Undenatured type II collagen mitigates inflammation and cartilage degeneration in healthy Labrador Retrievers during an exercise regimen.

The aim of this experiment was to evaluate the effect of undenatured type II collagen supplementation on inflammation and cartilage degeneration after exercise in healthy dogs. Forty healthy Labrador Retrievers (20 male/20 female; range 5-12 yr; average 8 yr) were sorted into two groups: undenatured type II collagen group receiving 40 mg UC-II (10 mg collagen type II/min. 3% undenatured type II collagen; Lonza Consumer Health, Inc.) and placebo group receiving 40 mg maltodextrin daily by capsule. After 2-wk loading, all dogs began an 11-wk endurance exercise regimen consisting of two weekly runs, starting at 5 km and increasing incrementally to 8 km, with one final 16 km run. Blood samples were collected at baseline, pre and post first 5 km run, and pre- and post-16 km run. Activity per kilometer was greater in male undenatured type II collagen vs. male placebo over all runs (P = 0.004), and average moving speed was greater in all undenatured type II collagen dogs compared with placebo over all runs (P < 0.001). Hematology analysis indicated that during the first insult, undenatured type II collagen dogs had a greater lymphocyte count (P < 0.001) and lymphocyte percentage (P = 0.001) vs. placebo dogs. Undenatured type II collagen dogs had a lesser neutrophil percentage (P = 0.042) and neutrophil to lymphocyte ratios (P = 0.001) compared to placebo dogs. For the final insult, undenatured type II collagen dogs had greater lymphocyte percentage (P = 0.013) and lesser mean corpuscular hemoglobin concentration (P = 0.043) compared with placebo dogs. Both groups had significant changes between timepoints for several hematological parameters. Biomarker IL-6 was lesser in undenatured type II collagen dogs compared with placebo at post 5 km (P = 0.037). Cartilage oligomeric matrix protein (COMP) was lesser in undenatured type II collagen dogs at post 16 km (P = 0.023), and only the placebo dogs had a significant increase in COMP from pre to post 16 km (P = 0.021). In summary, Labrador Retrievers supplemented with undenatured type II collagen had decreased inflammation and cartilage degeneration compared with nonsupplemented dogs during exercise.

To What Extent do Social Determinants of Health Modulate Presentation, ITU Admission and Outcomes among Patients with SARS-COV-2 Infection? An Exploration of Household Overcrowding, Air Pollution, Housing Quality, Ethnicity, Comorbidities and Frailty.

Background: Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape. Methods: An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes. Results: Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission. Conclusion: Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

BACKGROUND: Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population. METHODS: Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, BMI and study covariates. RESULTS: Adjusting for covariates and allowing for between-study variation, women identifying as lesbian (OR = 1.41, 95% CI: 1.16, 1.72) or bisexual (OR = 1.24, 95% CI: 1.03, 1.48) were at increased risk of overweight/obesity compared to heterosexual women, but men identifying as gay were at decreased risk (OR = 0.72, 95% CI: 0.61, 0.85) compared to heterosexual men. Increased risk of being underweight was seen for women identifying as 'other' (OR = 1.95, 95% CI: 1.07, 3.56), and men identifying as gay (OR = 3.12, 95% CI: 1.83, 5.38), bisexual (OR = 2.30, 95% CI: 1.17, 4.52), 'other' (OR = 3.95, 95% CI: 1.85, 8.42). CONCLUSIONS: The emerging picture of health disparities in this population, along with well documented discrimination, indicate that sexual orientation should be considered as a social determinant of health.

Gluten-free and low-FODMAP sourdoughs for patients with coeliac disease and irritable bowel syndrome: A clinical perspective.

Wheat- and gluten-containing products are often blamed for triggering a wide range of gastrointestinal symptoms, and this has fueled demand for gluten-free products worldwide. The best studied 'gluten intolerance' is coeliac disease, an auto-immune disease that affects the small intestine. Coeliac disease occurs in 1% of the population and requires strict, life-long avoidance of gluten-containing foods as the only medical treatment. There is a larger group of individuals (around 10-15% of the population) who report a wide-range of gastrointestinal symptoms that respond well to a 'gluten-free diet', but who do not have coeliac disease - so called 'non-coeliac gluten sensitivity (NCGS)'. The team at Monash University has identified other factors in gluten-containing foods that may be responsible for symptoms in this group of individuals with so-called, NCGS. We have evidence that certain poorly absorbed short chain carbohydrates (called FODMAPs) present in many gluten-containing food products, induce symptoms of abdominal pain, bloating, wind and altered bowel habit (associated with irritable bowel syndrome, IBS). Our research has shown that FODMAPs, and not gluten, triggered symptoms in NCGS. Going forward, there are great opportunities for the food industry to develop low FODMAP products for this group, as choice of grain variety and type of food processing technique can greatly reduce the FODMAP levels in foods. The use of sourdough cultures in bread making has been shown to reduce the quantities of FODMAPs (mostly fructan), resulting in bread products that are well tolerated by patients with IBS. Greater interaction between biomedical- and food-scientists will improve understanding about the clinical problems many consumers face, and lead to the development of food products that are better tolerated by this group.

