massa fresca e seca da parte aérea e das raízes. Não houve interação entre as espécies de menta e substratos para as variáveis analisadas. O substrato organo-mineral Plantmax® apresentou os melhores resultados para o número de folhas (8,44), altura (8,46 cm), produção de massa fresca (1,56 g planta-1), seca (0,23 g planta-1) e 100 por cento de pegamento de mudas a campo o que para o produtor de menta é de grande interesse. Com base nos resultados obtidos, pode-se concluir que para a produção de mudas de Mentha gracilis e Mentha villosa o substrato Plantmax® HA é o mais recomendado.

The determination of viable alternative substrates is of great importance for the production of medicinal seedlings since the use of residues from agricultural activities represents an alternative to solve environmental and social problems. The experiments were carried out in protected environment and in the field, located in the Federal Technological University of Paraná, Dois Vizinhos Campus, Paraná State, Brazil. The aim of this work was to evaluate organic substrates for the production of mint seedlings in the field. Experimental design was in randomized blocks, with three replicates, in a factorial arrangement evaluating four substrates [bovine manure + vermiculite + sand (1:1:1); bovine manure + sand + soil (1:1:1); soil + vermiculite + poultry manure (1:1:1); and the organomineral substrate Plantmax® HA] and two mint species (Mentha gracilis and Mentha x villosa). Plant height and leaf number were evaluated at 07, 14 and 21 days after transplanting, besides death rate and fresh and dry matter of shoots and roots. There was no interaction between mint species and substrates for the evaluated variables. The organomineral substrate Plantmax® HA presented the best results for leaf number (8.44), height (8.46 cm), fresh matter (1.56 g plant-1), dry matter (0.23 g plant-1) and set (100 percent seedlings in the field), which is of great interest for the mint producer. Based on these results, we concluded that the substrate Plantmaxâ HA is the most recommended for the production of Mentha x villosa and Mentha gracilis seedlings.

[How to improve the continuity of pharmacotherapy at hospital admission and discharge]. / Comment optimiser la continuité du traitement médicamenteux entre l'hôpital et le domicile?

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.

Exergy: its potential and limitations in environmental science and technology.

New technologies, either renewables-based or not, are confronted with both economic and technical constraints. Their development takes advantage of considering the basic laws of economics and thermodynamics. With respect to the latter, the exergy concept pops up. Although its fundamentals, that is, the Second Law of Thermodynamics, were already established in the 1800s, it is only in the last years that the exergy concept has gained a more widespread interest in process analysis, typically employed to identify inefficiencies. However, exergy analysis today is implemented far beyond technical analysis; it is also employed in environmental, (thermo)economic, and even sustainability analysis of industrial systems. Because natural ecosystems are also subjected to the basic laws of thermodynamics, it is another subject of exergy analysis. After an introduction on the concept itself, this review focuses on the potential and limitations of the exergy conceptin (1) ecosystem analysis, utilized to describe maximum storage and maximum dissipation of energy flows (2); industrial system analysis: from single process analysis to complete process chain analysis (3); (thermo)economic analysis, with extended exergy accounting; and (4) environmental impact assessment throughout the whole life cycle with quantification of the resource intake and emission effects. Apart from technical system analysis, it proves that exergy as a tool in environmental impact analysis may be the most mature field of application, particularly with respect to resource and efficiency accounting, one of the major challenges in the development of sustainable technology. Far less mature is the exergy analysis of natural ecosystems and the coupling with economic analysis, where a lively debate is presently going on about the actual merits of an exergy-based approach.

[Evaluation of the vaccine coverage of the general practitioners in the French Community]. / Evaluation de la couverture vaccinale des médecins généralistes en Communauté Française et en Région de Bruxelles-Capitale.

