Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ).

BACKGROUND: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. METHODS: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments. RESULTS: Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ. CONCLUSIONS: The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.

Impedance spectroscopy for the non-destructive evaluation of in vitro epidermal models.

PURPOSE: Reconstructed human epidermis (RHE) is standardly used for the risk assessment of chemical compounds. However, analysis is dependent on invasive methods such as histological processing or 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) staining. METHODS: As an alternative, we have developed a non-destructive technology to analyze the integrity of epidermal equivalents based on impedance spectroscopy. RHEs were generated and impedance spectra were recorded. from these spectra, we extrapolated electrical characteristics such as the capacitance and the ohmic resistance. Furthermore, the measurable electrical parameters were used to quantify the effects of mechanical and chemical disruption of the epidermal integrity. RESULTS: A fully matured RHE exhibits typical impedance spectra in a frequency ranging between 1 Hz and 100 kHz, which is comparable to the spectra of freshly isolated human epidermal biopsies. We could show that, during RHE maturation, these characteristics change significantly. Thus, capacitance and ohmic resistance can be employed as a criterion for the quality control of skin equivalents. Additionally, our application of impedance spectroscopy reveals sufficient sensitivity to detect a transient decreased ohmic resistance caused by 2-propanol, which is classified as a non-irritant by MTT assays. CONCLUSION: These results indicate that impedance spectroscopy can be employed as a non-destructive complementary method to assess mild irritative effects, which is currently not possible.

Short-term balance consolidation relies on the primary motor cortex: a rTMS study.

Structural and functional adaptations occur in the primary motor cortex (M1) after only a few balance learning sessions. Nevertheless, the role of M1 in consolidating balance tasks remains to be discussed, as direct evidence is missing due to the fact that it is unclear whether adaptations in M1 are indeed the driving force for balance improvements or merely the consequence of improved balance. The aim of the present study was to investigate whether the primary motor cortex is involved in the learning and consolidation of balance tasks. Thirty participants were randomly allocated into a repetitive transcranial magnetic stimulation (rTMS) or sham-rTMS group. The experimental design included a single balance acquisition phase, followed by either 15 min of low-frequency rTMS (1 Hz at 115% of resting motor threshold to disrupt the involvement of M1) or sham-rTMS, and finally a retention test 24 h later. During the acquisition phase, no differences in balance improvements were observed between the two groups. However, significant differences between the rTMS and the sham-rTMS group were found from the end of the acquisition phase to the retention test. While the rTMS group had a performance loss, the sham-rTMS group displayed significant off-line gains (p = 0.001). For the first time, this finding may propose a causal relationship between the involvement of M1 and the acquisition and consolidation of a balance task.

Interference of balance tasks revisited: Consolidation of a novel balance task is impaired by subsequent learning of a similar postural task.

BACKGROUND: Interference effects have repeatedly been demonstrated for simple motor tasks but not for the complex whole-body task of balancing. It was therefore assumed that different balance tasks are so specific that they do not elicit interacting adaptations; neither in a positive (contextual interference) nor in a negative way (disruption of motor consolidation). RESEARCH QUESTION: Is a novel balancing task susceptible to interference if a similar balance task is learned shortly afterwards? METHODS: The common A1-B-A2 interference intervention design was applied. Participants were assigned to one of four intervention groups that differed with respect to task B. All four groups performed postural task A on a rocker board device (6 series of 8 trials of 8 s). Shortly after completion of task A, participants performed their respective task B (postural wobble board (P-WB), ballistic force, accuracy) or rested (control group). 24 h later, all groups performed a retention test of task A consisting of one series of 8 trials. To test for interference, we calculated repeated mixed design analysis of covariance (ANCOVA). RESULTS: For the retention test, the ANCOVA revealed a significant TIME*GROUP interaction (p = .010), which was followed up by separate Bonferroni-corrected post-hoc tests for each group. These tests showed a significant performance decrease for the P-WB group (p = .016) but no change in performance for the other three groups. SIGNIFICANCE: In contrast to previous findings, our results indicate that the complex whole-body task of balancing is susceptible to interference, but only, when task B consists of a similar balance task. This is of great functional relevance as for example fall prevention programs incorporate many different balance tasks to prepare participants for all sorts of situations. In such interventions, it seems therefore advisable to apply a random instead of a blocked practice design.

Apple and peach consumption habits across European countries.

