A stearic acid-rich diet improves thrombogenic and atherogenic risk factor profiles in healthy males

Objective: To determine whether healthy males who consumed increased amounts of dietary stearic acid compared with increased dietary palmitic acid exhibited any changes in their platelet aggregability, platelet fatty acid profiles, platelet morphology, or haemostatic factors.

Design: A randomized cross-over dietary intervention.

Subjects and interventions: Thirteen free-living healthy males consumed two experimental diets for 4 weeks with a 7 week washout between the two dietary periods. The diets consisted of ~30% of energy as fat (66% of which was the treatment fat) providing ~6.6% of energy as stearic acid (diet S) or ~7.8% of energy as palmitic acid (diet P). On days 0 and 28 of each dietary period, blood samples were collected and anthropometric and physiological measurements were recorded.

Results: Stearic acid was increased significantly in platelet phospholipids on diet S (by 22%), while on diet P palmitic acid levels in platelet phospholipids also increased significantly (8%). Mean platelet volume, coagulation factor FVII activity and plasma lipid concentrations were significantly decreased on diet S, while platelet aggregation was significantly increased on diet P.

Conclusion: Results from this study indicate that stearic acid (19 g/day) in the diet has beneficial effects on thrombogenic and atherogenic risk factors in males. The food industry might wish to consider the enrichment of foods with stearic acid in place of palmitic acid and trans fatty acids.

Perceived environment attributes, residential locaction, and walking for particular purposes

Background
Identifying environmental factors that can influence physical activity is a public health priority. We examined associations of perceived environmental attributes with walking for four different purposes: general neighborhood walking, walking for exercise, walking for pleasure, and walking to get to and from places.

Methods
Participants (n =399; 57% women) were surveyed by mail. They reported place of residence, walking behaviors, and perceptions of neighborhood environmental attributes.

Results
Men with the most positive perceptions of neighborhood “aesthetics” were significantly more likely (odds ratio [OR]=7.4) to be in the highest category of neighborhood walking. Men who perceived the weather as not inhibiting their walking were much more likely (OR=4.7) to be high exercise walkers. Women who perceived the weather as not inhibiting their walking were significantly more likely to be high neighborhood walkers (OR=3.8) and those with moderate perceptions of “accessibility” were much more likely to do more walking for pleasure (OR=3.5).

Conclusions
Different environmental attributes were associated with different types of walking and these differed between men and women. Approaches to increasing physical activity might usefully focus on those attributes of the local environment that might influence particular subsets of walking behavior.

Relationship of glutathione S-transferase genotypes with side-effects of pulsed cyclophsphamide therapy in patients with systemic lupus erythematosus

Aims
Cyclophosphamide (CTX) is an established treatment of severe systemic lupus erythematosus (SLE). Cytotoxic CTX metabolites are mainly detoxified by multiple glutathione S-transferases (GSTs). However, data are lacking on the relationship between the short-term side-effects of CTX therapy and GST genotypes. In the present study, the effects of common GSTM1, GSTT1, and GSTP1 genetic mutations on the severity of myelosuppression, gastrointestinal (GI) toxicity, and infection incidences induced by pulsed CTX therapy were evaluated in patients SLE.
Methods
DNA was extracted from peripheral leucocytes in patients with confirmed SLE diagnosis (n = 102). GSTM1 and GSTT1 null mutations were analyzed by a polymerase chain reaction (PCR)-multiplex procedure, whereas the GSTP1 codon 105 polymorphism (Ile→Val) was analyzed by a PCR-restriction fragment length polymorphism (RFLP) assay.
Results
Our study demonstrated that SLE patients carrying the genotypes with GSTP1 codon 105 mutation [GSTP1*-105I/V (heterozygote) and GSTP1*-105 V/V (homozygote)] had an increased risk of myelotoxicity when treated with pulsed high-dose CTX therapy (Odds ratio (OR) 5.00, 95% confidence interval (CI) 1.96, 12.76); especially in patients younger than 30 years (OR 7.50, 95% CI 2.14, 26.24), or in patients treated with a total CTX dose greater than 1.0 g (OR 12.88, 95% CI 3.16, 52.57). Similarly, patients with these genotypes (GSTP1*I/V and GSTP1*V/V) also had an increased risk of GI toxicity when treated with an initial pulsed high-dose CTX regimen (OR 3.33, 95% CI 1.03, 10.79). However, GSTM1 and GSTT1 null mutations did not significantly alter the risks of these short-term side-effects of pulsed high-dose CTX therapy in SLE patients.
Conclusions
The GSTP1 codon 105 polymorphism, but not GSTM1 or GSTT1 null mutations, significantly increased the risks of short-term side-effects of pulsed high-dose CTX therapy in SLE patients. Because of the lack of selective substrates for a GST enzyme phenotyping study, timely detection of this mutation on codon 105 may assist in optimizing pulsed high-dose CTX therapy in SLE patients.

