The biology of the glutamatergic system and potential role in migraine

Migraine is a common genetically linked neurovascular disorder. Approximately ~12% of the Caucasian population are affected including 18% of adult women and 6% of adult men (1, 2). A notable female bias is observed in migraine prevalence studies with females affected ~3 times more than males and is credited to differences in hormone levels arising from reproductive achievements. Migraine is extremely debilitating with wide-ranging socioeconomic impact significantly affecting people's health and quality of life. A number of neurotransmitter systems have been implicated in migraine, the most studied include the serotonergic and dopaminergic systems. Extensive genetic research has been carried out to identify genetic variants that may alter the activity of a number of genes involved in synthesis and transport of neurotransmitters of these systems. The biology of the Glutamatergic system in migraine is the least studied however there is mounting evidence that its constituents could contribute to migraine. The discovery of antagonists that selectively block glutamate receptors has enabled studies on the physiologic role of glutamate, on one hand, and opened new perspectives pertaining to the potential therapeutic applications of glutamate receptor antagonists in diverse neurologic diseases. In this brief review, we discuss the biology of the Glutamatergic system in migraine outlining recent findings that support a role for altered Glutamatergic neurotransmission from biochemical and genetic studies in the manifestation of migraine and the implications of this on migraine treatment.

Effects of four different single exercise sessions on lipids, lipoproteins, and lipoprotein lipase

The purpose of this study was to determine the threshold of exercise energy expenditure necessary to change blood lipid and lipoprotein concentrations and lipoprotein lipase activity (LPLA) in healthy, trained men. On different days, 11 men (age, 26.7 +/- 6.1 yr; body fat, 11.0 +/- 1.5%) completed four separate, randomly assigned, submaximal treadmill sessions at 70% maximal O-2 consumption. During each session 800, 1,100, 1,300, or 1,500 kcal were expended. Compared with immediately before exercise, high-density lipoprotein cholesterol (HDL-C) concentration was significantly elevated 24 h after exercise (P < 0.05) in the 1,100-, 1,300-, and 1,500-kcal sessions. HDL-C concentration was also elevated (P < 0.05) immediately after and 48 h after exercise in the 1,500-kcal session. Compared with values 24 h before exercise, LPLA. was significantly greater (P < 0.05) 24 h after exercise in the 1,100-, 1,300-, and 1,500-kcal sessions and remained elevated 48 h after exercise in the 1,500-kcal session. These data indicate that, in healthy, trained men, 1,100 kcal of energy expenditure are necessary to elicit increased HDL-C concentrations. These HDL-C changes coincided with increased LPLA.

Serum uric acid and metabolic risk factors in three ethnic groups: Asian Indians and Creoles in Mauritius and Chinese in Qingdao, China

