Effect of changes in food groups intake on magnesium, zinc, copper, and selenium serum levels during 2 years of dietary intervention.

BACKGROUND: Essential elements in serum are related to specific changes in food groups intake. OBJECTIVE: To address the effect of 2-year food intake changes in an intervention study on serum concentrations of magnesium, zinc, copper, and selenium. METHOD: Two hundred thirty-one participants, a subgroup of the Dietary Intervention Randomized Control Trial (DIRECT) study (age = 52 years; body mass index = 32.8 kg/m(2); 85% males) randomized to low-fat, Mediterranean, or low-carbohydrate diets in a 2-year dietary intervention trial were followed for serum concentrations determined using inductively coupled plasma-mass spectrometry. Changes in the intake of 11 food groups were evaluated by food frequency questionnaires. RESULTS: Using multivariate regression models, adjusted for age, sex, baseline body weight (kg), and changes in intakes of 11 food groups (g/d), at 12 months, serum element elevations were observed mainly in the low-carbohydrate group: selenium, by increasing consumption of fats and oils (ß = 0.415, p = 0.009) and legumes (ß = 0.183, p = 0.010) and decreasing fruit intake (ß = -0.438, p = 0.030); copper, by increasing consumption of legumes (ß = 0.453, p = 0.018) and dairy products (ß = 0.320, p = 0.039); magnesium by increasing fish consumption (ß = 0.374, p = 0.042) in the low-carbohydrate group and in the entire study population (ß = 0.237, p = 0.016); and zinc exclusively in the low-fat group by decreasing consumption of fats and oils (ß = -0.575, p = 0.022). At 24 months, serum elements were elevated mainly in the low-fat diet group, mostly by decreasing intake of snacks, sweets, and cakes: zinc (ß = -0.570, p = 0.027), copper (ß = -0.649, p = 0.012), and selenium (ß = -0.943, p < 0.001). Also in this group, magnesium levels were elevated by increasing vegetable intake (ß = 0.395, p = 0.041), copper by increasing fruit intake (ß = 0.375, p = 0.025), and selenium by increasing consumption of bread, pasta, and cereals (ß = 0.751, p = 0.011). The entire group, further adjusted to assigned diet type, increased selenium (ß = 0.294, p = 0.004) and copper (ß = 0.220, p = 0.038) by increasing consumption of bread, pasta, and cereals; selenium level was also predicted by decreasing consumption of snacks, sweets, and cakes (ß = -0.256, p = 0.014). Introducing energy expenditure, expressed in metabolic equivalents (MET = 1 kcal·kg(-1)·h(-1)), as an additional variable emphasized the negative effect of sweets and cakes on increasing serum concentrations of zinc, copper, and selenium after 24 months (ß = -0.549, p = 0.021; ß = -0.669, p = 0.012; ß = -0.982, p < 0.001, respectively), especially in the low-fat diet group. No significant associations between changes in food groups intake and the 4 elements were found in the Mediterranean diet group. CONCLUSIONS: During this 2-year intervention, serum concentrations of 4 essential elements were associated with a diversity of food group intake patterns. Comprehensive predictors for elevating zinc, copper, and selenium in serum included decreasing consumption of sweets and cakes while increasing consumption of bread, cereals, and pasta.

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

BACKGROUND: Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. METHODS: In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. RESULTS: The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). CONCLUSIONS: Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.)

The effect of women's occupational psychologic stress on outcome of fertility treatments.

OBJECTIVE: The objective of this study was to examine the possible association between women's occupational stress and outcome of fertility treatments. METHODS: A prospective cohort study was performed, including a consecutive group of 75 working women with a female fertility problem attending fertility clinics between the years 1999 and 2000. A structured questionnaire measuring burnout, job strain, and job satisfaction was used. Workload was assessed by number of working hours and shift work. RESULTS: Women who perceived their job as more demanding were less likely to conceive (relative risk [RR], 0.6; 95% confidence interval [CI] = 0.42-0.96). Actual workload, measured by full-time versus part-time job, was found among women who conceived to be significantly associated with less likelihood to successfully complete a pregnancy (RR, 0.3; 95% CI = 0.11-0.96). CONCLUSIONS: An inverse association was found between perceived higher workload and conceiving. The likelihood to deliver after fertility treatment was associated with less working hours.

[Blocking of the thyroid against I-131 following a nuclear disaster].

The Chernobyl accident, the recent terrorists' attacks and constant threats, have all once again evoked the fear of a nuclear disaster, in Israel and worldwide. Iodine-131 is a major fission product of nuclear reactors and is highly likely to be released into the atmosphere in severe nuclear disasters. The radioiodine is released as a gas, easily spreads over large areas and is easily absorbed via the respiratory system. Iodine-131 emits gamma and beta radiation in high energies, and is readily absorbed by the thyroid which is a target organ for iodine. The resulting exposure to the thyroid might be very high. A sharp increase in thyroid cancer incidence in children was observed following the Chernobyl accident. This article reviews the medical knowledge about strategies and medications aimed at minimizing the absorption of radioiodine into the thyroid. In addition to regular safety means such as sheltering, restriction of locally produced food products and relocation of the population, the best prophylaxis against thyroid exposure is overloading the gland with stable iodine (as potassium iodide), as soon as possible. Recently, the Israeli government decided to distribute Potassium Iodide tablets to the population in the vicinity of the two nuclear research centers in the country. When this treatment is contraindicated, iodine free thionamides or potassium perchlorate are suggested.

Ethnic differences influence care giver's estimates of pain during labour.

The present study compared the childbirth experience of two different ethnic groups living in the same area and sharing the same medical facilities. We investigated the influence of ethnic differences between patient and care provider on the interpretation of pain. The subjects were 225 Jewish and 192 Bedouin parturients, who were prospectively evaluated for their labour pain experience. The pain intensity level was assessed by the parturient ('self-reported pain') and by a Jewish doctor and midwife ('exhibited pain') in the initial active phase of labour, using the visual analog scale (VAS). On the day after delivery, the women were asked to evaluate the present pain intensity level. Although the means of the self-assessments of pain intensity levels at the initial active phase of Jewish and Bedouin parturients were similar (8.55 and 8.53 respectively, P = 0.25), the Jewish medical staff interpreted Bedouin women to experience less pain than Jewish women (6.89 vs. 8.52, P < 0.001). On the day after delivery, the Jewish women's evaluation of their pain intensity levels again resembled that of the Bedouin women (2.02 and 2.11 respectively, P = 0.52). The Pearson correlation coefficients between the measures of self-reported and exhibited pain, were higher for Jewish than for Bedouin women (0.74 and 0.63, respectively). In a multiple linear regression analysis, both self-reported and exhibited pain scores were associated significantly with ethnicity and parity. In the model predicting exhibited pain, the level of religious observance was negatively associated with pain intensity scores. We conclude that the ethnic background of the care provider is an important determinant in estimating the suffering of the patients. It is important for the clinician to be aware of the wide spectrum of factors that might influence pain expression and interpretation. The knowledge that there are inter-ethnic differences might prevent a stereotyped response to the patient in pain.

Potential association between male infertility and occupational psychological stress.

The purpose of this work was to investigate the influence of working conditions, occupational exposures to potential reproductive toxic agents, and psychological stress on male fertility. The study population consisted of 202 consecutive male patients attending a fertility clinic. Of those, 106 patients had attended the clinic because of a male infertility problem (case group), 66 patients had attended the clinic because of a female infertility problem (control group), and 30 patients had a combined infertility problem (male and female). Male infertility was associated with working in industry and construction as compared with other occupations (78.6% vs 58.3%, P = 0.044). Industry and construction workers were of lower educational level than the other workers (mean: 12.1 vs 13.4 years, P = 0.021). These patients also tended to smoke more than the other workers (OR = 2.53, 95% CI = 1.08 to 5.98), more often worked in shifts (OR = 3.12, 95% CI = 1.19 to 8.13), reported physical exertion in work (OR = 3.35, 95% CI = 1.44 to 7.80), and were more exposed to noise and welding (OR = 3.84, 95% CI = 1.63 to 9.14, OR = 4.40, 95% CI = 1.11 to 1.76, respectively). Male infertility (case group) was found to be statistically related to higher marks in all four measures of burnout as compared with the controls. The largest difference was obtained in the measure of cognitive weariness (mean: 2.9 vs 2.1, P < 0.001). In a multiple logistic regression analysis, industry and construction jobs (adjusted OR = 2.2, 95% CI 1.2 to 2.7) and cognitive weariness (adjusted OR = 1.8, 95% CI = 1.03 to 4.6) were found to be independent risk factors for male infertility problems. Male infertility was independently associated with industry and construction jobs as well as job burnout.

Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality.

OBJECTIVE: To determine maternal characteristics and perinatal outcomes of unattended out-of-hospital deliveries. STUDY DESIGN: A population-based study including all singleton deliveries between 1988 and 1999. Maternal characteristics and pregnancy outcomes of accidental out-of-hospital births were compared with those of women who delivered in the hospital. Multiple logistic regression analysis was performed to investigate independent risk factors for out-of-hospital deliveries. Another model was constructed to assess the independent risk of out-of-hospital delivery for perinatal mortality. RESULTS: The incidence of unattended, out-of-hospital deliveries was 2% (2,328/114,938). Multiparity, Bedouin ethnicity and lack of prenatal care were independently associated with out-of-hospital deliveries. Parturients who delivered out of hospital had a significantly lower rate of previous cesarean deliveries. Perinatal mortality was significantly higher among out-of-hospital deliveries, and those newborns were significantly more likely to be small for gestational age as compared to newborns with in-hospital births. In a multivariable model investigating risk factors for perinatal mortality, out-of-hospital delivery was an independent risk factor for perinatal mortality. Other significant risk factors were Bedouin ethnicity and lack of prenatal care. CONCLUSION: Accidental out-of-hospital birth, associated with multiparity, Bedouin ethnicity and lack of prenatal care, is an independent risk factor for perinatal mortality.

Effect of occupational exposures on male fertility: literature review.

The present review was aimed to determine the influence of working conditions, occupational exposures to potential chemical and physical reproductive toxic agents and psychological stress during work on male fertility. Significant associations were reported between impaired semen parameters and the following chemical exposures: metals (lead, mercury), pesticides (dibromochlorophane, 2,4-dichlorophenoxyacetic acid), ethylene glycol ethers and estrogens. The following physical exposures were shown to deteriorate sperm parameters: radiation (both ionized and microwaves) and heat. Psychological distress has another important contribution to infertility. Several studies indicated that stress has a negative impact on sperm parameters. Occupational parameters should be an important part of history taking among patients attending infertility clinics.

The influence of hearing impairment on sleep quality among workers exposed to harmful noise.

OBJECTIVE: To assess connections between sleeping quality and hearing impairment due to prolonged exposure to industrial noise. DESIGN: Observational cross-sectional study. SETTING: Occupational clinic of the Clalit Health Services in Israel. PARTICIPANTS: 298 male volunteers occupationally exposed to harmful noise, who had an audiometric examination performed by an occupational nurse as a part of the national workers health supervision programs. MEASUREMENTS AND RESULTS: The participants underwent an audiometric testing, and their sleep quality was measured by a validated Mini Sleep Questionnaire (MSQ). Participants with hearing loss greater than 25 dBA in the range of 1000-4000 Hz were defined as the research group (n = 99) and were compared to those with no hearing impairment (n = 199). Sleeping disorders were age related (30% higher MSQ score among workers above 50 years, P = 0.003). Tinnitus was the highest sleep disturbing factor, with 75% higher score among those affected, P = 0.001. In multiple linear regression analysis, tinnitus was the leading sleep-disturbing factor (regression coefficient B = 8.66, P < 0.001) followed by hearing impairment (regression coefficient B = 2.42, P = 0.084), adjusted for age (or years of exposure) and coffee drinking. A part of the MSQ, related to insomnia, was further evaluated using logistic regression models. Tinnitus was again the leading sleep disturbing factor [OR = 11.91; CI95% (1.56-91.2)], followed by hearing impairment [OR = 3.051; CI95% (1.18-7.86)]. CONCLUSION: Although tinnitus was the main sleep disrupting factor, hearing impairment among workers occupationally exposed to harmful noise, independently contributed to sleep impairment, especially to insomnia, regardless of age and years of exposure.