Family risk factors for cannabis use: a population-based survey of Australian secondary school students

The objective of this study was to investigate relationships between adolescent cannabis use and indices of parent - child attachment, family functioning and parent attitudes to drugs and delinquency. A total of 2848 year 9 and 2363 year 11 students participated in the Victorian Adolescent Health and Well-Being Survey (1999). The study was a school-based random sample of 535 metropolitan and rural, government and non-government secondary schools throughout Victoria, Australia. Cannabis use was defined as 'any' and 'weekly' use in the last 30 days. Multivariate logistic regression was used to identify independent associations between cannabis use and parent - child attachment, family functioning and parent attitudes to drugs and delinquency. Cannabis use in year 9 was associated with permissive parent attitudes to drugs and delinquency (any use: adjusted odds ratio (OR) = 8.1; weekly use: adjusted OR = 7.6), and was particularly sensitive to small changes in the quality of the parent - child relationship with risk increasing threefold for those describing their attachment as 'good' compared with 'very good' (any use: adjusted OR = 2.8, weekly use adjusted OR = 2.9). A similar, but more moderate pattern association was evident in year 11. After adjusting for other family and background factors, poor family functioning showed minimal association with level of cannabis use at both year levels. Results suggest that intervention efforts might sensibly target strengthening parent - children relationships and promoting less permissive parent attitudes to drug use.

Predicting the grade of disability 1 year after stroke following rehabilitation

The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.

Cage colour and post-harvest K+ concentration affect skin colour of Australian snapper Pagrus auratus (Bloch & Schneider, 1801)

In an attempt to improve post-harvest skin colour in cultured Australian snapper Pagrus auratus, a two-factor experiment was carried out to investigate the effects of a short-term change in cage colour before harvest, followed by immersion in K⁺-enriched solutions of different concentrations. Snapper supplemented with 39 mg unesterified astaxanthin kg⁻¹ for 50 days were transferred to black (for 1 day) or white cages (for 1 or 7 days) before euthanasia by immersing fish in seawater ice slurries supplemented with 0, 150, 300, 450 or 600 mmol L⁻¹ K⁺ for 1 h. Each treatment was replicated with five snapper (mean weight=838 g) held individually within 0.2 m³ cages. L*, a* and b* skin colour values of all fish were measured after removal from K⁺ solutions at 0, 3, 6, 12, 24 and 48 h. After immersion in K⁺ solutions, fish were stored on ice. Both cage colour and K⁺ concentration significantly affected post-harvest skin colour (P<0.05), and there was no interaction between these factors at any of the measurement times (P>0.05). Conditioning dark-coloured snapper in white surroundings for 1 day was sufficient to significantly improve skin lightness (L*) after death. Although there was no difference between skin lightness values for fish held for either 1 or 7 days in white cages at measurement times up to 12 h, fish held in white cages for 7 days had significantly higher L* values (i.e. they were lighter) after 24 and 48 h of storage on ice than those held only in white cages for 1 day. K⁺ treatment also affected (improved) skin lightness post harvest although not until 24 and 48 h after removal of fish from solutions. Before this time, K⁺ treatment had no effect on skin lightness. Snapper killed by seawater ice slurry darkened (lower L*) markedly during the first 3 h of storage in contrast with all K⁺ treatments that prevented darkening. After 24 and 48 h of storage on ice, fish exposed to 450 and 600 mmol L⁻¹ K⁺ were significantly lighter than fish from seawater ice slurries. In addition, skin redness (a*) and yellowness (b*) were strongly dependent on K⁺ concentration. The initial decline in response to K⁺ was overcome by a return of a* and b* values with time, most likely instigated by a redispersal of erythrosomes in skin erythrophores. Fish killed with 0 mmol L⁻¹ K⁺ maintained the highest a* and b* values after death, but were associated with darker (lower L*) skin colouration. It is concluded that a combination of conditioning snapper in white surroundings for 1 day before harvest, followed by immersion in seawater ice slurries supplemented with 300–450 mmol L⁻¹ K⁺ improves skin pigmentation after >24 h of storage on ice.