In humans with a loss of uricase the final oxidation product of purine catabolism is uric acid (UA). The prevalence of hyperuricemia has been increasing around the world accompanied by a rapid increase in obesity and diabetes. Since hyperuricemia was first described as being associated with hyperglycemia and hypertension by Kylin in 1923, there has been a growing interest in the association between elevated UA and other metabolic abnormalities of hyperglycemia, abdominal obesity, dyslipidemia, and hypertension. The direction of causality between hyperuricemia and metabolic disorders, however, is unceartain. The association of UA with metabolic abnormalities still needs to be delineated in population samples. Our overall aims were to study the prevalence of hyperuricemia and the metabolic factors clustering with hyperuricemia, to explore the dynamical changes in blood UA levels with the deterioration in glucose metabolism and to estimate the predictive capability of UA in the development of diabetes. Four population-based surveys for diabetes and other non-communicable diseases were conducted in 1987, 1992, and 1998 in Mauritius, and in 2001-2002 in Qingdao, China. The Qingdao study comprised 1 288 Chinese men and 2 344 women between 20-74, and the Mauritius study consisted of 3 784 Mauritian Indian and Mauritian Creole men and 4 442 women between 25-74. In Mauritius, re-exams were made in 1992 and/or 1998 for 1 941 men (1 409 Indians and 532 Creoles) and 2 318 non pregnant women (1 645 Indians and 673 Creoles), free of diabetes, cardiovascular diseases, and gout at baseline examinations in 1987 or 1992, using the same study protocol. The questionnaire was designed to collect demographic details, physical examinations and standard 75g oral glucose tolerance tests were performed in all cohorts. Fasting blood UA and lipid profiles were also determined. The age-standardized prevalence in Chinese living in Qingdao was 25.3% for hyperuricemia (defined as fasting serum UA > 420 μmol/l in men and > 360 μmol/l in women) and 0.36% for gout in adults between 20-74. Hyperuricemia was more prevalent in men than in women. One standard deviation increase in UA concentration was associated with the clustering of metabolic risk factors for both men and women in three ethnic groups. Waist circumference, body mass index, and serum triglycerides appeared to be independently associated with hyperuricemia in both sexes and in all ethnic groups except in Chinese women, in whom triglycerides, high-density lipoprotein cholesterol, and total cholesterol were associated with hyperuricemia. Serum UA increased with increasing fasting plasma glucose levels up to a value of 7.0 mmol/l, but significantly decreased thereafter in mainland Chinese. An inverse relationship occurred between 2-h plasma glucose and serum UA when 2-h plasma glucose higher than 8.0 mmol/l. In the prospective study in Mauritius, 337 (17.4%) men and 379 (16.4%) women developed diabetes during the follow-up. Elevated UA levels at baseline increased 1.14-fold in risk of incident diabetes in Indian men and 1.37-fold in Creole men, but no significant risk was observed in women. In conclusion, the prevalence of hyperuricemia was high in Chinese in Qingdao, blood UA was associated with the clustering of metabolic risk factors in Mauritian Indian, Mauritian Creole, and Chinese living in Qingdao, and a high baseline UA level independently predicted the development of diabetes in Mauritian men. The clinical use of UA as a marker of hyperglycemia and other metabolic disorders needs to be further studied. Keywords: Uric acid, Hyperuricemia, Risk factors, Type 2 Diabetes, Incidence, Mauritius, Chinese

Adhésion thérapeutique en oncologie : persistance, qualité d'exécution et satisfaction des patients sous traitement oral et MEMS®

Introduction: en oncologie apparaissent sur le marché depuis quelques années de nouveaux traitements en formulation orale facilitant l'administration et améliorant la qualité de vie du patient mais augmentant le risque de non adhésion et d'erreurs de posologie. L'observation par MEMS® (Medication Event Monitoring System) permet le suivi et l'encadrement du traitement oral et par le biais d'entretiens semi structurés menés par le pharmacien, ouvre la discussion sur les problèmes révélés par cette prise en charge. Méthode: étude non randomisée prospective uni centrique regroupant 50 patients inclus dans 3 groupes de traitements oncologiques oraux courants (capecitabine, letrozole/exemestane, imatinib/sunitinib) bénéficiant d'un suivi oncologique classique et équipés d'un MEMS® pour un an maximum. La persistance et la qualité d'exécution sont les deux paramètres mesurés grâce aux données récoltées électroniquement. Les entretiens sont dédiés à la prévention de la non adhésion et à la gestion des effets secondaires médicamenteux. La satisfaction est évaluée par un questionnaire à la fin du suivi. Résultats: à ce jour 38 patients ont été inclus dans l'étude. Les données complètes sont disponibles pour les 19 premiers patients dont 10 sous capecitabine et 9 sous letrozole/exemestane. Dans ce collectif l'âge médian est de 66 ans avec une majorité de femmes (11:8). La persistance à 10 jours est de 85% et la qualité d'exécution de 99%. Les toxicités observées supérieures à grade 1 sont 1 syndrome mains-pieds (G3) et 1 syndrome coronarien aigu (G3). Le questionnaire de fin de suivi relève une satisfaction de 85% des patients pour les entretiens proposés (57% utiles, 28% très utiles, 15% inutiles) et le succès quant à l'intégration du MEMS® dans leur quotidien (57% très facile, 43% facile). Conclusion: la persistance et la qualité d'exécution observées dans notre collectif sont excellentes. La satisfaction retrouvée auprès des patients reflète le besoin d'un soutien complémentaire face à la complexité de la maladie oncologique. La gestion pluridisciplinaire profite tant aux patients qu'au binôme médecin-pharmacien par l'amélioration de la communication globale entre les divers acteurs et par l'identification précoce des risques de non adhésion. La poursuite de cette étude et l'analyse des futures données permettra de mesurer le réel impact de notre intervention et de justifier le bénéfice pour des patients sous traitement similaire.