The cost-effectiveness of hospital-based telephone coaching for people with type 2 diabetes: a 10 year modelling analysis.

BACKGROUND: Type 2 diabetes (T2DM) is a burdensome condition for individuals to live with and an increasingly costly condition for health services to treat. Cost-effective treatment strategies are required to delay the onset and slow the progression of diabetes related complications. The Diabetes Telephone Coaching Study (DTCS) demonstrated that telephone coaching is an intervention that may improve the risk factor status and diabetes management practices of people with T2DM. Measuring the cost effectiveness of this intervention is important to inform funding decisions that may facilitate the translation of this research into clinical practice. The purpose of this study is to assess the cost-effectiveness of telephone coaching, compared to usual diabetes care, in participants with poorly controlled T2DM. METHODS: A cost utility analysis was undertaken using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model to extrapolate outcomes collected at 6 months in the DTCS over a 10 year time horizon. The intervention's impact on life expectancy, quality-adjusted life expectancy (QALE) and costs was estimated. Costs were reported from a health system perspective. A 5 % discount rate was applied to all future costs and effects. One-way sensitivity analyses were conducted to reflect uncertainty surrounding key input parameters. RESULTS: The intervention dominated the control condition in the base-case analysis, contributing to cost savings of $3327 per participant, along with non-significant improvements in QALE (0.2 QALE) and life expectancy (0.3 years). CONCLUSIONS: The cost of delivering the telephone coaching intervention continuously, for 10 years, was fully recovered through cost savings and a trend towards net health benefits. Findings of cost savings and net health benefits are rare and should prove attractive to decision makers who will determine whether this intervention is implemented into clinical practice. TRIAL REGISTRATION: ACTRN12609000075280.

Effect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial.

BACKGROUND: Failure to achieve treatment targets is common among people with type 2 diabetes. Cost-effective treatments are required to delay the onset and slow the progression of diabetes-related complications. AIMS: This study aimed to measure the effect of a 6-month telephone coaching intervention on glycaemic control, risk factor status and adherence to diabetes management practices at the intervention's conclusion (6 months) and at 12 months. METHOD: This randomised controlled trial recruited 94 adults with type 2 diabetes and an HbA1C > 7% from the Diabetes Clinic of St Vincent's Hospital Melbourne. People who were non-English speaking, cognitively impaired, severely hearing impaired or without telephone access were excluded. Participants were randomised to receive usual care plus 6 months of telephone coaching focusing on achieving treatment targets and complication screening, or usual care only. The primary outcome was HbA1C at 6 months; secondary outcomes included other physiological and monitoring measures. RESULTS: Significant interaction effects were observed between group and time at 6 months, demonstrating improvement in HbA1C, fasting glucose, diastolic blood pressure and physical activity. The intervention's effect on these parameters was not sustained at 12 months. Intervention group participants also improved compliance with foot examinations and pneumococcal vaccination by 6 months and retinal screening by 12 months. CONCLUSIONS: Telephone coaching improved glycaemic control and adherence to complication screening in people with type 2 diabetes, for the duration of its delivery, but these effects were not maintained on withdrawal of the intervention. Strategies that assist patients to sustain these benefits are required.

Double esterase staining and other neutrophilic granule abnormalities in 237 patients with the myelodysplastic syndrome studied by the cancer and leukemia group B.

We investigated double (specific and nonspecific) esterase (DE) staining in marrow cells of 237 patients with the myelodysplastic syndromes (MDS). Additional abnormalities of neutrophilic granules were examined cytochemically and immunocytochemically for myeloperoxidase activity and antigen elastase, lactoferrin and CD15 granule-membrane glycoproteins. Abnormal DE staining (>/=3% of all nucleated marrow cells) was present in 27% of patients with no difference among different MDS subtypes. However, the prevalence of high abnormal DE staining (>/=10%) was significantly lower in refractory anemia with excess blasts in transformation (1%) compared to other MDS subtypes (12-15%; p = 0.004). The prevalence of other granule abnormalities was not statistically different in the DE normal and DE abnormal groups. Abnormal DE staining is relatively common among all MDS subtypes. High DE staining may identify a subgroup of patients with a lower grade MDS.

Deficiency of neutrophilic granule membrane glycoproteins in the myelodysplastic syndromes: a common deficiency in 216 patients studied by the Cancer and Leukemia Group B.

Previous studies on neutrophils in patients with the myelodysplastic syndromes (MDS) have indicated deficiencies in the contents of primary and secondary granules. However, the granule membrane remains virtually unstudied despite its essential role in the dynamic function of the cytoplasmic granules. In this study, we examined the membrane glycoproteins of primary and secondary granules of peripheral blood and/or bone marrow neutrophils using the monoclonal antibody H36/71 to CD15 glycoproteins. In addition, myeloperoxidase activity and antigen, elastase and lactoferrin were also studied using cytochemical and immunocytochemical stains. A total of 216 patients were included. Deficiencies of granule membrane glycoproteins were the most common, detected in 49%, followed by myeloperoxidase activity (17%), elastase (16%), myeloperoxidase antigen (9%), and lactoferrin (8%). Multiple deficiencies always included granule membrane deficiency. We conclude that granule membrane defects are common in MDS, may provide a common mechanism for multiple granule deficiencies, and may prove to be an additional abnormality associated with granulocyte dysfunction.

Hospitalizations for hip fractures among elderly persons in Hawaii, 1986-1990.

Hawaii differs ethnically, geographically, and culturally from other states; therefore, United States hip fracture data cannot be assumed to apply to Hawaii. The purpose of this research was to gain new knowledge about hip fracture in Hawaii to plan and target appropriate services and design preventive measures. Peer Review Organization Medicare data were analyzed for persons age 65+ over a 4-year period. Average length of hospital stay was 20 days resulting in an average estimated charge per hospitalization of $20,000. Of those with E-Codes, 94% sustained falls. Fifty-five percent had one or more complicating illness. Unexpected significant differences were found among the islands: the average annual hospitalization incidence rate/1,000 on Kauai (8.4) was almost twice that of the Island of Hawaii (4.4), and Maui (3.9), and significantly greater than Oahu (5.4), primarily in women over 85. The island differences raise important questions in need of investigation, and suggest target populations and locations for prevention.

Morphologic characteristics of acute lymphoblastic leukemia (ALL) with abnormalities of chromosome 8, band q24.

The CALGB prospectively studied 140 adult acute lymphoblastic leukemia (ALL) patients for cytogenetic abnormalities. Seven (5%) patients with adequate cytogenetic preparations had t(8;14)(q24;q32) or t(8;22)(q24;q11). Patients were compared with non-8q24 patients for clinical and laboratory characteristics, response to therapy, and survival. The median age of patients with translocations involving 8q24 (71% males) was 40 years. Forty-three percent had lymphadenopathy, 29% splenomegaly, and 29% hepatomegaly. None exhibited central nervous system (CNS), skin, or gum involvement. These features did not differ significantly from non-8q24 ALLs. Patients with 8q24 translocations had higher hemoglobins (11.5 vs. 9.8 g/dl; P = 0.04) and lower percentage of blasts in the peripheral blood (8.5% vs. 69%; P = 0.007). Although all seven were finally categorized as ALL-L3, a marked variation in the proportion of typical L3 blasts was observed that initially resulted in the diagnoses of ALL-L2 in three cases and prolymphocytic leukemia in one. In five of five patients, the blasts typed as B cells (SIg+ and CD19+). Complete remission rates for patients with 8q24 translocations were 43%, whereas they were 68% for non-8q24 ALLS (P = 0.22). Furthermore, patients with 8q24 abnormalities exhibited significantly shorter survival (4.8 vs. 18.4 mo; P less than 0.001). We conclude that ALL with translocations of 8q24 in adults shows a mature B-cell immunophenotype (SIg+), poor prognosis and morphology ranging from classical ALL-L3 to ALL with a subpopulation of L3 cells. Thus, the diagnosis of ALL-L3 should be made when blastic cells possess a mature B-cell immunophenotype (SIg+) and an 8q24 translocation, even though the number of L3 cells is low.

Traumatic spinal cord injury in Hawaii.

As a prelude to continuing surveillance in Hawaii, a 2-year retrospective study (1987-1989) was conducted by the Pacific Basin Rehabilitation Research & Training Center (PBRRTC) and the Rehabilitation Hospital of the Pacific (REHAB) in order to examine the frequency and causes of traumatic spinal cord injury (SCI) at REHAB; determine similarities and differences when compared to national statistics and make recommendations for future study. Data were abstracted from patient records at REHAB. During the period of study, 59 persons were treated for SCI. Similar to the national database, 85% were males and 70% were teenagers and young adults. Motor Vehicle Accidents (MVAs) contributed to 38% of the injuries followed by falls (28%), sports (19%) and violence (16%); however, etiology differed according to age. Sixty-two percent of the lesions were cervical. Almost 50% were neurologically complete. Sixty-six percent were in wheelchairs. Over 50% were independent in mobility and feeding and nearly 40% were independent in bathing and dressing. Eighty-eight percent returned to their homes. In general, the case at REHAB did not differ from the national database. Because reporting has not been mandatory, actual SCI incidence in Hawaii is most likely higher. Information derived from a mandatory reporting system would lead to identification of high risk groups, development and evaluation of prevention programs, identification of patients requiring early intervention and rehabilitation, and better planning of health care services.

Polio survivors in Hawaii: new problems of health and disability.

U.S. mainland studies reveal an alarming rise of progressive disability reported by long-term polio survivors. To determine if polio survivors residing in Hawaii were experiencing similar problems, this study of 100 volunteers was undertaken. Extensive interviews and physical examinations were performed. Results indicate that many patients were complaining of new or greater disability due to late complications of polio or medical conditions unrelated to polio. Twenty percent appeared at greater risk for having post-polio syndrome (PPS). Over half described mobility that was less than fully independent. Subjects voiced a clear need for specialized health, social and rehabilitative services. Consistent with Mainland reports, polio survivors in Hawaii are demonstrating changes in disability that challenge the traditional notion that polio is a static, permanently stable neurologic condition.

Comparison of two methods for assessing the removal of total organisms and pathogens from the skin.

A standard hand-wash sampling technique was compared with a simple finger-streak sampling method in assessing the relative effectiveness of a number of alternative preparations used for disinfecting the surgeon's hands (alcoholic 0.5% chlorhexidine, alcoholic 0.1% tetrabrom-o-methyl phenol, a 4% chlorhexidine detergent solution, aqueous 0.5% chlorhexidine, 2% 'Irgasan' detergent solution and, as control, bar soap). There was a fairly good correlation between the results of assessment by the two methods after a single disinfection and after six disinfections, three on one day and three on the next. Significant differences were shown in 21 comparisons between treatments when the hand-wash sampling test was used, and 16 of these comparisons also showed a significant difference by the finger-streak test. Staphylococcus aureus was found in hand samplings from 5 out of 8 nurses in the Burns Unit of Birmingham Accident Hospital by the hand-wash sampling method and from 2 of the same 8 nurses by the finger-streak method; the numbers were small, and no Staph. aureus were isolated from the same hands after 1 min. wash in 70% ethyl alcohol. Similar sampling on 29 nurses in other wards showed Staph. aureus on 3 nurses (one in large numbers) by the hand-wash technique and on 1 nurse by the finger-streak test; in only 1 nurse whose hands showed Staph. aureus before disinfection was the organism found, by hand-wash sampling, after disinfection. Parallel sampling of nurses' hands after washing with soap and water and after disinfection with 95% ethanol showed larger numbers of Staph. aureus in a hospital for skin diseases than in a general hospital, and a lower incidence and somewhat lower density of Staph. aureus after ethanol treatment than after washing with soap and water; Gram-negative bacilli, on the other hand, were commoner on hands in the general than in the skin hospital, and present in much smaller numbers after disinfection with ethanol than after washing with soap and water. Antibiotic sensitivity tests showed the frequent recurrence on the hands of some nurses of multi-resistant Staph. aureus with resistance patterns similar to those found in infective lesions in some of the patients; different sensitivity patterns were usually found in staphylococci isolated from the nose. Even in wards where many patients were infected, carriage by nurses' hands of a particular strain of Staph. aureus did not seem to last for more than a few days.