Associations of iron status with dietary and other factors in 6-year-old children.

OBJECTIVE: To investigate the associations of iron status at 6 years of age with dietary and other factors. DESIGN: In a cross-sectional study, children's dietary intakes (3-day weighed food record) were recorded, body size was measured and blood samples were taken near their sixth birthday. SUBJECTS: A sample of 188 children, from two previous studies (cohorts 1 and 2), was contacted, and 139 (74%) agreed to participate. RESULTS: Multiple regression analyses with dietary and other factors showed that meat and fish consumption, multivitamin/mineral supplement intake (both positively) and cow's milk product consumption (negatively) were associated with log serum ferritin (SF) (adjusted R (2)=0.125; P=0.028; n=129), and juices and residence (rural>urban) with haemoglobin (Hb) (adjusted R (2)=0.085; P=0.034; n=127). Of 21 multivitamin/mineral consumers, none had depleted iron stores compared to 21 iron-depleted of 108 non-consumers (P=0.024). Children living in rural areas (<10,000 inhabitants) (n=33) had higher mean corpuscular volume (MCV) (83.3+/-2.3 fl) than those living in urban areas (>10,000 inhabitants) (82.1+/-3.2 fl; n=103) (P=0.048). Multiple regression analyses with dietary and other factors and growth showed in cohort 1 that residence (rural>urban), weight gain 0-1years (negatively), and meat and fish intake (positively) were associated with Hb (adjusted R (2)=0.323; P=0.030; n=51), meat and fish (positively) with both log SF (adjusted R (2)=0.069; P=0.035; n=52) and MCV (adjusted R (2)=0.064; P=0.035; n=52), and in cohort 2 cow's milk product consumption (negatively) was associated with log SF (adjusted R (2)=0.119; P=0.017; n=41) and residence (rural>urban) with MCV (adjusted R (2)=0.102; P=0.025; n=41). CONCLUSIONS: Consumption of meat and fish and possibly also juices, as well as multivitamin/mineral intake might affect iron status in 6-year-old children positively, whereas cow's milk product consumption might affect iron status negatively. Slower growth in the first year of life and rural residence are positively related to iron status of 6-year-olds.

Evaluation of natural sounds in urban greenery: potential impact for urban nature preservation.

Most humans now live in cities and their main experience of nature is through urban greenery. An increasing number of studies show the importance of urban green spaces for well-being, although most of them are based on visual perception. A questionnaire examining people's evaluations of natural sounds was answered by 1326 individuals living near one of six urban green areas of varying naturalness in the city of Gothenburg, Sweden. Women and the elderly reported greater calmness when hearing bird song and rustling leaves (and placed a higher importance on the richness of bird species) than did men, younger and middle-aged individuals. Independent of age and gender, urban woodlands (high naturalness) had higher evaluations than parks (low naturalness). Our results suggest that to increase positive experiences of urban green areas, demographic variables of gender and age should be taken into account, and settings that mimic nature should be prioritized in planning.

Iron status in 6-y-old children: associations with growth and earlier iron status.

OBJECTIVE: To investigate the iron status of 6-y-old children and its association with growth and earlier iron status. DESIGN: In a cross-sectional study, children's body size measurements were recorded and blood samples taken near their sixth birthday. SUBJECTS: A sample of 188 children, randomly selected in two previous studies, was contacted, and 139(74%) agreed to participate. RESULTS: No children had iron deficiency anaemia, one was iron-deficient (serum ferritin (SF) <15 microg/l and mean corpuscular volume (MCV) <76 fl but 16% had depleted iron stores (SF<15 microg/l). Iron status indices were generally higher than at 1 and 2 y, but correlation was seen between iron status indices at 6 y and earlier values. Haemoglobin concentration at 6 y was negatively associated with length gain from birth to 1 y (B+/-s.e.=-1.269+/-0.452; P=0.007; adj. R2=0.119) (n=52), and proportional weight gain from birth to 1 y was higher among children with SF<15 microg/l at 6 y (295+/-33%; n=10) than those with SF> or =15 microg/l (258+/-31%; n=49) (P=0.001). MCV at 2 y predicted weight gain from 2 to 6 y (B+/-s.e.=1.721+/-0.581; P=0.005; adj. R2=0.153) (n=44); also, children with SF<15 microg/l at 6 y (n=9) gained 7.8+/-1.2 kg from 2 to 6 y, while children with SF> or =15 microg/l (n=35) gained 9.6+/-2.8 kg (P=0.007), furthermore a difference was seen in proportional weight gain from 2 to 6 y between children with depleted iron stores at 2 y and not, or 156+/-13 vs 169+/-18% (P=0.038). CONCLUSION: The results suggest that low iron status at 1 and 2 y might lead to slower growth up to 6 y of age. Low iron status at 1 and 2 y and/or slower growth from 1 and 2 y up to 6 y might contribute to worse iron status at 6 y, while faster growth in early childhood is related to lower iron status.