Level of urbanization and noncommunicable disease risk factors in Tamil Nadu, India

Objective To investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) through the application of a quantitative measure of urbanicity.

Methods We constructed a measure of the urban environment for seven areas using a seven-item scale based on data from the Census of India 2001 to develop an “urbanicity” scale. The scale was used in conjunction with data collected from 3705 participants in the World Health Organization’s 2003 STEPwise risk factor surveillance survey in Tamil Nadu, India, to analyse the relationship between the urban environment and major NCD risk factors. Linear and logistic regression models were constructed examining the relationship between urbanicity and chronic disease risk.

Findings
Among men, urbanicity was positively associated with smoking (odds ratio, OR: 3.54; 95% confidence interval, CI: 2.4–5.1), body mass index (OR: 7.32; 95% CI: 4.0–13.6), blood pressure (OR: 1.92; 95% CI: 1.4–2.7) and low physical activity (OR: 3.26; 95% CI: 2.5–4.3). Among women, urbanicity was positively associated with low physical activity (OR: 4.13; 95% CI: 3.0–5.7) and high body mass index (OR: 6.48; 95% CI: 4.6–9.2). In both sexes urbanicity was positively associated with the mean number of servings of fruit and vegetables consumed per day (P < 0.05).

Conclusion
Urbanicity is associated with the prevalence of several NCD risk factors in Tamil Nadu, India.

Individual, social and physical environmental correlates of children's active free-play : a cross-sectional study

Background
Children's unstructured outdoor free-play (or active free-play) has the potential to make an important contribution to children's overall physical activity levels. Limited research has, however, examined physical activity in this domain. This study examined associations between individual, social and physical environmental factors and the frequency with which children play in particular outdoor locations outside school hours. This study also investigated whether the frequency of playing in outdoor locations was associated with children's overall physical activity levels.

Methods
Participants including 8-9 year old children and their parents (n = 187) were recruited from a selection of primary schools of varying socioeconomic status across metropolitan Melbourne, Australia. Parents completed a survey and children's overall physical activity levels were measured by accelerometry. Regression models examined the odds of children playing in various outdoor settings according to particular correlates.

Results
Inverse associations were found between preference for activities not involving physical activity, and the likelihood of children playing in the yard at home on the weekend (OR = 0.65; CI = 0.45,0.95). Positive correlates of children playing in their own street included: parental perceptions that it was safe for their child to play in their street (weekdays [OR = 6.46; CI = 2.84,14.71], weekend days [OR = 6.01; CI = 2.68,13.47]); children having many friends in their neighbourhood (OR = 2.63; CI = 1.21,5.76); and living in a cul-de-sac (weekdays [OR = 3.99; CI = 1.65,9.66], weekend days [OR = 3.49; CI = 1.49,8.16]). Positive correlates of more frequent play in the park/playground on weekdays included family going to the park together on a weekly basis on weekdays (OR = 6.8; CI = 3.4,13.6); and on weekend days (OR = 7.36; CI = 3.6,15.0). No differences in mean mins/day of moderate-vigorous physical activity were found between children in the highest and lowest tertiles for frequency of playing in particular outdoor locations.

Conclusion
The presence of friends, safety issues and aspects of the built environment were reported by parents to be associated with children's active free-play in outdoor locations. Future research needs to further examine associations with time spent in active free-play and objectively-measured overall physical activity levels. It is also important to investigate strategies for developing a supportive social and physical environment that provides opportunities for children to engage in active free-play.