The aim of this study was to gain information concerning apple and peach consumption frequency within different European countries in relation to age and gender. The survey was a part of a complex experiment with the aim of evaluating consumers' preferences towards new varieties, and the data is based on the self-reported declarations of respondents, male and female, between 15 and 70 years old. 4271 consumers from 7 European countries were invited to supply information about their apple consumption habits, whereas 499 respondents from 5 countries answered questions relating to frequency of peach and nectarine consumption. In both, the apple and the peach surveys, data analysis of declared intake showed significant differences between nationalities. The highest apple consumption was in Poland, where over 55% declared a consumption of more than 5 apples per week. In comparison, Italian consumers most often indicated eating 3-5 apples per week (39.3%). The lowest apple consumption was in the Netherlands and Spain. In the case of peaches, the highest consumption was indicated in France where 48% of respondents declared a peach consumption of 3-5 per week with 40% eating more than 5 fruits per week. The lowest peach intake was declared in Germany. Irrespective of country women were shown to eat more apples that men. Furthermore, the group of older people (61-70 years) consume apples more often than the adult group (36-60), while within the youngest group of consumers (16-35) eating apples was not at all popular. As with apples females declared a higher peach consumption, and again significantly lower fruit consumption by the youngest group (16-35) was indicated. Although the availability of fruit at the market remains a prime factor in determining apple and peach consumption, our survey confirmed the trends of declining this popular fruit intake by the younger generation, as well as the persistent tendency of lower frequency of fruit consumption among men than women.

The Cancer, Lifestyle and Evaluation of Risk Study (CLEAR): Rationale and design of an unmatched "case-spouse control" study of over 10,000 participants in New South Wales, Australia.

INTRODUCTION: The New South Wales (NSW) Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) is an open epidemiological bioresource, using an all cancer unmatched case-spouse control design. Participant characteristics and selected confirmed associations are compared to published estimates: current smoking and lung cancer; country of birth and melanoma; body mass index (BMI) and bowel cancer; and paternal history of prostate cancer and prostate cancer, to illustrate the validity of this design. MATERIAL AND METHODS: Cases are NSW residents, ≥18 years, with an incident cancer of any type. Controls are cancer-free spouses of cases. Participants complete a consent form, a questionnaire, and provide an optional blood sample. For analyses, odds ratios for males and females are calculated for cancers and exposures of interest, by sex-matching controls to cases. RESULTS: 10,816 participants (8569 cases, 2247 controls, 54% female) recruited to-date, median age: 61.6 y cases, 61.3 y controls. The top five cancer types are female breast (n=1691), prostate (n=1102), bowel (n=888), melanoma (n=608), and lung (n=265). Adjusted odds ratios (OR) were: 20.65 (95% CI: 13.25-32.19) for lung cancer in current versus never smokers; 1.16 (1.05-1.28) for bowel cancer per 5 kg/m(2) increment in BMI; 1.41 (1.01-1.96) for melanoma in Australian-born compared to those born in UK/Ireland; and 2.47 (1.82-3.37) for prostate cancer in men with versus without a paternal history of prostate cancer. DISCUSSION: This study design, where controls are the spouses of cases diagnosed with a variety of cancers and which are analysed unmatched, avoids potential biases due to overmatching, considered problematic in standard case-spouse control studies, and illustrates that risk estimates analysed are consistent with the published literature. CLEAR methodology provides a practical design to advance local knowledge on the causes of various leading and emerging cancers.

A system for obtaining undiluted intraoperative vitreous biopsy samples.

For many analyses of the vitreous, it is essential to obtain undiluted vitreous specimens under sterile conditions intraoperatively. In this new technique, a metal device is integrated into the aspiration system. The device fits on standard laboratory plastic containers with integrated caps. Undiluted vitreous accumulates in the container, which is then removed and sent to the laboratory. With a new container in place, vitrectomy can be continued as usual. This technique is simple, safe, effective, and inexpensive.

Anterior chamber contamination during cataract surgery with intraocular lens implantation.

PURPOSE: To measure anterior chamber bacterial and fungal contamination at the beginning and end of cataract surgery with intraocular lens (IOL) implantation in a large series of patients and to determine the influence of preoperative treatment and operative technique on contamination. SETTING: Department of Ophthalmology, County Hospital of Salzburg, Austria. METHODS: This prospective study comprised 700 consecutive patients having planned cataract extraction (511 phacoemulsification, 189 extracapsular cataract extraction [ECCE]). Thirty-four patients required an anterior vitrectomy; 8 myopic patients did not receive an IOL. A preoperative smear and two intraoperative (at the beginning and end of surgery) anterior chamber aspirates were obtained from each patient. Postoperative smears were obtained at discharge. Three preoperative treatments were evaluated: no lacrimal system irrigation, no topical antibiotic (n = 282); lacrimal system irrigation with balanced saline solution, no topical antibiotic (n = 243); lacrimal system irrigation, antibiotic (neomycin) eyedrops (n = 175). All patients received topical indomethacin twice a day preoperatively. RESULTS: Preoperative conjunctival smears showed bacterial growth in 76.6% of eyes, with coagulase-negative staphylococci (75%) the most common bacteria. Anterior chamber aspirates were culture positive in 14.1% at the beginning and in 13.7% at the end of surgery, with coagulase-negative staphylococci and corynebacteria the most common. Contamination rates of conjunctival smears taken at discharge were significantly lower (35%) than those taken preoperatively. There was no statistically significantly higher risk of anterior chamber contamination in eyes having ECCE than in those having phacoemulsification. Preoperative treatment did not statistically significantly influence intraoperative aqueous humor contamination rates. There were no cases of acute postoperative endophthalmitis. CONCLUSION: Bacteria entered the anterior chamber during cataract extraction and remained there at the end of surgery in a significant percentage of patients. Surgical technique, preoperative antibiotics, and preoperative lacrimal system irrigation had no statistically significant effect on contamination.