Price indices of drugs and the switching to new drugs. Two empirical examples.

Standard price indices may not account for the price decrease that results when patients switch to pharmaceutical products for which their demand-reservation price exceeds the price of the new product. In a similar way, standard price indices may not account for the price increase that results when patients switch to pharmaceuticals for which the reservation price is below the price of the new drug. This study was designed to assess whether standard pharmaceutical price indices under- or overestimate the real price development resulting from new drug introductions. We illustrate that both situations may occur. In our first example, the switch from a branded to a generic drug, we showed that standard price indices recorded a price increase of about 16%, although the price actually decreased by about 5%. In our second example, the introduction of new formulation of a currently marketed drug, we showed that standard price indices recorded a price increase of about 6%, when the actual price increased by more than 65%.

The effect of changes in treatment patterns on drug expenditure.

This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. The aggregate real drug expenditure increased by 50% between 1990 and 1995. The relative retail price index of drugs decreased by 9% and the quantity index measured in terms of defined daily doses increased by 27%. The remaining residual increased by 30%. This implies that, if the residual had been unchanged during the study period, the aggregate expenditure would have increased by only 15%. The results also show that the size of the residual varies substantially across different ATC groups. The increase in the residual was largest for drugs that affect the nervous system (ATC group N); the residual increased by 86%. From the observed changes in residual values, it can be concluded that the underlying factor responsible for the increase in drug expenditure in Sweden is changes in drug therapy from less expensive to more expensive drugs.

Iron status in 2-year-old Icelandic children and associations with dietary intake and growth.

OBJECTIVE: To investigate the effects of food and nutrient intake at 2 y and growth from birth on iron status at 2 y in a population with high birth weight. DESIGN: In a cross-sectional study, children's food consumption and body size measurements were recorded and blood samples taken. Weighed 3-day food records were used to analyse food and nutrient intake. SETTING: Children were recruited from across Iceland from the Icelandic National Registry by the University of Iceland, Computing Services. The children in the sample were born over a 1-y period. SUBJECTS: Parents of randomly selected 2-year-old children (n=130) were contacted, and 72% (n=94) participated. Blood samples were analysed in 76% (n=71) of participating children. RESULTS: In total, 9% of the children were iron-deficient (serum ferritin (SF)<12 microg/l and mean corpuscular volume (MCV) <74 fl) and 1.4% were also anaemic (Hb<105 g/l), while 27% of children were iron-depleted (SF<12 microg/l). Iron status indices were negatively associated with cow's milk consumption. Half of children consuming>500 g cow's milk/day (n=10) were iron-deficient, while one child in 58 consuming<500 g cow's milk/day had iron deficiency (P<0.001). In multiple regression analyses, also biscuits and crackers consumption was positively associated with MCV. Weight gain from birth to 2 y was negatively associated with SF (adjusted R(2)=0.15; P=0.002; n=58). Iron-depleted children were heavier than children not iron-depleted (14.7+/-1.3 vs 13.8+/-1.7 kg; P=0.043), had higher BMI (17.7+/-1.5 vs 16.7+/-1.4 kg/m(2); P=0.028) and gained more weight from birth (11.2+/-1.3 vs. 10.0+/-1.6 kg; P=0.011). CONCLUSIONS: The results suggest that cow's milk consumption above 500 g/day should be avoided at the age of 2 y for better iron status. Iron depletion at 2 y is associated with faster growth from birth.

Iron status at 12 months of age -- effects of body size, growth and diet in a population with high birth weight.