Alcohol-attributable mortality in Switzerland in 2011--age-specific causes of death and impact of heavy versus non-heavy drinking.

BACKGROUND: Alcohol use causes high burden of disease and injury globally. Switzerland has a high consumption of alcohol, almost twice the global average. Alcohol-attributable deaths and years of life lost in Switzerland were estimated by age and sex for the year 2011. Additionally, the impact of heavy drinking (40+grams/day for women and 60+g/day for men) was estimated. METHODS: Alcohol consumption estimates were based on the Addiction Monitoring in Switzerland study and were adjusted to per capita consumption based on sales data. Mortality data were taken from the Swiss mortality register. Methodology of the Comparative Risk Assessment for alcohol was used to estimate alcohol-attributable fractions. RESULTS: Alcohol use caused 1,600 (95% CI: 1,472 - 1,728) net deaths (1,768 deaths caused, 168 deaths prevented) among 15 to 74 year olds, corresponding to 8.7% of all deaths (men: 1,181 deaths; women: 419 deaths). Overall, 42,627 years of life (9.7%, 95% CI: 40,245 - 45,008) were lost due to alcohol. Main causes of alcohol-attributable mortality were injuries at younger ages (15-34 years), with increasing age digestive diseases (mainly liver cirrhosis) and cancers (particularly breast cancers among women). The majority (62%) of all alcohol-attributable deaths was caused by chronic heavy drinking (men: 67%; women: 48 %). CONCLUSION: Alcohol is a major cause of premature mortality in Switzerland. Its impact, among young people mainly via injuries, among men mainly through heavy drinking, calls for a mix of preventive actions targeting chronic heavy drinking, binge drinking and mean consumption.

Cáncer gástrico en Colombia entre 2000 y 2009

Introducción: De todos los casos de cáncer en el mundo el 80% se presentan en países en vía de desarrollo siendo el cáncer de estómago o cáncer gástrico la segunda causa de muerte por cáncer en el mundo con aproximadamente 700.000 muertes cada año. En Colombia, el cáncer gástrico es la primera causa de muerte por tumores malignos en ambos sexos, aún cuando no es la primera neoplasia en frecuencia. Metodología: Estudio observacional descriptivo, de registros de defunción del DANE, Colombia 2000 a 2009. Se analizaron tasas anuales crudas y por grupos de edad, género, procedencia geográfica, estado civil, nivel educativo y área de residencia habitual estableciendo diferencias estadísticas entre las variables y sus categorías. Resultados: En el período estudiado se registraron 43759 defunciones por cáncer gástrico, con mayor frecuencia en hombres 1,5:1. Las tasas de mortalidad por cáncer gástrico ajustadas por grupos etáreos aumentan después de la quinta década de la vida. Se encontraron diferencias estadísticamente significativas en todos los años estudiados y el departamento de residencia habitual del fallecido presentando Cauca (18,11- 19) y Boyacá (14,54-1742) las tasas más altas por 100.000 habitantes. Las tasas más altas se concentran en la zona de la Cordillera de los Andes, al estandarizar por grupos etáreos el Cauca tiene una tasa de 114,98 casos por 100.000 habitantes. Conclusión: El cáncer gástrico es la neoplasia que causa más muertes en Colombia por lo cual es necesario diseñar e implementar programas de detección precoz que vayan dirigidos al control de la mortalidad.

Una propuesta para el desarrollo de la autonomía y responsabilidad en un programa de observación

En el proceso educativo colombiano hay múltiples deficiencias, debidas, entre otras cosas, a la poca importancia que los diferentes estamentos gubernamentales le dan a ésta, al bajo estatus en el que se tiene a los maestros y a su escasa capacitación.