[Isotretinoin administration in treatment of acne vulgaris. A prospective study of the kind and extent of ocular complications]. / Isotretinoinapplikation zur Behandlung der Akne vulgaris. Prospektive Studie über Art und Ausmass der okulären Komplikationen.

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. In the skin this substance causes an atrophy of sebaceous gland acini and a decrease in sebum production. Systemic treatment also alters meibomian gland function and structure. These alterations seem to be responsible for ocular complications (dryness of the eye, blepharitis, conjunctivitis) during therapy with isotretinoin. We inspected 30 patients before, during and after therapy with isotretinoin with regard to ocular side effects. Examination included careful slit-lamp inspection, measurement of break-up time (BUT) and the Schirmer test. Conjunctival smears were taken from every patient. The most frequently observed side-effects were decreased tear break up time and alterations of the lid margin. In addition, an enormous increase of Staphylococcus aureus in conjunctival flora was noticed. However, all ocular complications of systemic treatment with isotretinoin were reversible after cessation of therapy.

[Contamination of intraocular fluid in pars plana vitrectomy]. / Kontamination intraokularer Flüssigkeiten bei Pars-plana-Vitrektomien.

UNLABELLED: Endophthalmitis after pars plana vitrectomy is rare, with an incidence of 0.05-0.14%. The aim of this study was to evaluate the microbiological situation during pars plana vitrectomy and to ascertain what organisms and how many enter the eye during the operation. PATIENTS AND METHODS: Twenty-five consecutive subjects undergoing primary pars plana vitrectomy were included in the study. Patients were excluded if they had evidence of local or systemic infections or had undergone antibiotic therapy within 3 weeks before surgery. A standard three-port pars plana vitrectomy was performed on each patient. Preoperative smears of the conjunctiva and intraoperative aspirates of the vitreous were taken immediately after sclerotomy, and aspirates of the intraocular fluid at the conclusion of operation. RESULTS: We obtained preoperative smears from the conjunctival sac of all patients, and found that 19 patients (76%) had positive cultures, with coagulase-negative staphylococci as the most commonly isolated organisms, (n = 14; 56%). Vitreous--aspirated immediately after sclerotomy--was sterile in 68% (n = 17). In 32% (n = 8) contamination occurred, the microorganisms isolated being coagulase-negative staphylococci (20%) and Staphylococcus aureus (12%). Five of the samples (20%) of intraocular fluid from the vitreous cavity--aspirated before wound closure--were contaminated, coagulase-negative staphylococci (8%) and Staphylococcus aureus (12%) again being found in culture. In no case did postoperative endophthalmitis develop. CONCLUSIONS: This study demonstrates that bacteria enter the eye during pars plana vitrectomy and that there is a change in the contaminating bacterial species during operation. Even if bacteria remain in the eye after pars plana vitrectomy, postoperative endopthalamitis does not necessarily develop.

A collaborative international nursing informatics research project: predicting ARDS risk in critically ill patients.

An international nursing informatics research collaboration between Duke University Medical Center in Durham, North Carolina, USA and Allgemeine Krankenhaus Hospital in Vienna, Austria used data mining techniques called Knowledge Discovery in Databases (KDD) to explore the relationship between clinical data variables and adult respiratory distress syndrome (ARDS) in critically ill patients. Results of the study and logistics of international research collaboration will be presented at NI '97. The conceptual model, data mining methodology, and objectives for the collaboration are described here.

[Dirofilariosis: subconjunctival infection with Dirofilaria repens]. / Dirofilariose: Subkonjunktivale Infektion mit Dirofilaria repens.

A 45-year-old female patient from Bosnia complained of recurrent swelling and redness of the upper eyelid and 24 h later the patient consulted the Salzburg eye hospital because of a subconjunctival swelling. The slit lamp investigation showed a living Dirofilaria repens which could be removed by forceps. On the basis of this case the infection pathway, possible increasing incidence and therapy are discussed.

