Gamma-linolenic acid supplementation for prophylaxis of atopic dermatitis--a randomized controlled trial in infants at high familial risk.

BACKGROUND: Studies suggest that low concentrations of n-6 long-chain polyenes in early life are correlated to atopic disease in later life. OBJECTIVE: The purpose of the study was to investigate the possible preventive effect of gamma-linolenic acid (GLA) supplementation on the development of atopic dermatitis in infants at risk. DESIGN: In a double-blind, randomized, placebo-controlled trial, formula-fed infants (n = 118) with a maternal history of atopic disease received borage oil supplement (containing 100 mg GLA) or sunflower oil supplement as a placebo daily for the first 6 mo of life. Main outcome measures were the incidence of atopic dermatitis in the first year of life (by UK Working Party criteria), the severity of atopic dermatitis (SCORing Atopic Dermatitis; SCORAD), and the total serum immunoglobulin E (IgE) concentration at the age of 1 y. RESULTS: The intention-to-treat analysis showed a favorable trend for severity of atopic dermatitis associated with GLA supplementation ( x+/- SD SCORAD: 6.32 +/- 5.32) in the GLA-supplemented group as compared with 8.28 +/- 6.54 in the placebo group (P = 0.09; P = 0.06 after adjustment for total serum IgE at baseline, age 1 wk), but no significant effects on the other atopic outcomes. The increase in GLA concentrations in plasma phospholipids between baseline and 3 mo was negatively associated with the severity of atopic dermatitis at 1 y (Spearman's correlation coefficient = -0.233, P = 0.013). There was no significant effect on total serum IgE concentration. CONCLUSION: Early supplementation with GLA in children at high familial risk does not prevent the expression of atopy as reflected by total serum IgE, but it tends to alleviate the severity of atopic dermatitis in later infancy in these children.

A clinical prediction rule for histological chorioamnionitis in preterm newborns.

BACKGROUND: Histological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns. AIM: Develop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns. METHODS: Clinical data and placental pathology were obtained from singleton preterm newborns (gestational age ≤ 32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Máxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth. RESULTS: HC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92-0.98), a positive predictive value of 80% (95%CI = 74-84%), and a negative predictive value of 93% (95%CI = 88-96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88-0.96), positive predictive value 59% (95%CI = 52-62%), and negative predictive value 97% (95%CI = 93-99%). External validation expectedly resulted in some loss of test performance, preferentially affecting positive predictive rather than negative predictive values. CONCLUSION: Using a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.

Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory.

OBJECTIVE: To translate the Dizziness Handicap Inventory into German (DHI-G) and investigate reliability, assess the association between selected items of the University of California Los Angeles Dizziness Questionnaire and the DHI-G, and compare the scores of patients and healthy participants. STUDY DESIGN: Cross-sectional design. SETTING: Tertiary center for vertigo, dizziness, or balance disorders. PATIENTS: One hundred forty-one patients with vertigo, dizziness, and unsteadiness associated with a vestibular disorder, with a mean age (standard deviation) of 51.5 (13.2) years, and 52 healthy individuals participated. INTERVENTIONS: Fourteen patients participated in the cognitive debriefing; 127 patients completed the questionnaires once or twice within 1 week. MAIN OUTCOME MEASURES: The DHI-G assesses disability caused by dizziness and unsteadiness; the items of the University of California Los Angeles Dizziness Questionnaire assess dizziness and impact on everyday activities. Internal consistency was estimated using Cronbach alpha, reproducibility by calculating Bland-Altman limits of agreement and intraclass correlation coefficients. Associations were estimated by Spearman correlation coefficients. RESULTS: Patients filled out the DHI-G without problem and found that their self-perceived disabilities were mostly included. Cronbach alpha values for the DHI-G and the functional, physical, and emotional subscales were 0.90, 0.80, 0.71, and 0.82, respectively. The limits of agreement were +/-12.4 points for the total scale (maximum, 100 points). Intraclass correlation coefficients ranged from 0.90 to 0.95. The DHI-G correlated moderately with the question assessing functional disability (0.56) and fairly with the questions quantifying dizziness (0.43, 0.35). The DHI-G discriminated significantly between healthy participants and patients. CONCLUSION: The DHI-G demonstrated good reliability and is recommended as a measure of disability in patients with dizziness and unsteadiness.

Prescription of benzodiazepines in general practice in the context of a man-made disaster: a longitudinal study.

BACKGROUND: Mental health problems associated with benzodiazepine treatment are often highly prevalent in the aftermath of disasters. Nevertheless, not much is known about benzodiazepine use after disasters. Considering the negative effects associated with prolonged use and the adverse effects of benzodiazepines on recovery of patients with acute stress, the aim of the present study was to explore benzodiazepine use in the context of the Enschede fireworks disaster of 13 May 2000. METHODS: A longitudinal study using electronic medical records of general practitioners. Subjects were patients aged 16 years and older, registered at one of the practices between 1999 and 2003 (1541 victims and 5370 references). Pre- and post-disaster data were available on benzodiazepine prescriptions, healthcare utilization and sociodemographic characteristics. Benzodiazepine use was defined using different criteria (e.g. any use, daily use, chronic use). Data were analysed using multivariate multilevel logistic regression analyses. RESULTS: Compared with patients from a reference group, disaster victims were at increased risk of becoming an incident benzodiazepine user after the disaster. Benzodiazepine use also had a different time course among victims compared with references. However, daily or prolonged use of benzodiazepines was not often observed and did not show dramatic deviations among disaster victims compared with references. CONCLUSION: There is no convincing evidence that general practitioners systematically deviated from clinical guidelines for benzodiazepines, which generally advocate their short time application.