Sunlight exposure caused yellowing and increased mineral content in wool

This study determines how levels of various trace metals in wool and the colour of the fibre change as a result of sunlight exposure and treatment with chelating compounds during wool growth. Twenty-four yearling Merino sheep were clipped on the shoulders and rumps and fitted with sheep coats modified with transparent patches. Patches over the shoulder wool (one per sheep) were either polyethylene (PE) that transmits ultraviolet light or polyvinyl chloride (PVC) that excludes ultraviolet light. The rump wool on each sheep was treated either with a copper chelator treatment (kojic acid or methyl gentisate in aqueous alcohol) or aqueous alcohol only. For 12 of the sheep the rumps were exposed to sunlight through PE patches while rump wool on the other sheep was covered by the sheep coat. Wool was harvested after 11 weeks’ growth with yellowness (Y-Z) and individual mineral contents measured using the same clean wool sample. Sunlight exposure through PE patches caused a mean increase in Y-Z to 9.1 (shoulder) or 9.5–10.1 (rump) from a base level of 7.1–7.2 (shoulder) or 7.0–7.6 (rump) in wool protected by the sheep coat. In contrast, there was no significant change in Y-Z for the PVC patch (shoulder). Therefore, it appears that ultraviolet light damage caused the increased Y-Z. Most of the trace metals analysed increased in the shoulder wool exposed to sunlight but the paired differences for PVC were lower than PE. It appears that changes in fibre caused by sunlight exposure (especially ultraviolet light) facilitate adsorption of minerals from the environment, including the animal’s own suint. Application of the chelating compounds to the rump wool caused pronounced yellowing of the wool with Y-Z increase being most pronounced for kojic acid. Copper levels in the wool were reduced by kojic acid and methyl gentisate while calcium levels were increased by kojic acid and reduced by methyl gentisate. It is not clear from these findings whether minerals and copper in particular contribute to yellowing of wool. However, the different effects of sunlight and chelation on mineral contents in wool shown may well relate to alternative mechanisms of discoloration (i.e. photoyellowing versus bacterial).

Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood : findings from a 10-year longitudinal study

Aims To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in young adulthood.

Design A prospective cohort study of adolescent and young adult health (n = 1943). Teen assessments occurred at 6-monthly intervals, with two follow-up assessments in young adulthood (wave 7, 1998; wave 8, 2001–03).

Setting Victoria, Australia.

Participants Students who participated at least once during the first six (adolescent) waves of the cohort study.

Measurements Adolescent depression and anxiety symptomswere assessed using the Revised Clinical Interview Schedule (CIS-R).Young adult tobacco usewas defined as: daily use (6 or 7 days perweek) and dependent use (>4 on the Fagerstrom Test for Nicotine Dependence).

Findings Among adolescent ‘less than daily’ smokers, those with high levels of depression and anxiety symptoms had an increased risk of reporting nicotine dependence in young adulthood [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2–9.1] compared to young adults who had low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Similarly, in the adjusted model (OR 1.9, 95% CI 1.0–3.4), among adolescent ‘daily’ smokers, those with high levels of depression and anxiety symptoms had an almost two-fold increase in the odds of reporting nicotine dependence in young adulthood compared to young adults with low levels of adolescent depression and anxiety symptoms.

Conclusions Adolescent smokerswith depression and anxiety symptoms are at increased risk for nicotine dependence into young adulthood. They warrant vigilance from primary care providers in relation to tobacco use well into adulthood.

Gender differences in first episode psychotic mania

Background : The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients.
Methods : Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures.
Results : Males with FEPM had increased likelihood of substance use (OR = 13.41, p < .001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge.
Conclusions : Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.

Unwanted sexual advances at work: variations by employment arrangement in a sample of working Australians

Objective: We tested the hypothesis that the risk of experiencing unwanted sexual advances at work (UWSA) is greater for precariously-employed workers in comparison to those in permanent or continuing employment. Methods: A cross-sectional population-based telephone survey was conducted in Victoria (66% response rate, N=1,101). Employment arrangements were analysed using eight differentiated categories, as well as a four-category collapsed measure to address small cell sizes. Self-report of unwanted sexual advances at work was modelled using multiple logistic regression in relation to employment arrangement, controlling for gender, age, and occupational skill level. Results: Forty-seven respondents reported UWSA in our sample (4.3%), mainly among women (37 of 47). Risk of UWSA was higher for younger respondents, but did not vary significantly by occupational skill level or education. In comparison to Permanent Full-Time, three employment arrangements were strongly associated with UWSA after adjustment for age, gender, and occupational skill level: Casual Full-Time OR = 7.2 (95% Confidence Interval 1.7-30.2); Fixed-Term Contract OR = 11.4 (95% CI 3.4-38.8); and Own-Account Self-Employed OR = 3.8 (95% CI 1.2-11.7). In analyses of females only, the magnitude of these associations was further increased. Conclusions: Respondents employed in precarious arrangements were more likely to report being exposed to UWSA, even after adjustment for age and gender. Implications: Greater protections from UWSA are likely needed for precariously employed workers.