I Congreso Provincial de Educaci??n : Ciudad Real, 17 a 20 de Junio de 1987

Falta el vol??men 1 con los cap??tulos I y II. Contiene: V. 2 : Cap??tulo III: Las ense??anza medias en el ??mbito provincial. Cap??tulo IV: Relaciones interniveles. Cap??tulo V: La educaci??n compensatoria. V. 3 : Cap??tulo VI: orientaci??n e integraci??n. Cap??tulo VII: Las nuevas tecnolog??as. V. 4 : Cap??tulo VIII: Formaci??n inicial y perfeccionamiento del profesorado. Cap??tulo IX: El hecho educativo provincial desde la perspectiva de las Apas. V. 5: Cap??tulo X: Protecci??n de menores. Asociacionismo juvenil-cooperativismo. Cap??tulo XI: An??lisis y problem??tica de la educaci??n provincial. Cap??tulo XII: Educaci??n no sexista.

Under-reporting of energy intake in the 1997 national nutrition survey

Aims To estimate the level of under-reporting of energy intake by gender, age, ethnicity and body size (normal, overweight, obese) in the 1997 National Nutrition Survey (NNS97) in New Zealand.
Methods Data were from 4,258 participants (1,808 men and 2,450 women aged 15 years and over) who completed the 24-hour diet recall; the primary methodology used in the NNS97. Under-reporting was assessed using the ratio of reported energy intake to estimated resting metabolic rate (EI: RMRest). Cut-off limits were used to identify percentages of under-reporters in the various subgroups.
Results Mean EI: RMRest was 1.40 for all participants (1.51 for men, 1.30 for women, p<0.001) with older age being associated with lower EI: RMRest (p<0.001). There were no significant differences in mean EI: RMRest between ethnic groups for men.
Mean EI: RMRest for women were: Maori 1.46, European 1.29, and Pacific 1.37 (p<0.01). A larger body size was associated with a significantly lower EI: RMRest especially for women.
Percentages of ‘definite’ under-reporters (individual EI: RMRest <0.9) were as follows: men 12%, women 21%; Europeans 16%, Maori 23% and Pacific 26%; normal weight (11%), overweight (19%) and obese (27%) participants; and from 10% in the youngest to 23% in the oldest age group (p<0.001 for all results).
Conclusion In this study, in agreement with the literature, women, older people and obese people under-reported more than men, younger people and non-obese people. Possible ethnic differences in under-reporting rates need further study. Care is needed in interpreting the energy intake data from the NNS97.

Relative deprivation between neighbouring wards is predictive of coronary heart disease mortality after adjustment for absolute deprivation of wards

Background The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk.

Methods Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards.

Results Deprivation inequality within LAs was positively associated with CHD mortality rates per 100 000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (p<0.001 for all models). Relative deprivation for wards was positively associated with CHD mortality rates per 100 000 (eg, all men 1.4; 0.7 to 2.1) after adjustment for absolute deprivation (p<0.001 for all models). Subgroup analyses showed that relative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards.

Conclusions Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas, and poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.

The importance of extinguishing secondhand smoke

Government policies have enormous influence on the health of nations. Arguably, this is illustrated most vividly with tobacco control. However, smoking continues to be a global problem and the major cause of preventable death. The countries with the highest per-capita smoking prevalence rates include (alphabetically) Bangladesh (20.9% of adults), Brazil (16.2% of adults), China (31.4% of adults), Germany (27.2% of adults), India (32.7% of men, 1.4% of women), Indonesia (34.5% of adults), Japan (43.3% of men and 12% of women), the Russian Federation (60.4% of men, 15.5% of women), Turkey (34.6%), and the United States(23.2%).1 Prevalence rates among younger people vary, but in the United States, 18.4% of youths still smoke.

Sex-differences in reasons for non-participation at recruitment : Geelong Osteoporosis Study

Background : Understanding reasons for non-participation in health studies can help guide recruitment strategies and inform researchers about potential sources of bias in their study sample. Whilst there is a paucity of literature regarding this issue, it remains highly plausible that men and women may have varied reasons for declining an invitation to participate in research. We aimed to investigate sex-differences in the reasons for non-participation at baseline of the Geelong Osteoporosis Study (GOS).

Methods : The GOS, a prospective cohort study, randomly recruited men and women aged 20 years and over from a region in south-eastern Australia using Commonwealth electoral rolls (2001–06 and 1993–97, respectively). Reasons for non-participation (n=1,200) were documented during the two recruitment periods. We used the Pearson’s chi squared test to explore differences in the reasons for non-participation between men and women.

Results : Non-participation in the male cohort was greater than in the female cohort (32.9% vs. 22.9%; p<0.001). Overall, there were sex-differences in the reasons provided for non-participation (p<0.001); apparent differences related to time constraints (men 26.3% vs. women 10.4%), frailty/inability to cope with or understand the study (men 18.7% vs. women 30.6%), and reluctance over medical testing (men 1.1% vs women 9.9%). No sex-differences were observed for non-participation related to personal reason/disinterest, and language- or travel-related reasons.

Conclusions : Improving participation rates in epidemiological studies may require different recruitment strategies for men and women in order to address sex-specific concerns about participating in research.

Avaliação da exposição ao mercúrio em famílias de pescadores em Imperatriz, Maranhão

Na região do Tocantins, comunidades ribeirinhas com elevado consumo em pescado através da dieta, localizadas distantes de área de mineração de ouro, no Município de Imperatriz do Maranhão podem estar expostas ao mercúrio, tendo em vista a influencia de outros fatores contaminantes do ambiente incluindo a atividades de hidrelétricas e possíveis queimadas da floresta, nessa região. O objetivo deste estudo foi avaliar a exposição ao mercúrio em famílias de pescadores do Distrito Beira Rio, em Imperatriz do Maranhão. Realizou-se um estudo transversal envolvendo famílias de pescadores residentes na comunidade Beira Rio, localizada às margens do Rio Tocantins no município de Imperatriz, Maranhão. O perfil sócio-demográfico foi comum ao da população geral brasileira e similares à população ribeirinha situada em outras bacias. O perfil alimentar não fugiu a regra do padrão alimentar dos ribeirinhos tendo o pescado como a principal fonte de proteína alimentar. A espécie piscívora mostrou diferença significativa (p<0,01) em relação às espécies herbívora/omnívoras e detrívoras estudadas, e a espécie zooplanctófaga mostrou diferença significativa (p<0,01) em relação as duas espécies anteriormente citadas. Dentre as 25 famílias avaliadas a menor concentração média de Hgtotal /família foi 0,186 ± 0,043μg/g e a maior foi 5,477± 2,896μg/g. Mesmo dentro de limites aceitáveis, a concentração média de Hgtotal apresentada pelos homens (1,01+1,97 ppm) foi mais alta que a das mulheres (0,69+ 0,82 ppm) (p<0,05).Conclui-se que famílias de pescadores de Imperatriz possuem baixos níveis de exposição ao mercúrio em virtude do consumo alimentar de peixes com baixos níveis de contaminação, incluindo as espécies piscívoras, que encontravam-se abaixo do limite de segurança para consumo humano estabelecido pelas normas brasileiras, podendo servir de referencia para outros estudos.

Epidemiologia molecular e estudo dos fatores de virulência de Staphylococcus aureus resistentes à oxacilina isolados de feridas em pacientes atendidos em unidades básicas de saúde da cidade de Botucatu

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Low prevalence of atrial fibrillation in asymptomatic adults in Geneva, Switzerland

Aims To determine the prevalence of atrial fibrillation (AF) in a population-based sample of adults. Methods and results Between January 2005 and December 2007 individuals aged >/=50 years, residents of the city of Geneva, who had participated in a previous random survey were invited for follow-up examination. AF was assessed on a single resting 6-lead ECG. Reported prevalences were standardized for the age distribution of Canton Geneva. Overall participation was 72.8%. Twenty-nine cases of AF (22 men) were diagnosed among 3285 subjects (1696 men). The crude prevalence of AF (95% CI) was 0.88% (0.86, 0.90) overall, but higher in men [1.30% (1.26, 1.34)] than in women [0.44% (0.41, 0.47)]. The age-standardized AF prevalence was slightly higher [overall: 0.94% (0.91, 0.97), men: 1.23% (1.19, 1.27), women: 0.54% (0.47, 0.61)]. AF prevalence increased with age in both sexes. A 'history of suspected arterial embolism' (brain or legs) was higher in the AF cases (10.3 vs. 3.3%; P = 0.03). Conclusion This population-based survey of a general Swiss population indicates that the prevalence of AF remains below 1%. These results are less alarming than those from previous studies based on patients seeking medical care.