The present inter-University study aims to analyze the vaccine statute of the Belgian French-speaking general practionners and the reasons of their possible non-vaccination. A questionnaire with an exhaustive list of vaccines was sent by postal way to a random sample of thousand two hundred and twenty general practitioners. The results were analyzed via SPSS 13. The rate of answer is 60.83%. Two thirds of the doctors (67%) considered themselves in order of vaccination anti-influenza. A majority of doctors (59.7%) is vaccinated systematically each year. The majority of the doctors (83%) considered themselves in antitetanus order of vaccination. Two thirds (67%) think that the vaccine protects from 5 to 10 years. Nearly 73% of the doctors considered themselves in order of vaccination against hepatitis B. More than 50% of the doctors received a vaccine HBV since less than 10 years. The majority of the doctors (79.2%) made a blood control of their protection after vaccination HBV Almost half of the doctors thinks that the vaccine protect for life, 23% from 10 to 20 years and 14% from 5 to 10 years. Two thirds (67%) of the doctors did not make a vaccine against rubella. In 80% of the cases vaccination dated from more than 20 years. In nearly two thirds of the cases the doctors did not make blood control of their protection. Nearly 60% of the questioned doctors think that vaccination offers a protection to life. About half of the doctors did not consider themselves in order of vaccination against the whooping-cough. In three quarter of the cases last vaccination dated from more than 20 years. The two principal durations of protection of the vaccine are with life and between 10 and 20 years. Three quarters of the questioned doctors are considered in order of vaccination against the poliomyelitis. However in 62% of the cases the last vaccine goes up with more than 20 years. More two thirds of the doctors think than the vaccine protects with life or from 10 to 20 years. Two thirds of doctors considered themselves in order of vaccination against the diphteria. For a third of the doctors the vaccine dated from less than 5 years, in more than one quarter of the cases to more than 20 years like between 5 and 10 years. About half of the doctors said they were vaccinated against other pathologies: hepatitis A (34.5%), the yellow fever (21.1%), the thyphoid fever (12.5%), the BCG (8.9%), the pneumococcus (6.6%), meningitis and variola (5%). In the French Community, the vaccine coverage of the general practitioners against the influenza (67%), tetanus (83%) and hepatitis B (73%) is, in this study, higher or equal to the other Belgian and international studies but remains insufficient. A bad vaccine coverage is observed concerning rubella, the whooping-cough, the poliomyelitis. The answers over the durations of protection of the vaccines are rather disparate and show a bad knowledge of these durations and diagrams of vaccination. An update of this knowledge could be carried out during the continuous medical trainings.

Use of office spirometers in Flemish general practice: results of a telephone survey.

BACKGROUND: While office spirometry is seen as potentially useful and feasible in general practice, little is known about its use in Flemish general practice. Our aim was to describe the use of spirometers by Flemish GPs, characteristics of their spirometry practice, training needs and preferences, and attitudes towards office spirometry. METHODS: A telephone survey was set up in a random sample of Flemish GPs. Interviews were carried out by a GP researcher using a structured piloted questionnaire. RESULTS: 197 out of 243 eligible GPs (81%) were interviewed. Most GPs (66%) had never used an office spirometer, 17.3% were using one and 16.7% stopped using one. Time constraints (54%) and insufficient knowledge and skills (27%) were the main reasons for not using an office spirometer (any longer). GPs particularly used their spirometer to diagnose COPD and asthma, and less frequently in follow-up. GPs (67.9%), especially current users (91.2%), considered spirometry as a GP task. Spirometry training should be provided (86%) and spirometry by GPs should be reimbursed (79.5%). More information on spirometry would be very useful (62.3%), with a marked preference for training in small groups (86.8%). CONCLUSION: Although office spirometry is not widespread in Flemish general practice, GPs show an undoubted interest in it. They need educational and financial support to overcome prevailing barriers in establishing office spirometry on a routine basis.

Substantial use of primary health care by prisoners: epidemiological description and possible explanations.

OBJECTIVES: To describe the use of primary care services by a prisoner population so as to understand the great number of demands and therefore to plan services oriented to the specific needs of these patients. DESIGN: Retrospective cohort study of a sample of prisoners' medical records. SETTING: All Belgian prisons (n = 33). PATIENTS: 513 patients over a total of 182 patient years, 3328 general practitioner (GP) contacts, 3655 reasons for encounter. MAIN RESULTS: Prisoners consulted the GP 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. CONCLUSION: The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.

Automated segmentation of the optic nerve head for diagnosis of glaucoma.

Glaucoma is the second most common cause of blindness worldwide. Low awareness and high costs connected to glaucoma are reasons to improve methods of screening and therapy. A well-established method for diagnosis of glaucoma is the examination of the optic nerve head using scanning-laser-tomography. This system acquires and analyzes the surface topography of the optic nerve head. The analysis that leads to a diagnosis of the disease depends on prior manual outlining of the optic nerve head by an experienced ophthalmologist. Our contribution presents a method for optic nerve head segmentation and its validation. The method is based on morphological operations, Hough transform, and an anchored active contour model. The results were validated by comparing the performance of different classifiers on data from a case-control study with contours of the optic nerve head manually outlined by an experienced ophthalmologist. We achieved the following results with respect to glaucoma diagnosis: linear discriminant analysis with 27.7% estimated error rate for automated segmentation (aut) and 26.8% estimated error rate for manual segmentation (man), classification trees with 25.2% (aut) and 22.0% (man) and bootstrap aggregation with 22.2% (aut) and 13.4% (man). It could thus be shown that our approach is suitable for automated diagnosis and screening of glaucoma.

Evaluation of computer-assisted image enhancement in minimal invasive endoscopic surgery.

