Brief report: The KIDSCREEN follow-up study on Health-related Quality of Life (HRQoL) in Spanish children and adolescents. Pilot test and representativeness.

The Spanish KIDSCREEN follow-up study reassessed the Spanish baseline sample (n=840) of the European KIDSCREEN study 3 years later (2006). The aims of this paper were to describe the KIDSCREEN follow-up study and the pilot test, and to analyze participation rates and representativeness. Instruments included the KIDSCREEN-52 HRQoL measure and a set of scales including the possible explanatory variables. Focus groups and individual interviews were carried out in a pilot test. Participants were compared with non-participants at baseline, and also with Eurostat census data. Twenty-two out of 24 subjects were interviewed in the pilot test. Fifteen items needed to be modified after the pilot test. Participation rate reached 54% (n=454). Participants (mean age=12.71 years old) were on average 6 months younger than non-participants (p=0.03), and from more educated families. KIDSCREEN follow-up instrumentation seems adequate for collecting factors with potential influence on HRQoL. Follow-up respondents' representativeness seems to be acceptable.

Changes in health-related quality of life (HRQoL) in a population-based sample of children and adolescents after 3 years of follow-up.

OBJECTIVES: To assess changes in health-related quality of life (HRQoL) in children and adolescents over a 3-year period and to examine factors associated with change. METHODS: A representative sample of Spanish children and adolescents aged 8-18 years and their parents completed the KIDSCREEN-52 questionnaire at baseline and again after 3 years. Data were also collected on gender, pubertal development (PD), and family socio-economic status (SES). Change in HRQOL over time was evaluated using effect sizes (ES). Generalized estimating equations (GEE) were used to analyze associations among changes in KIDSCREEN scores, socio-demographic factors, and pubertal development. RESULTS: Response rate at follow-up was 54% (n = 454). Overall, HRQoL worsened in eight out of the ten KIDSCREEN dimensions, with ES ranging from -0.10 (Moods and Emotions) to -0.34 (Psychological Well-being). The decrease was most marked in the intermediate age group (13-17 years of age at follow-up) and in girls. In the GEE models, pubertal development more strongly impacted changes in girls than in boys. CONCLUSIONS: In this representative, population-based sample of children and adolescents, moderate decrements in HRQoL were observed after 3 years. Changes were particularly important among girls and in relation to pubertal development. These results could provide useful reference data for other longitudinal studies in population sub-groups.

The adaptation into Spanish of the Coddington Life Events Scales (CLES).

AIMS: To obtain a conceptually and psychometrically equivalent Spanish version of the Coddington Life Events Scales (CLES) for children and adolescents and to test their psychometric properties. METHODS: Forward and backward translations were performed. Comprehension, acceptability, and alternative translations were tested in focus groups and semi-structured interviews. An expert panel and the copyright holders of the original version were actively involved. Test-retest reliability [Intraclass Correlation Coefficient (ICC)] was assessed by administering the questionnaire on two occasions 3 months apart to children aged 12-14 years (n = 30). Construct validity was assessed by comparing children's responses with those of their parents (n = 19). The methods replicated those of the validation of the original version. RESULTS: Of the 53 CLES items translated, ten were found to be difficult to understand. Following back-translation, seven items were modified and a final version was obtained. Test-retest ICC reliability for total scores was 0.63. The ICC between children and parents was 0.42. Both results were very similar to those reported for the original version. CONCLUSIONS: These preliminary findings suggest that the Spanish version of the CLES is understandable and acceptable and that it is similar to the original in terms of validity and reliability. Although further validation is needed, it is recommended for use in research settings in Spain.

Hand-assisted laparoscopic nephrectomy versus transperitoneal anterior approach in living donors for renal transplantation.

The objective of this study was to compare two surgical approaches for living donor nephrectomy: transperitoneal anterior approach and the hand-assisted laparoscopic nephrectomy. Between January 2001 and October 2003 we performed 63 kidney transplantations from living donors. The transperitoneal anterior approach was used in 36 cases and the hand-assisted laparoscopic nephrectomy in 27. Outcomes were compared in terms of hospital stay, postoperative analgesia, and graft quality. Mean hospital stay was 4.7 days in the transperitoneal anterior approach group and 3.7 days in the hand-assisted laparoscopic group (P < .005). Postoperative analgesia dosage was significantly lower in the hand-assisted laparoscopic group (P < .001). Surgical complications and graft quality were similar. We concluded that hand-assisted laparoscopic nephrectomy patients had shorter hospital stays and less pain in the postoperative period, with better cosmetic results and equivalent graft quality compared to transperitoneal anterior approach patients.