OBJECTIVE: To investigate effects of growth and food intake in infancy on iron status at the age of 12 months in a population with high birth weight and high frequency of breast-feeding. DESIGN: In a longitudinal observational study infants' consumption and growth were recorded. Weighed 2 day food records at the ages of 6, 9 and 12 months were used to analyse food and nutrient intake. SETTING: Healthy-born participants were recruited from four maternity wards. Blood samples and growth data were collected from healthcare centres and food consumption data at home. SUBJECTS: Newborn infants (n=180) were selected randomly according to the mother's domicile and 77% (n=138) participated, of them, 83% (n=114), or 63% of original sample, came in for blood sampling. RESULTS: Every fifth child was iron-deficient (serum ferritin <12 microg/l and mean corpuscular volume<74 fl) and 2.7% were also anaemic (Hb<105 g/l). Higher weight gain from 0 to 12 months was seen in infants who were iron-deficient at 12 months (6.7+/-0.9 kg) than in non-iron-deficient infants (6.2+/-0.9 kg) (P=0.050). Serum transferrin receptors at 12 months were positively associated with length gain from 0 to 12 months (adjusted r(2)=0.14; P=0.045) and mean corpuscular volume negatively to ponderal index at birth (adjusted r(2)=0.14; P=0.019) and 12 months (adjusted r(2)=0.17; P=0.006). Iron-deficient infants had shorter breast-feeding duration (5.3+/-2.2 months) than non-iron-deficient (7.9+/-3.2 months; P=0.001). Iron status indices were negatively associated with cow's milk consumption at 9-12 months, significant above 460 g/day, but were positively associated with iron-fortified breakfast cereals, fish and meat consumption. CONCLUSIONS: : In a population of high birth weight, iron deficiency at 12 months is associated with faster growth and shorter breast-feeding duration from 0 to 12 months of age. The results suggest that a diet of 9-12-month-olds should avoid cow's milk above 500 g/day and include fish, meat and iron-fortified breakfast cereals to improve iron status.

Partial liquid ventilation influences pulmonary histopathology in an animal model of acute lung injury.

PURPOSE: The aim of this study was to assess the effect of partial liquid ventilation (PLV) and conventional mechanical ventilation (CMV) in the pattern of distribution of lung injury in a rabbit model of acute lung injury. MATERIALS AND METHODS: Animals (1.5 to 3.5 kg) were assigned to receive CMV (tidal volume of 10 mL/kg and a PEEP of 5 cm H2O) or PLV with 18 mL/kg of intratracheal perflubron (tidal volume of 10 mL/kg and a PEEP of 5 cm H2O). Lung injury was elicited by intravenous administration of Escherichia coliendotoxin. Uninjured animals ventilated as the CMV group served as controls. After 4 hours of mechanical ventilation, the lungs were removed and tissue injury was assessed by light microscopy using a scoring system. RESULTS: Animals in the CMV group had higher lung injury scores in comparison to the PLV group (10+/-4.5 vs. 5+/-3.3, respectively, P < .05). The injury scores were similar for nondependent lung regions (CMV: 8+/-4.3, PLV: 6+/-2.9) but significantly different for the dependent regions (CMV: 12+/-4.6, PLV: 5+/-3.8, P< .05). CONCLUSIONS: PLV is associated with significant attenuation of lung injury, in comparison to CMV. This effect is predominantly due to attenuation of injury in the dependent region of the lung.

The effects of three different heparin regimes on heparin concentrations in plasma and fibrin formation in dialyzers.

Anticoagulation effects were studied during a 4-hr hemodialysis in 6 patients using 3 different heparin regimens: I. Intravenous loading dose only; II. priming of the dialyzer and continuous infusion of heparin for 2 hr; III. intravenous loading dose and continuous infusion of heparin based on anticoagulation kinetics. In all regimens the difference of fibrinopeptide A (delta FPA) between the blood inlet and outlet of the dialyzers increased at the end of the dialyses, indicating increased fibrin formation. There was a good correlation between delta FPA and the fibrin deposition on the membranes measured with I-125-fibrinogen. delta FPA increased when heparin concentration in plasma was less than 0.5 IU/ml. The anticoagulation kinetic regimen offered no advantage over the single loading dose regimen with regard to the formation and deposition of fibrin in the dialyzers.

Fibrin deposition in disposable dialyzers before and after re-use.

We have estimated the degree of fibrin deposition as well as changes in dialyzer efficiency of Gambro Optima 13.5 mu dialyzers, re-used up to six times in six regular dialysis patients. After each dialysis the dialyzer was rinsed and left filled with formaldehyde. The patients were given I-125-fibrinogen before the study. The radioactivity from the dialyzer was continuously measured during each dialysis and rinsing procedure. Urea and creatinine clearances were determined 30 min after start of each dialysis. After the last re-use the dialyzer membranes were removed and divided into sections and the radioactivity of each section was measured. Twice as much fibrin deposition was found near the blood inlet of the dialyzer as near the outlet. A higher fibrin deposition was found after each re-use than after the initial dialysis. The clearances of urea and creatinine were scarcely influenced by the re-use. The half-life of fibrinogen in the patients was in the same range as in normal subjects.

Measurement of fibrinopeptide A in the evaluation of heparin activity and fibrin formation during hemodialysis.

In order to monitor heparin activity during hemodialysis, were evaluated three commonly used methods; measurement of whole blood activated coagulation time (WBACT), whole blood thrombin time (WBTT) and heparin concentration in plasma, determined with a chromogenic substrate. Studies were performed on six regular dialysis patients during 4-hour dialysis sessions, employing three different heparin regimens; a single intravenous loading dose only, priming of the dialyzer with heparin followed by a heparin infusion and a pharmaco-kinetic model. Efficacy of heparinization was assessed by determination of fibrinopeptide A (FPA) which is a peptide split product of the fibrinogen molecule formed during thrombin-induced conversion to fibrin. There was a linear correlation (r = 0.95) between FPA-production in the dialyzer and the FPA content of the blood at the inlet to the dialyzer; the slope of the correlation line indicates that at least 65% of FPA formed in the dialyzer is disposed during passage through the patient. Considerably higher production of FPA was noted when the heparin concentration was below 0.5 IU/ml than at a higher level. This was a common finding at the end of a dialysis, regardless of regimen. No consumption of antithrombin (AT III) occurred during a dialysis with any of the heparin regimens. Good correlations were found between WBACT, WBTT and heparin concentration. Heparin activity during a dialysis may be monitored with any of these three methods with equal reliability. However, from a practical point of view, WBACT appears most attractive because of its simplicity. FPA generation, frequency of visible clots in the dialyzer and hemorrhagic manifestations were essentially the same for each of the heparin dose regimens. The simple administration of a single loading dose was as safe as the more complicated infusion technique.

The influence of dialysis fluid composition on the blood pressure response during dialysis.

To elucidate the relative role of osmolar (sodium) and acetate shifts during dialysis, 6 patients with problems of overhydration underwent rapid ultrafiltration for 1 hr (mean weight reduction 2.0 kg), using the 1 m2 RP 6 dialyzer. Ultrafiltration was carried out at the beginning of each of 5 dialysis treatments at weekly intervals. Ultrafiltration was undertaken without dialysis (controls) and with simultaneous dialysis using acetate (40 mmoles/1) or bicarbonate (25 mmoles/1) in the dialysis fluid with dialyzate sodium concentration of 133 and 145 mmoles/1. The systolic blood pressure and mean arterial pressure which were stable with ultrafiltration only fell slightly when a high dialyzate sodium concentration was used and much further when the dialyzate sodium concentration was kept low. These changes were apparently related to the changes in plasma osmolality. Acetate had no effect on blood pressure at the higher sodium concentration, but a slight (insignificant) additive effect when used in the low-sodium dialyzate. Shifts in osmolality (sodium concentration) seem to be more important than the effect of acetate in inducing dialysis-associated hypotension.

Successful lysis of an obstructive aortic and renal artery thrombus in a neonate on extracorporeal membrane oxygenation.

We describe a neonate on venoarterial extracorporeal membrane oxygenation (ECMO) with acute renal failure associated with extensive aortic and bilateral renal artery thrombosis. Concurrent anticoagulation and continuous systemic thrombolytic therapy with tissue plasminogen activator (t-PA) resulted in complete thrombolysis as evaluated by Doppler flow. The relative risk and benefits of thrombolytic therapy in heparinized patients undergoing ECMO needs to be further studied.

Effects of simulated acid rain on growth rate in a spruce-living spider.

Growing juveniles of the spruce-living spider Pityohyphantes phrygianus were sprayed with water of different acidity--pH approximately 7 (control), 4.0 (acid rain) and 2.2-in a 2.5-month laboratory experiment. The growth rates did not differ between control and pH 4.0, while there was a significant growth reduction at pH 2.2. A low mortality occurred only in the pH 2.2 group. P. phrygianus seems to be resistant against acid rain although negative long-term effects cannot be ruled out.

Cost and utilisation of pharmaceuticals in Sweden.

Issues of efficiency, access, equity and cost have informed Swedish national policy toward pharmaceuticals for many years. While retail pharmacies have been owned and operated by a single state company since 1971, the manufacturing of pharmaceuticals has remained privately owned and operated. Costs to the health care system for pharmaceuticals have been rising 4-8% in the last several years, despite greater use of generic substitutes. Beyond price-reduction pressures created by the state retail monopoly, by reference pricing, by positive lists, and by an expanded system of capped patient copayments, the national government is considering plans to decentralise responsibility for all outpatients as well as inpatient drug expenditures to the 26 country councils.

Factors influencing decision making among ambulance nurses in emergency care situations.

The aim of this study was to investigate which factors that influences decision making among Swedish ambulance nurses in emergency care situations. Nurses in ambulance are sometimes forced to make decisions without adequate information. Data collected from interviews with 14 ambulance nurses was analyzed. The informants described 30 incidents during which they had to make fast decisions. A qualitative content analysis of the text was made, from which different categories were identified. It was found that when nurses are called to an emergency, the extent and degree of difficulty of the incident is decisive for how decisions are made. In addition, the nurses' experience is important for decision making, because the experience factor constitutes a qualitative difference between a novice nurse and a more experienced nurse's influence on decision-making. Furthermore, external factors, such as the uncertainty of a prehospital environment, expectations and pressures from an environment in which one is working while being observed by other people, and collaborating with many different operators, all contribute to making decisions in an urgent situation even more complex. Further studies are needed to understand the complexity of decision making in emergency situations.

Iron status at 1 and 6 years versus developmental scores at 6 years in a well-nourished affluent population.

AIM: To examine the association between iron status at 1 and 6 years with development at 6 years. METHODS: In a longitudinal study of children (n = 77), iron status was measured at 1 and 6 years and the Icelandic Developmental Inventory, which evaluates children's motor and verbal development, was filled in by mothers near the children's sixth birthday. RESULTS: Children, iron-deficient at 1 year (n = 10), had lower fine motor development scores at 6 years than non-iron-deficient (n = 56) (46.7 +/- 4.1 vs. 49.3 +/- 2.0; p = 0.011). Fine motor scores were also lower in children with depleted iron stores at 1 year (n = 26) than non-iron-depleted children (n = 40) (48.0 +/- 3.3 vs. 49.5 +/- 1.8; p = 0.045). Multiple regression analyses, with iron status indices at 6 years, showed that mean corpuscular volume along with male gender predicted significantly positively for expression (adj. R(2)= 0.15; p = 0.018; n = 73), while regression analyses, including iron status at 1 and 6 years, showed that haemoglobin at 6 years was positively associated with gross motor (adj. R(2)= 0.05; p = 0.038; n = 63). CONCLUSIONS: In an affluent society, iron deficiency and depleted iron stores at 1 year may contribute to worse fine motor developmental scores at 6 years, while low mean corpuscular volume and haemoglobin at 6 years might affect subsequent expression and gross motor scores negatively.

Spatial variation in colour morph, spotting and allozyme frequencies in the candy-stripe spider, Enoplognatha ovata (Theridiidae) on two Swedish archipelagos.

The selective significance, if any, of many invertebrate visible polymorphisms is still not fully understood. Here we examine colour- and black spotting-morph frequencies in the spider Enoplognatha ovata in populations on two Swedish archipelagos with respect to different spatial scales and, in one archipelago, against the background of variation at four putative neutral allozyme marker loci. Every population studied was polymorphic for colour and 28 out of 30 contained all three colour morphs--lineata, redimita and ovata. We found no evidence for a breakdown in the traditional colour morph designation previously suggested for other northern European populations of this species. For colour there is no significant heterogeneity at spatial scales greater than between local populations within islands. Black spotting frequencies show a similar lack of pattern over larger spatial scales except that there are significant differences between the Stockholm and Göteborg archipelagos. Measures of population differentiation (theta) within the Stockholm islands for the two visible systems show them to be significantly more differentiated than the neutral markers, suggesting local selection acting on them in a population-specific manner. On the basis of previous observations and the distribution of spotting phenotypes on a European scale, it is argued that thermal selection might operate on black spotting during the juvenile stages favouring more spots in continental climates. It is not clear what selective forces act on colour.

[Hemodynamic changes during ultrafiltration and hemodialysis in uremia]. / Hämodynamische Veränderungen während Ultrafiltration und Hämodialyse bei Urämikern.

1. The ultrafiltration causes a reduction of blood pressure and minute output of the heart which is compensated by vasoconstriction and thus a decrease of blood pressure is prevented. 2. Changes in the salt concentrations with reduction of the osmolarity during the dialysis without simultaneous ultrafiltration lead to vasodilation and hypotension despite increase of the minute output of the heart. 3. During a usual haemodialysis (i.e. dialysis with simultaneous ultrafiltration) the vasodilating effect of the dialysis may abolish the vasoconstrictive effect of the ultrafiltration and thus may be the cause of the hypotension.