OBJECTIVES: This paper focuses on the evaluation of the usage of computer-aided image processing methods for minimal invasive surgery. During video endoscopy of visceral cavities the images are displayed directly on the monitor without further processing. In the course of the operation the former good quality of the images decreases due to typical disturbances like bleeding, smoke or flying particles. These disturbances can be reduced by using image processing methods like color normalization, temporal filtering or equalization. METHODS: In this double-blinded analysis, 14 surgeons with different levels of experience evaluated 120 image pairs and 5 image sequences, directly comparing original and processed images or movies. RESULTS: Color normalization and equalization proved to significantly enhance video endoscopic images. With regard to temporal filtering, an improvement could be seen in the image sequences with filter size 5 being a greater enhancement than filter size 3. Comparing the state of experience and its influence on the results, it occurred that the experienced surgeons preferred the original color while altogether agreeing that the color-normalized images were better. CONCLUSIONS: The results obtained in the present evaluation show that the image processing methods which were used can significantly improve the quality of video endoscopic images. As a result of this, necessary lavages of the operated area are reduced and a better overview and orientation for the surgeon can be reached.

Light fields for minimal invasive surgery using an endoscope positioning robot.

OBJECTIVES: To generate a fast and robust 3-D visualization of the operation site during minimal invasive surgery. METHODS: Light fields are used to model and visualize the 3-D operation site during minimal invasive surgery. An endoscope positioning robot provides the position and orientation of the endoscope. The a priori un-known transformation from the endoscope plug to the endoscope tip (hand-eye transformation) can either be determined by a three-step algorithm, which includes measuring the endoscope length by hand or by using an automatic hand-eye calibration algorithm. Both methods are described in this paper and their respective computation times and accuracies are compared. RESULTS: Light fields were generated during real operations and in the laboratory. The comparison of the two methods to determine the unknown hand-eye transformation was done in the laboratory. The results which are being presented in this paper are: rendered images from the generated light fields, the calculated extrinsic camera parameters and their accuracies with respect to the applied hand-eye calibration method, and computation times. CONCLUSION: Using an endoscope positioning robot and knowing the hand-eye transformation, the fast and robust generation of light fields for minimal invasive surgery is possible.

[Image analysis system for detection facial paralysis]. / Bildanalysesystem zur Erkennung einer Fazialisparese.

BACKGROUND: Evaluation of facial nerve paresis depends on visual assessment and naturally differs from examiner to examiner. An objective measurement instrument is presented. PATIENTS AND METHOD: Facial features are automatically localized by a parametric face model in videos of a face during relaxation and exercises. Gray-level information is analyzed by a special steerable filter and used to identify symmetries. The computer system was tested in 19 individuals. RESULTS: Automatic localization of facial features such as the upper arc of the head and ears was correct in 95%, the eyes in 82%, and the mouth in 73%. Lid paresis was correctly recognized in seven of ten (70%) and oral paresis in 10 of 12 (83%) cases. Unaffected eyelid movements were identified in eight of nine (89%) and healthy oral regions in all seven (100%) cases. CONCLUSION: The computer system presented is able to automatically localize facial features and to identify facial nerve paresis. It is a considerable step toward automatic and objective grading of facial nerve paresis.

Dietary habits during adolescence--results of the Belgian Adolux Study.

UNLABELLED: OBJECTIVE OF THE PRESENT STUDY: To analyse the usual dietary habits of Belgian adolescents from a high cardiovascular risk population. METHODS: A food frequency questionnaire (57 items) was administered to the whole sample. Complementary questions specified some types of food (eg fat content). A subgroup of 234 adolescents gave detailed information on portion size (picture book and food samples). SETTING: Twenty-four secondary schools in the Belgian province of Luxembourg. SUBJECTS: A total of 1,526 adolescents (12-17y) selected by a multiclustered stage sampling (participation: 83.6%). RESULTS: Respectively 46% and 60% of the adolescents did not eat fruit and vegetables daily. Most of the adolescents (72%) consumed at least one dairy product daily. The frequent consumption of chocolate and French fries indicated the strong cultural influence on dietary habits while imported foods (like hamburgers) had little success. One-third of the adolescents (33%, n = 509) drank alcohol at least once a week and this proportion rose to 57% in the oldest age group. Boys and girls differed significantly in their diet, with girls choosing healthier foods. Dietary habits, in particular drinking habits, differed also significantly between education levels, assessed by the learning option of the participants. The semi-quantitative questionnaire showed that two-thirds of the adolescents had a lipid intake (mainly saturated fatty acids) which exceeded 35% of the total caloric intake. Complex carbohydrates represented less than half of the total carbohydrates intake. CONCLUSION: The study of the diet of Belgian adolescents confirmed the strong influence of tradition, in particular on the consumption of high fat content foods. The promotion of healthy diet in adolescents should consider the cultural influence, even for this young age group.