Penetration of nutrition information on food labels across the EU-27 plus Turkey.

OBJECTIVES: The European Union (EU)-funded project Food Labelling to Advance Better Education for Life (FLABEL) aims to understand how nutrition information on food labels affects consumers' dietary choices and shopping behaviour. The first phase of this study consisted of assessing the penetration of nutrition labelling and related information on various food products in all 27 EU Member States and Turkey. METHODS: In each country, food products were audited in three different types of retailers to cover as many different products as possible within five food and beverage categories: sweet biscuits, breakfast cereals, pre-packed chilled ready meals, carbonated soft drinks and yoghurts. RESULTS: More than 37 000 products were audited in a total of 84 retail stores. On average, 85% of the products contained back-of-pack (BOP) nutrition labelling or related information (from 70% in Slovenia to 97% in Ireland), versus 48% for front-of-pack (FOP) information (from 24% in Turkey to 82% in the UK). The most widespread format was the BOP tabular or linear listing of nutrition content. Guideline daily amounts labelling was the most prevalent form of FOP information, showing an average penetration of 25% across all products audited. Among categories, breakfast cereals showed the highest penetration of nutrition-related information, with 94% BOP penetration and 70% FOP penetration. CONCLUSIONS: Nutrition labelling and related information was found on a large majority of products audited. These findings provide the basis for subsequent phases of FLABEL involving attention, reading, liking, understanding and use by consumers of different nutrition labelling formats.

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT.

The aim of this study was to assess the frequency of potential drug-drug interactions (pDDIs) and adverse drug events (ADEs) associated with antimycotics in hospitalized patients with hematopoietic SCT (HSCT). Of the 120 HSCT recipients evaluated, 36 received antimycotics. A total of 124 ADEs were recorded in 32 of the 36 patients treated, with 54 ADEs being possibly and 9 probably related to antimycotics. Of the treatments with amphotericin B, 93% were associated with one or more possible and 36% with probable ADEs. The corresponding figures for lipid-based amphotericin B were 100% and 7%, for voriconazole 68% and 11% and for caspofungin 70% and 0%. A total of 57 potentially severe DDIs associated with antimycotics were detected in 31 of the 36 patients. Of these, 14 DDIs were a possible cause of an ADE and 5 (4 times a combination of voriconazole with CYA and once a combination of CYA with conventional amphotericin B) were probably related. Although the prevalence of pDDIs and ADEs is high in HSCT patients, ADEs related with a high probability to treatment with antimycotics are rare. Regarding the high prevalence of pDDIs, our findings underscore the importance of close monitoring of laboratory and clinical parameters, as well as dose adjustment for critical drugs, in patients with HSCT.

[Subtherapeutic blood levels of phenytoin due to a medication error]. / Subtherapeutische Phenytoinspiegel infolge eines Medikationsfehlers.

We report a female patient who was admitted to the emergency ward with suspected cerebral ischemia and in whom transvenous clot lysis was performed. Following lysis the patient developed recurrent complex partial seizures and treatment with intravenous phenytoin was started. Initial phenytoin serum levels were within the therapeutic range. During the course of the in-hospital treatment a sudden fall of phenytoin serum levels was detected and could not be explained by pharmacokinetic changes. Only when the drug application process was further analysed the reason for the fall in serum levels became obvious. Phenytoin sodium injections had not been administered directly into the veins but had been diluted in 0.9% saline infusions. As a result phenytoin sodium injections precipitated and were retained by the particle filter, thus leading to subtherapeutic phenytoin serum levels.

[Minocycline-induced lupus erythematodes]. / Minocyclin-induzierter Lupus erythematodes.

We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies.

[Disposable contact lenses and their complications]. / Wegwerfkontaktlinsen und ihre Komplikationen.

Disposable soft contact lenses (DSCLs) have been marketed as a safer alternative to conventional soft lenses. Extended-wear DSCLs are designed for one or two weeks of continuous use before disposal. Those for daily wear are designed for use as conventional daily wear soft lenses, with daily removal and storage for 2 to 4 weeks before disposal. Beside minor complications, such as corneal abrasion, giant papillary conjunctivitis and toxic epithelial reactions to contact lens solutions, the most serious complication occurring in contact lens users is ulcerative keratitis. Several case-control studies performed over the last years, demonstrated that disposable contact lenses were associated with a 14-fold excess risk of ulcerative keratitis compared with that for patients wearing conventional daily-wear soft contact lenses and a 13-fold excess risk compared with that for wearers of rigid gas permeable contact lenses. However, the major risk factor for corneal ulceration in contact lens wearers is overnight lens wear of 1 to 3 nights. It was estimated that 49 to 74% of cases of contact lens associated ulcerative keratitis could be prevented by eliminating overnight wear.