Ethnicity and glutathione S-transferase (GSTM1/GSTT1) polymorphisms in a Brazilian population.

The distribution of polymorphisms related to glutathione S-transferases (GST) has been described in different populations, mainly for white individuals. We evaluated the distribution of GST mu (GSTM1) and theta (GSTT1) genotypes in 594 individuals, by multiplex PCR-based methods, using amplification of the exon 7 of CYP1A1 gene as an internal control. In São Paulo, 233 whites, 87 mulattos, and 137 blacks, all healthy blood-donor volunteers, were tested. In Bahia, where black and mulatto populations are more numerous, 137 subjects were evaluated. The frequency of the GSTM1 null genotype was significantly higher among whites (55.4%) than among mulattos (41.4%; P = 0.03) and blacks (32.8%; P < 0.0001) from São Paulo, or Bahian subjects in general (35.7%; P = 0.0003). There was no statistically different distribution among any non-white groups. The distribution of GSTT1 null genotype among groups did not differ significantly. The agreement between self-reported and interviewer classification of skin color in the Bahian group was low. The interviewer classification indicated a gradient of distribution of the GSTM1 null genotype from whites (55.6%) to light mulattos (40.4%), dark mulattos (32.0%) and blacks (28.6%). However, any information about race or ethnicity should be considered with caution regarding the bias introduced by different data collection techniques, specially in countries where racial admixture is intense, and ethnic definition boundaries are loose. Because homozygous deletions of GST gene might be associated with cancer risk, a better understanding of chemical metabolizing gene distribution can contribute to risk assessment of humans exposed to environmental carcinogens.

Ethnicity and glutathione S-transferase (GSTM1/GSTT1) polymorphisms in a Brazilian population

The distribution of polymorphisms related to glutathione S-transferases (GST) has been described in different populations, mainly for white individuals. We evaluated the distribution of GST mu (GSTM1) and theta (GSTT1) genotypes in 594 individuals, by multiplex PCR-based methods, using amplification of the exon 7 of CYP1A1 gene as an internal control. In São Paulo, 233 whites, 87 mulattos, and 137 blacks, all healthy blood-donor volunteers, were tested. In Bahia, where black and mulatto populations are more numerous, 137 subjects were evaluated. The frequency of the GSTM1 null genotype was significantly higher among whites (55.4 percent) than among mulattos (41.4 percent; P = 0.03) and blacks (32.8 percent; P < 0.0001) from São Paulo, or Bahian subjects in general (35.7 percent; P = 0.0003). There was no statistically different distribution among any non-white groups. The distribution of GSTT1 null genotype among groups did not differ significantly. The agreement between self-reported and interviewer classification of skin color in the Bahian group was low. The interviewer classification indicated a gradient of distribution of the GSTM1 null genotype from whites (55.6 percent) to light mulattos (40.4 percent), dark mulattos (32.0 percent) and blacks (28.6 percent). However, any information about race or ethnicity should be considered with caution regarding the bias introduced by different data collection techniques, specially in countries where racial admixture is intense, and ethnic definition boundaries are loose. Because homozygous deletions of GST gene might be associated with cancer risk, a better understanding of chemical metabolizing gene distribution can contribute to risk assessment of humans exposed to environmental carcinogens.

Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

Analysis of DNA in minute volumes of blood from stains and crusts.

As the first step, the locus D1S80 was amplified by the polymerase chain reaction technique from genomic DNA extracted from artificial bloodstains and crusts with different amount of blood (32 microl, 16 microl, 8 microl, 4 microl, 2 microl, and 1 microl). In all samples of bloodstains and crusts, identification by DNA analysis was possible. As the second step, the locus HLA-DQA1 was amplified from genomic DNA extracted from diluted blood samples (640, 320, 160, 80, 40, 20, 10, and 5 leukocytes). DNA amplification was possible in diluted blood samples with at least 10 leukocytes. Considering the conditions in which the present study was carried out, it was possible to conclude that 1 microl of bloodstains or crusts was enough for identification. It was also concluded that five leukocytes are not enough material to render consistent DNA identification.

Effect of lipids and oleic acid on biomass development in anaerobic fixed-bed reactors. Part I: Biofilm growth and activity.

Two similar anaerobic fixed-bed bioreactors which allowed the biomass to be periodically withdrawn were run in parallel. After feeding each digester with synthetic dairy wastes of different lipid content (Period I), both digesters were fed with increasing sodium oleate concentrations with skim milk as co-substrate (Period II) and oleate as the sole carbon source (Period III). In Period I, the digester fed with lipids was more efficient and exhibited lower levels of volatile fatty acids than the digester fed without lipids. The biofilm built up in the presence of lipids was thinner, but more resistant to the presence of oleate than the biofilm formed in the absence of lipids, which lost 53% of its solids after contacting with oleic acid. The specific methanogenic activity with butyrate as substrate was enhanced in the presence of lipids, but no significant effect was detected on the acetoclastic and hydrogenophilic activities, which remained similar for both digesters along the trial period.

Effects of lipids and oleic acid on biomass development in anaerobic fixed-bed reactors. Part II: Oleic acid toxicity and biodegradability.

Oleic acid toxicity and biodegradability were followed during long-term operation of two similar anaerobic fixed-bed units. When treating an oleate based effluent, the sludge from the bioreactor that was acclimated with lipids during the first operation period, showed a higher tolerance to oleic acid toxicity (IC50 = 137 mg/l) compared with the sludge fed with a non-fat substrate (IC50 = 80 mg/l). This sludge showed also the highest biodegradation capacity of oleic acid, achieving maximum methane production rates between 33 and 46 mlCH4(STP)/gVS.day and maximum percentages of methanization between 85 and 98% for the range of concentrations between 500 and 900 mg oleate/l. When oleate was the sole carbon source fed to both digesters, the biomass became encapsulated with organic matter, possibly oleate or an intermediate of its degradation, e.g. stearate that was degraded at a maximum rate of 99 mlCH4(STP)/gVS.day. This suggests the possibility of using adsorption-degradation cycles for the treatment of LCFA based effluents. Both tolerance to toxicity and biodegradability of oleic acid were improved by acclimatization with lipids or oleate below a threshold concentration.

Parentage testing on blood crusts from firearms projectiles by DNA typing settles and insurance fraud case.

We describe a case of a fraudulent insurance claim. The family of an adult white male (DLF) notified the police of their son's disappearance. After a few weeks, a corpse that presented characteristics similar to those of the DLF was found in advanced stages of decay and was identified by the family as being DLF. The family then filed a claim for the life insurance that DLF had taken out just before he disappeared. Suspicions were raised about the identification of the corpse, because it had been done only visually, and because the insurance policy had been taken out just prior to DLF's disappearance. The insurance company requested a postmortem examination for identification. As the corpse had been cremated immediately after identification by the family, the biological material that was encrusted on the two projectiles removed from the body was used for analysis. The blood crusts provided enough genomic DNA for us to carry out PCR base typing of HLA-DQA1, D1S80, HUMCSF1PO, HUMTPOX, HUMTH01, D3S1744, D12S1090, D18S849, and amelogenin. Results from all loci typing from the corpse presumed to be that of DLF were then compared with that of his alleged biological parents, revealing genetic incompatibility.

Allele and genotype frequencies for D1S80 locus in a Brazilian population sample.

Gene and genotype frequencies in relation to the D1S80 locus were determined in a sample of 197 unrelated individuals (144 Caucasians and 53 Mulattoes), living in the city of São Paulo, Brazil. The Mulatto group was composed by mixed individuals who presented at least one negroid physical characteristic or declared themselves to be of mixed (Black-White) ancestry. Nineteen different alleles were detected in the Caucasian sample and 15 among Mulattoes. Alleles 18 and 24 were found to be the most common ones in the Caucasian population with frequencies of 0.173 and 0.357 respectively; the sample heterozygote frequency was estimated in 0.824. Alleles 18, 24, and 28 were found to be the most common alleles among Mulattoes with respective frequencies of 0.150, 0.349, and 0.113; the sample heterozygote frequency was 0.759. Fifty-five different genotypes were detected among Brazilian Caucasians whereas the respective figure among Mulattoes was 31. No significant deviations from Hardy-Weinberg equilibrium were found in both population samples.

Post-mortem forensic identity testing: application of PCR to the identification of fire victim.

CONTEXT: DNA analysis has been used with success in the identification of carbonized corpses and victims of large accidents. The analysis requires relatives of crash victims to donate blood for analysis. The relatives are generally willing contribute to the identification by giving a blood sample. OBJECTIVE: To describe the use of the polymerase chain reaction (PCR) for genetic characterization of one victim extensively burned by fire. DESIGN: Case report. CASE REPORT: DNA was extracted from blood of the cardiac chamber, and 15 different loci (D1S80, ApoB, D17S30, D3S1744, D18S849, D12S1090, FGA, D7S820, D1S533, D9S304, HUMCSF1PO, HUMTPOX, HUMTHO1, amelogenin and HLA-DQA1) were analyzed using the PCR technique. Results from all loci typing of the corpse were then compared to that of his alleged biological parents, revealing a genetic compatibility.

Cytochrome P450-2E1 and glutathione S-transferase mu polymorphisms among Caucasians and mulattoes from Brazil.

The variable interindividual ability to metabolize environmental toxicants, also known as metabolic polymorphism, may be of substantial importance in the modulation of cancer risk. The ethnic distribution of these polymorphisms could be interesting in order to establish an association with cancer risk or even to establish selective advantage of some genotypes. Cytochrome P450 2E1 (CYP2E1) is a secondary enzyme that can metabolize ethanol, and glutathione S-transferase (GSTM1) is thought to be involved in the detoxification of epoxides and polycyclic aromatic hydrocarbons. Mutation in these genes was investigated in a random sample of healthy subjects from São Paulo, Brazil, which included 206 Caucasians and 86 mulattoes. Pst I restriction fragment length polymorphism (RFLP) in the 5'-flanking region of the CYP2E1 gene has been identified in 10.2% of Caucasian individuals and in 11.6% of mulattoes. For GSTM1 the frequency of the null genotype was significantly higher in Caucasian individuals (60.2%) than in mulattoes (41.9%). Allele frequencies were (1) CYP2E1 locus: P = 0.949, q = 0.051, se(p) = se(q) = 0.011 among Caucasians; and p = 0.942; q = 0.058; se(P) = se'(q) = 0.018 among mulattoes; and (2) GSTM1 locus: p = 0.224, q = 0.776, se(p) = se(q) = 0.022 among Caucasians; and p = 0.353; q = 0.647; se(p) = se(q) = 0.041 among mulattoes.

Gene and genotype frequencies for HLA-DQA1 in Caucasians and Mulattoes in Brazil.

Gene and genotype frequencies of the HLA-DQA1 locus were determined in a sample of 197 unrelated individuals (144 Caucasians and 53 Mulattoes), living in the city of São Paulo, Brazil. The Mulatto group consisted of mixed individuals who presented at least one negroid physical characteristic or declared themselves to be of mixed ancestry. A total of six different alleles were identified with frequencies ranging from 0.087 to 0.316 in the Caucasian population and from 0.066 to 0.330 in the Mulatto population. We observed an increased frequency of allele 1.2 among Mulattoes in relation to Caucasians. The sample heterozygote frequency was 0.722 among Caucasians and 0.736 among Mullatoes. No significant deviations from Hardy-Weinberg equilibrium were found either in the Caucasian or in the Brazilian Mullato population samples.

An international perspective on the treatment of pediatric shock: the Brazilian experience.

Shock in the pediatric population has many preventable causes. Treatment of children in shock will depend on access to health services, training of health personnel, availability of diagnostic procedures, monitoring, and therapeutic measures. Countries will differ among themselves and within themselves in the care provided to children developing shock. In Brazil, the majority of children are cared for in public hospitals, which often lack resources for basic care. Many children in shock do not even reach healthcare services. Investment in training healthcare personnel in a simplified and systematic approach to shock and access to equipped health services are basic to improved outcomes in the treatment of pediatric shock. The Brazilian experience in the treatment of children in shock outside hospital facilities, in the emergency department, and in the ICU is described.

[Anopheles (Culicidae, Anophelinae) and Malaria in Buriticupu-Santa Luzia, pre-Amazonic Maranhao]. / Anopheles (Culicidae, Anophelinae) e a Malária em Buriticupu-Santa Luzia, Pré-Amazônia maranhense.

Seven species belonging the subgenus Nyssorhyncus were found. Anopheles (N.) darlingi, the principal vector of human malaria, was the most abundant (53.1%) followed by A. (N.) evansae (21.0%, A. (N.) triannulatus (17.4%) e A. (N.) nuñeztovari (4.8%). The others, A. (N.) argyritarsis. A. (N.) oswaldoi and A. (N.) rangeli, were less frequently found, representing only 3.7% of the total sample. The anophelines were most frequent in both the extra (51.7%) and peridomiciles (45.7%). The intradomicile was visited by some specimens of the A. (N.) darlingi and A. (N.) evansae (active in both the rain and dry seasons, especially in the former, when the malaria reached high levels of transmission.