Oral contraception and cardiovascular risk factors during adolescence.

The objective of the present study was to analyze the pattern of oral contraceptive (OC) use in teenagers and to examine the relationship between OC use and other cardiovascular risk factors. The study was conducted in 24 Belgian secondary schools. Most students (1526 adolescents aged 12-17 years) agreed to participate (participation rate: 83.6%). Smoking, physical activity habits, menarche, and OC use were assessed by a self-administered questionnaire. Total cholesterol level, blood pressure and anthropometric measurements were also measured. Fourteen per cent of mature girls (14%, n = 92) were OC users. Two-thirds of them (66.3%, n = 61) were taking OC which contained either gestodene or desogestrel. Blood pressure and BMI were similar for OC users and non-users. Total cholesterol level was significantly higher in OC users than in non-users (191 mg/dL versus 172 mg/dL). Logistic regression model confirmed the significant influence of OC use on total cholesterol level (OR = 3.08). OC users were also often smokers (39% versus 20% for non-users). In conclusion, the present study has found significant relationships between OC use and cardiovascular risk factors i.e., high total cholesterol and smoking. The first implication is a need for further research on lipoprotein profile in young OC users. Secondly, the combined use of OC and smoking in teenagers calls for preventive actions.

Blood pressure during adolescence: a study among Belgian adolescents selected from a high cardiovascular risk population.

INTRODUCTION: The Belgian province of Luxembourg has a high incidence of cardiovascular (CV) disease according to the MONICA register. Surveys conducted in adults and children have also found high CV risk factor levels in this province. DESIGN: cross-sectional study. OBJECTIVE OF THE PRESENT STUDY: To collect data about blood pressure (BP) and its determinants in adolescents from this high CV risk population and to analyse their relationship. PARTICIPANTS: 1526 adolescents (12-17 years) in 24 secondary schools of the province. RESULTS: Mean systolic BP levels were 125 mm Hg (sd = 12 mm Hg) and 122 mm Hg (sd = 11 mm Hg) for boys and girls, respectively. Mean diastolic BP was equal to 74 mm Hg (sd = 10 mm Hg) in both genders. Systolic BP increased with age and differed significantly between genders from 15 years onwards. Body fatness indices increased with age except waist-to-hip ratio in girls and triceps skinfold in boys. Regression models including age, anthropometric indices and physical activity explained a small percentage of BP variance (for systolic BP, r2 = 0.21 and 0.12 for boys and girls, respectively). Weight was the first parameter related to BP in correlation and regression analyses. CONCLUSIONS: This study showed high BP and body fatness indices in adolescents from a high CV risk population. The model under study showed a moderate relationship between body fatness and BP. This finding suggests other influences as a genetic component to account for the high levels observed.

Combination therapy with tacrolimus and mycophenolate mofetil following cardiac transplantation: importance of mycophenolic acid therapeutic drug monitoring.

BACKGROUND: Interest has recently been expressed in tacrolimus and mycophenolate mofetil (MMF), two potent immunosuppressants, for a variety of transplant indications. The efficacy of this combination was assessed as primary therapy following cardiac transplantation. METHODS: Forty-five patients were enrolled; 15 into Phase I and 30 to Phase II of the study. Intravenous tacrolimus was administered for 2-3 days to all patients prior to conversion to oral therapy; target blood concentrations were 10-15 ng/mL. Treatment also consisted of steroids and MMF. During Phase I, a fixed 2 g/day dose of MMF was given whilst doses were adjusted according to mycophenolic acid (MPA) plasma levels during Phase II (target range 2.5-4.5 microg/mL). Mean follow-up was 696 +/- 62 days and 436 +/- 88 days for Phases I and II, respectively. RESULTS: Phase I: Patient survival was 100%. Rejection was diagnosed in 66.7% of patients (mean number of episodes per patient 1.33 +/- 1.18). Retrospective analyses indicated that whereas mean MPA plasma levels >3.0 microg/mL were not associated with rejection, no correlation was found with tacrolimus blood concentrations. Phase II: A survival rate of 96.7% was evident, one patient having died from aspergillosis. Diagnoses of rejection were made in 10.0% of patients (0.10 +/- 0.31 episodes per patient) and confounding factors were present in all 3 cases. MPA trough levels were 1.0 +/- 0.3 microg/mL at this time. Resolution was apparent following pulse steroid therapy. Steroids were successfully withdrawn from all patients who completed 6 months' treatment. CONCLUSIONS: Combination therapy with tacrolimus and MMF is associated with suppression of acute myocardial rejection; however, this is dependent upon routine therapeutic drug monitoring.