Clinical features and risk factors of oedematous Mycobacterium ulcerans lesions in an Australian population: beware cellulitis in an endemic area

Introduction
Oedematous lesions are a less common but more severe form of Mycobacterium ulcerans disease. Misdiagnosis as bacterial cellulitis can lead to delays in treatment. We report the first comprehensive descriptions of the clinical features and risk factors of patients with oedematous disease from the Bellarine Peninsula of south-eastern Victoria, Australia.

Methods
Data on all confirmed Mycobacterium ulcerans cases managed at Barwon Health, Victoria, were collected from 1/1/1998–31/12/2012. A multivariate logistic regression model was used to assess associations with oedematous forms of Mycobacterium ulcerans disease.

Results
Seventeen of 238 (7%) patients had oedematous Mycobacterium ulcerans lesions. Their median age was 70 years (IQR 17–82 years) and 71% were male. Twenty-one percent of lesions were WHO category one, 35% category two and 41% category three. 16 (94%) patients were initially diagnosed with cellulitis and received a median 14 days (IQR 9–17 days) of antibiotics and 65% required hospitalization prior to Mycobacterium ulcerans diagnosis. Fever was present in 50% and pain in 87% of patients. The WCC, neutrophil count and CRP were elevated in 54%, 62% and 75% of cases respectively. The median duration of antibiotic treatment was 84 days (IQR 67–96) and 94% of cases required surgical intervention. On multivariable analysis, there was an increased likelihood of a lesion being oedematous if on the hand (OR 85.62, 95% CI 13.69–535.70; P<0.001), elbow (OR 7.83, 95% CI 1.39–43.96; p<0.001) or ankle (OR 7.92, 95% CI 1.28–49.16; p<0.001), or if the patient had diabetes mellitus (OR 9.42, 95% CI 1.62–54.74; p = 0.02).

Conclusions
In an Australian population, oedematous Mycobacterium ulcerans lesions present with similar symptoms, signs and investigation results to, and are commonly mistakenly diagnosed for, bacterial limb cellulitis. There is an increased likelihood of oedematous lesions affecting the hand, elbow or ankle, and in patients with diabetes.

The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently

In the presence of single-use airway filters, we quantified anaesthetic circuit aerobic microbial contamination rates when changed every 24 h, 48 h and 7 days. Microbiological samples were taken from the interior of 305 anaesthetic breathing circuits over a 15-month period (3197 operations). There was no significant difference in the proportion of contaminated circuits when changed every 24 h (57/105 (54%, 95% CI 45–64%)) compared with 48 h (43/100 (43%, 95% CI 33–53%, p = 0.12)) and up to 7 days (46/100 (46%, 95% CI 36–56%, p = 0.26)). Median bacterial counts were not increased at 48 h or 7 days provided circuits were routinely emptied of condensate. Annual savings for one hospital (six operating theatres) were $AU 5219 (£3079, €3654, $US 4846) and a 57% decrease in anaesthesia circuit steriliser loads associated with a yearly saving of 2760 kWh of electricity and 48 000 l of water. Our findings suggest that extended circuit use from 24 h up to 7 days does not significantly increase bacterial contamination, and is associated with labour, energy, water and financial savings.

Gestational weight gain information: seeking and sources among pregnant women

BACKGROUND: Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women's GWG information sources is limited. This study assessed pregnant women's sources of GWG information and how, where and which women seek GWG information. METHODS: Consecutive women (n = 1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. RESULTS: Participants (n = 368; 35.7 % response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7 % speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4 %) had actively sought GWG information. Nulliparous (OR 7.07, 95 % CI = 3.91-12.81) and obese (OR 1.96, 95 % CI = 1.05-3.65) women were more likely to seek information. Underweight (OR 0.29, 95 % CI = 0.09-0.97) women and those working part time (OR 0.52, 95 % CI = 0.28-0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7 %), books (55.4 %) and friends (51.5 %). The single most important sources were identified as the internet (32.8 %), general practitioners (16.9 %) and books (14.9 %). CONCLUSION: More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed.