Neuroendocrine Response to School Load in Prepubertal Children: Focus on Trait Anxiety.

At the time of school-age, the most frequent stress stimuli are related to school environment and educational process. Anxiety may play a big role in coping with stressful situations associated with school load. To approach this issue, we performed a real-life study at school during the classwork. The sample consisted of 36 healthy children aged 10 years, which were divided to low and high trait anxiety group based on the median value of the anxiety score. The investigations were carried out in the classroom during a stress condition (final exams) and non-stress condition (without any exam). In the whole sample, the condition with exam was associated with higher cortisol and lower testosterone concentrations in saliva compared to the condition without exam. The activity of salivary alpha-amylase increased at the end of the exam. Anxious children showed higher concentrations of aldosterone and lower activity of alpha-amylase compared to children with low trait anxiety. Cortisol levels were higher in anxious children in the first morning samples before starting the lessons. Children with high and low trait anxiety did not differ in extraversion, neuroticism, as well as non-verbal intelligence and school success. Thus, the anxious children at school showed a more rapid decrease of anticipatory stress-induced cortisol concentrations, higher aldosterone levels, and lower alpha-amylase activities compared to non-anxious children. These changes, particularly high concentrations of aldosterone in children with high trait anxiety, may have an impact on their psychophysiological development.

Environmental noise and cardiovascular disease in adults: research in Central, Eastern and South-Eastern Europe and Newly Independent States.

The adverse effects of noise on health have been intensely explored in the past 50 years. However, the scope of research conducted in the Central and Eastern Europe, South-East Europe, and Newly Independent States is not well-known. The aim of this review was to present studies on cardiovascular effects of environmental noise in adults published since 1965 and to point out the most important issues that need to be addressed in the future. More than 100 papers on noise and health and about 20 papers on cardiovascular effects of environmental noise in adults were identified by literature search. The authors reviewed scientific international and local journals, conference proceedings, and local reports published in national languages. The major endpoints were high blood pressure, ischemic heart disease, and myocardial infarction. The target populations were adults. Experimental and exposure-assessment studies, field, empirical studies, social surveys, and epidemiological studies are presented. The major sources of environmental noise were road and air traffic. The results were presented in tables and the most relevant articles were briefly discussed. The importance of this review is that it refers to some countries that no longer exist in the same political and governmental systems. The strength of this paper is that it includes publications that were not evaluated in earlier systematic reviews. Strategies for future noise-related research on national and global level are proposed.

Household exposure to secondhand smoke is associated with decreased physical and mental health of mothers in the USA.

Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000-2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80-0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73-0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers.

Community noise annoyance assessment in an urban agglomeration.

In urban areas community noise is one of the important factors in producing deterioration of both well-being and the quality of life. The aim of the study was to compare two noise annoyance surveys and two noise annoyance scales in the period of 15 years in selected areas of Slovak capital Bratislava, to calculate risks of community noise annoyance and disturbance in the observed samples. Noise annoyance risks were calculated by bivariate and stratified analysis in the form of odds ratio and Mantel-Haenszel weighted odds ratio from 2x2 and 2xn tables. The use of validated five-grade scale of noise annoyance assessment gives higher possibilities for more detailed analysis, allows to calculate the indicator--percentage of highly annoyed subjects (% HA), the rate of highly annoyed individuals. The percentage of highly annoyed subjects was 18% in the year 2004, which is comparable with recently published studies. The percentage of respondents that were not at all annoyed by road traffic noise has been decreased during the 15 year period by 10% (42% vs 32%). The increase of subjective community noise annoyance risks has been observed after 15 years as well. The sample from the year 2004 has been more annoyed by road traffic noise, neighbourhood noise, noise from entertainment facilities, noise from industry and railway noise. The highest risk increase has been observed in the entertainment facilities noise annoyance (OR(MH) =1.51; 95% CI = 0.90-2.52 vs OR(MH) = 4.47; 95% CI = 2.75-7.33). Using of standard five-grade noise annoyance questionnaire gives higher possibilities for data analysis in the studies investigating the influence of environmental noise annoyance on selected population groups (Tab. 3, Ref. 7).

Positive and negative trends in university students' food intake.

In the time period 1992-2004 the food intake data (24 hour recall, frequency questionnaire) in 3 417 students of Medical Faculty Comenius University in Bratislava (1257 men and 2160 women, the mean age 22.38 +/- 1.34) were obtained. The aim of this study was to evaluate the food intake and its trends in university students. Students' food consumption has not been in agreement with recommended dietary allowances (RDAs). The meat consumption was structurally unbalanced, though quantitatively sufficient (99% RDA); milk intake (75% RDA) was insufficient, fruit (65% RDA) and vegetable intake (62% RDA) even critical. On contrary, cereal products intake was excessive (130% RDA). Men eat more meat (p < 0.001), milk (p < 0.001), eggs (p < 0.01), cereals (p < 0.001) and fat (p < 0.001) than women. Women eat more fruit, vegetable and sugar than men. In the time period 1992-2004, students' meat consumption has decreased about 18%, milk and eggs about 23%, fruit about 42% and cereals intake has decreased about 45%. The fruit and vegetable intake structure has substantially improved (higher content of fresh fruit, fewer preserved products). In spite of a higher health awareness in students and tendency towards proper diet, their food intake has been negatively influenced by decreasing purchasing power in Slovak population (Tab. 2, Fig. 1, Ref. 15).

Stress and health-related behaviour, personality characteristics and blood pressure in older school children.

BACKGROUND: Frequent stress contributes to physical and psychical disorders already in school-age children. Subjective evaluation of stress level is considered adequately informative for differentiating eustress and distress. OBJECTIVES: Assessment of the extent of stress and connections with health-related factors and characteristics is a precondition for health promotion and stress prevention in school children. METHODS: In a cross-sectional study we analysed data from 213 older school children (107 boys and 106 girls) aged 10 and 14 years. Use was made of a self-evaluation questionnaire to assess the stress level, behavioural factors, feeling of health, 7-day report of data on diet and physical activity, J.E.P.I. test (Eysenck, 1971) evaluating neuroticism and extroversion. Sport activities were expressed as FIT value (product of frequency, intensity and time of exercises) and daily energy balance as ratio of average daily energy intake and energy expenditure. RESULTS: The girls felt stress more frequently than boys (38.7% vs 24.3%, p < 0.03). School stress was significantly more frequent than home stress. The stressed students more negatively evaluated their health and physical performance. The relation between stress degree and neuroticism score was confirmed. Sport and physical activities were significantly lower in boys with high stress load. Any closer relations between frequency of stress and health risk behaviour, sleep as well as school performance and blood pressure failed to be confirmed. CONCLUSION: The results have indicated the need of lowering school stress. One of effective ways is to promote physical activity in the life of children. (Tab. 3, Fig. 1, Ref. 24.)

Did the nutrition of Slovak medical students change? A comparison after 15 years.

OBJECTIVE: Authors aimed at positive and negative changes evaluation in nutrition and nutritional status of university-medical students comparing the situation in years 1984 and 1999. They were trying to determine, how was the nutrition of current medical students influenced by food consumption changes in the Slovak population and price liberalization of the food-stuffs as well. MATERIAL AND METHODS: Seven day reports from the year 1984 (199 students) and from the year 1999 (228 students) were processed using Food Research Institute, Food Composition Database and Programme. The quantity and quality of consumed food-stuffs and beverages were evaluated as well as energy and biologic value of students nutrition. Nutritional status of students was assessed by BMI (body mass index--kg/m2). Men and women (years 1999 vs. 1984) were separately evaluated by standard statistical methods. RESULTS: Lower energy, fat, cholesterol, animal protein and salt intake were observed in students in the year 1999; on the contrary, carbohydrates, sucrose, fibre, magnesium, vitamins C and E intake increased in comparison with the year 1984. The differences were mostly significant in women. Big changes in food consumption (1999 vs. 1984) were observed. Current students eat less meat (less pork, beef, fish, but more poultry), eggs and potatoes and women also less milk and dairy products than in the year 1984. On the contrary, the consumption of vegetable, fruits, legumes and non-alcoholic beverages increased. Alcohol intake decreased significantly. Students eat the most on Sunday, the least on Friday; women eat more rationally. Nutritional status in man was not changed, the percentage of slim women increased (p < 0.05). CONCLUSION: The food of current students (1999) is more varied, with the balanced content of plant and animal sources and with lower energy density than in the year 1984. Negative consequences of price liberalization in medical student nutrition are lower in comparison with Slovak global nutritional trends and they reflect the higher health awareness, eventually better socio-economic family background.

Radiation-induced apoptosis and cell cycle alterations in human carcinoma cell lines with different radiosensitivities.

Radiosensitivity of examined human neoplastic cell lines was assessed with the aid of MTT assay. Differences between radiosensitive and radioresistant human neoplastic cell lines were as follow: a) radiation-induced apoptosis detected by flow cytometry was apparent in the most radiosensitive (i.e. CH-1 ovarian carcinoma cell line), but not in the radioresistant (i.e. SKOV-3 ovarian carcinoma) cell lines, b) radiation-induced G2/M arrest appeared early after irradiation (6 hours) in both the radioresistant SKOV-3 cells and in the radiosensitive CH-1 human ovarian carcinoma cell line, but a different pattern was observed 24 hours after irradiation with 2 Gy dose with G2/M arrest only in radiosensitive cell line. The radiosensitivity and resistance to radiation-induced apoptosis in the radioresistant human breast carcinoma MDA-MB-231 cell line were similar to those observed in SKOV-3 cells. These data suggest that radiation-induced apoptosis and cell cycle alterations can predict radiosensitivity at least in some examined human malignant cells in vitro.

Doppler flowmetry in the differentiation of biological characteristics of ovarian cancer.

On basis of ultrasonographic structural criteria and Doppler flowmetry in a group of 76 patients with ovarian cancer, benign lesions were discovered in 59 patients and malignant lesions in 17 patients (77.6% and 22.4%, respectively). Surgical intervention was indicated according to the clinical findings and following of the trend of organ-specific oncomarkers in 32 out of 76 patients (42.1%). The stratification involved 17 patients with sonomorphologically/Doppler-flowmetry - diagnosed malignancy as well as 15 patients with sonographically diagnosed benign ovarian tumor. The clinical findings were histologically verified in all 32 patients. Histology confirmed malignant tumor in 16 patients, 1 histologically borderline malignancy and 15 benign tumors. The Doppler-flowmetry showed 94.1% sensitivity, 93.3% specificity, 93.3% positive predictive value, and 93.75% accuracy.

Relevance of the Doppler flowmetry in the diagnosis of pathological alterations in the post-menopausal endometrium.

The sonopathomorphology of the menopausal endometrium was investigated by measuring the endometrium thickness using the Doppler flowmetry technique. The endometrium thickness extending five millimeters has been considered critical, indicating possible neoplastic disorders. Such clinical status has been discovered in 21 out of 58 post-menopausal patients inspected (36.2%). Furthermore, the Doppler blood-flow analysis, based on the evaluation of the resistance indices (RI) in the ascendent branches of uterine arteries bilaterally, and - in case of the vascularization analysis - in the edometrial and perimetrial regions, has been performed. These investigations brought evidence indicating full capacity of the method in detecting blood flow through the uterine arteries, while significant differences in the endometrial flow-through parameters were detected only in 14 (66.7%) patients. In all 21 patients with endometrium thickness extending 5 millimeters, bioptic examination followed by histology confirmed endometrial cancer in 9 patients, epidermoid cancer in 3 patients, and cystic hyperplasia in 3 patients, respectively. The remaining 6 patients showed either secretory or quiet endometrium (5 cases), or necrotic endometrial regions (1 case). In all 12 cases of malignant endometrial cancer and in 2 out of 3 cases of histologically verified benign hyperplasia, intra- and periendometrial vascularization has been confirmed. It is to note that the mean RI values measured in the intra- and periendometrial vessels in case of endometrial cancer were significantly lower than in patients with benign cystic hyperplasia of the endometrium. Our results brought evidence indicating that the estimation of differences in the RI values in patients with detectable intra- and periendometrial vascularization has a significant relevance in the distinction of endometrial cancer from nonmalignant endometrial lesions, predominantly the benign atypical hyperplasia. The reliability of the test was 100%, however - in case of malignant disorders - a significant decrease in the RI values has been seen in the intratumoral vs. peritumoral vascularization.

Nosocomial candidaemias due to species other than Candida albicans in cancer patients. Aetiology, risk factors, and outcome of 45 episodes within 10 years in a single cancer institution.

Forty-five cases of fungaemia due non-albicans Candida spp. (NAC) in a single National Cancer Institution within 10 years were analysed for aetiology, risk factors and outcome. There had been 12 cases of fungaemia that were due to C. krusei, 14 due to C. parapsilosis, 7 due to C. (T.) glabrata, 6 to C. tropicalis, 2 to C. guillermondii, 2 to C. lusitaniae, 1 to C. stellatoidea, and 1 to C. rugosa. Comparison of 45 NAC fungaemia with 75 episodes of C. albicans fungaemia revealed differences only in two risk factors: previous empiric therapy with amphotericin B (16.0 vs 2.2%, P<0.01) appeared more frequently in cases of C. albicans fungaemia, and prior prophylaxis with fluconazole (8.9 vs 0%, P<0.02) was conversely more frequently observed with NAC. The incidence of other risk factors, such as underlying disease, chemotherapy, antibiotic prophylaxis or therapy, treatment with corticosteroids, catheter insertion, mucositis, cytotoxic chemotherapy, and neutropenia, was similar in both groups. There was no difference either in attributable or in overall mortality between NAC and C. albicans fungaemia in our cancer patients.

Taxol-enhanced cytotoxic effect of radiation in human promyelocytic leukemia cells: relative resistance of multidrug-resistant HL-60 cells in vitro.

Cytotoxic effects of sequential taxol (paclitaxel) and X-irradiation on drug-sensitive human cultured promyelocytic leukemia (HL-60) cell line and its multidrug-resistant sublines were examined using photometric MTT test and flow cytometry. Paclitaxel (at concentrations 1-10 nmol) stimulated the cytotoxic effect of irradiation in HL-60 and to a lesser extent also in HL-60/ADR, but not in HL-60/VCR cells. The stimulation of radiation-induced cytotoxic effect by paclitaxel correlated with its potential to induce cell cycle and viability alterations identified with flow cytometric analysis (i.e. increased propidium iodide staining, increased side scatter, decreased forward angle scatter, accumulation of necrotic cell detritus, apoptotic pre-G0 cells and cells in the G2/M phase of the cell cycle).

Imipenem-resistant Ps. aeruginosa bacteraemia in cancer patients: risk factors, clinical features and outcome.

Ninety nine patients with 101 bacteraemic episodes due to Ps. aeruginosa (PA) within 6 years were divided into two groups according to their resistance to imipenem-91 due to imipenem sensitive (ISPA) and 10 due to resistant (IRPA). Risk factors, the clinical course and the outcome were evaluated and compared. Acute leukaemia, prolonged neutropenia, previous therapy with amikacin, third generation of cephalosporins, imipenem and prophylaxis by quinolones were significantly more frequently associated with IRPA. Imipenem resistant PA bacteraemia were associated with higher incidence of septic shock (40% vs 19.8%, p < 0.02) and death (33.3%) than ISPA bacteraemias. Since 1992, when first IRPA appeared, the incidence of imipenem resistance increased tenfold, and in 1994, up to 10% of PA causing bloodstream infections in cancer patients in our center were imipenem resistant. (Tab. 3, Ref. 8.).

Funguria in cancer patients: analysis of risk factors, clinical presentation and outcome in 50 patients.

Fifty cancer patients with funguria of > 10(5) CFU/ml, dysuria and leukocyturia were retrospectively analyzed for etiology, risk factors and outcome. In 72% of cases Candida albicans and in 28% non-albicans Candida spp. (Candida krusei, Candida tropicalis) and non-Candida spp. yeasts (Blastoschizomyces capitatus) were isolated. Torulopsis glabrata was not found among these patients. The most frequent risk factors were: antibiotic therapy with more than one antibiotic agent (96%), concomitant fungal infection in other localizations than the urinary tract (36%), colonization with the same species (48%), catheterization with urinary catheter or nephrostomy (46%), prophylaxis with quinolones (50%) and previous therapy with corticosteroids (72%). Structural or anatomic malformations of the urinary tract (26%), neutropenia (28%), antifungal prophylaxis with azoles (22%), and diabetes mellitus (12%) were less frequently seen. Thirty of 36 patients treated with systemic antifungals were cured and six were not.

Vancomycin plus imipenem ceftazidime or ciprofloxacin in second line therapy in patients with febrile neutropenia not responding to first line therapy.

137 patients with febrile neutropenia after cytotoxic therapy not responding to ceftazidime plus or ceftriaxone plus netilmicin in received additionally to the previous combination either vancomycin alone or combined with another anti-gram-negative compound: imipenem in those treated prophylactically with ofloxacin and ciprofloxacin in those without prophylaxis. The addition of vancomycin to the previously ineffective combination of a third generation cephalosporin plus aminoglycoside, and replacement of ceftriaxone plus netilmicin with ceftazidime plus amikacin plus vancomycin or with ceftazidime plus vancomycin seems to be less effective (71.8-75 vs. 87.5-90.9%, p < 0.02) and more toxic (20.5-7.2 vs. 0-5%, p < 0.0005) than vancomycin in combination with a different anti-gram-negative compound as previously used: imipenem or ciprofloxacin.

Imipenen-resistant Ps. aeruginosa bacteraemia in cancer patients: risk factors, clinical features and outcome.

Ninety-nine patients with 101 bacteraemic episodes due to Pseudomonas aeruginosa (PA) within 6 years were divided into two groups according to their resistance to imipenem; of these 91 episodes were due to imipenem-sensitive (ISPA) and 10 due to imipenem-resistant (IRPA) strains. Risk factors, clinical course and outcome were evaluated and compared in the two groups. Acute leukaemia, long-lasting neutropenia, previous therapy with amikacin, third-generation cephalosporins, imipenem and prophylaxis with quinolones were significantly more frequently associated with IRPA than with ISPA. Imipenem-resistant PA bactereamias were associated with a higher incidence of septic shock (40% vs 19.8%) p. 161 0.02) and death 33.3%) than were ISPA bacteraemias. Since 1992, when first IRPA appeared, the incidence of imipenem-resistance increased tenfold, and in 1994, up to 10% of the PA populations causing bloodstream infections in cancer patients in our centre were imipenem-resistant.

The role of cisplatin in chemotherapy of advanced breast cancer.

Cisplatin containing regimens as first-line, second-line or as a third-line chemotherapy were administered in 26 and 36 patients, respectively. The overall response rate in patients on first-line chemotherapy was 53.9%, in patients on second or third-line chemotherapy 30.6%. The differences both in overall and disease-free survival between patients on first-line and on second/third-line chemotherapy were statistically significant in favor of women treated with first-line chemotherapy (p = 0.05). Hematologic and nonhematologic toxicities were mild to moderate and were more pronounced in patients on second and third-line chemotherapy. The overall response rate, DFS and OS were significantly better and longer in the group of patients treated with "bolus" CDDP in comparison to the group of patients treated with CVI CDDP. Our results confirm the activity of cisplatin-containing regimens (mainly CAP schedules) in patients with advanced breast cancer not only as a first-line therapy but also in heavily pretreated patients by chemotherapy and/or radiation therapy and endocrine manipulation.

T-lymphocyte subsets (CD4/CD8 ratio) in breast cancer patients.

T-lymphocyte subsets (CD4/CD8 antigen positive cells) were determined in peripheral lymphocytes from 48 patients with breast cancer of different stages by flow immunocytometry with the aid of anti-CD4 and CD8 monoclonal antibodies. A broad individual variability of the CD4/CD8 ratio among both healthy donors and breast cancer patients was observed. The average value of CD4/CD8 ratio decreased in groups as follows: Healthy donors and Stage I patients, Stage IIA, IIB and Stage IV breast cancer patients. These differences were generally statistically not significant. The difference between healthy donors and Stage IV breast cancer patients was statistically significant (p < 0.01), if one exceedingly elevated value of the CD4/CD8 ratio was excluded from statistical evaluation. The average CD4/CD8 value in the group of breast cancer patients with lymph node or distant metastases was lower than that of patients without metastases, but their difference was not statistically significant either.