Assessing the prevalence of hypertension in populations: are we doing it right?

BACKGROUND: Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. OBJECTIVE: To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. DESIGN: Population-based survey of BP and follow-up information. SETTING AND PARTICIPANTS: All residents aged 25-64 years in an area of Dar es Salaam (Tanzania). MAIN OUTCOME MEASURES: Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device.RESULTS BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading--or the average of the second and third readings--at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. CONCLUSIONS: Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.

Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study.

ABSTRACT: BACKGROUND: The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter. METHODS: The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year. RESULTS: Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs. CONCLUSIONS: The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.

Universal complex structures in written language

Quantitative linguistics has provided us with a number of empirical laws that characterise the evolution of languages and competition amongst them. In terms of language usage, one of the most influential results is Zipf’s law of word frequencies. Zipf’s law appears to be universal, and may not even be unique to human language. However, there is ongoing controversy over whether Zipf’s law is a good indicator of complexity. Here we present an alternative approach that puts Zipf’s law in the context of critical phenomena (the cornerstone of complexity in physics) and establishes the presence of a large-scale “attraction” between successive repetitions of words. Moreover, this phenomenon is scale-invariant and universal – the pattern is independent of word frequency and is observed in texts by different authors and written in different languages. There is evidence, however, that the shape of the scaling relation changes for words that play a key role in the text, implying the existence of different “universality classes” in the repetition of words. These behaviours exhibit striking parallels with complex catastrophic phenomena.

VAX1 mutation associated with microphthalmia, corpus callosum agenesis and orofacial clefting-the first description of a VAX1 phenotype in humans.

Vax1 and Vax2 have been implicated in eye development and the closure of the choroid fissure in mice and zebrafish. We sequenced the coding exons of VAX1 and VAX2 in 70 patients with anophthalmia/microphthalmia. In VAX1, we observed homozygosity for two successive nucleotide substitutions c.453G>A and c.454C>A, predicting p.Arg152Ser, in a proband of Egyptian origin with microphthalmia, small optic nerves, cleft lip/palate and corpus callosum agenesis. This mutation affects an invariant residue in the homeodomain of VAX1 and was absent from 96 Egyptian controls. It is likely that the mutation results in a loss of function, as the mutation results in a phenotype similar to the Vax1 homozygous null mouse. We did not identify any mutations in VAX2. This is the first description of a phenotype associated with a VAX1 mutation in humans and establishes VAX1 as a new causative gene for anophthalmia/microphthalmia. ©2011 Wiley Periodicals, Inc.

Characterisation of "fou2", a constitutive wound-activated mutant and analysis of the proteome and leaf physiology in the region proximal to wounds in Arabidopsis

Résumé : Les jasmonates (JA), une famille d'hor1none végétale, jouent un rôle central dans la réponse à la blessure, et aux attaques d'insectes et de pathogènes. Les JA sont principalement dérivés d'un acide gras, l'acide linolénique. L'addition par une lipoxygénase d'une molécule d'oxygène à l'acide linolénique initie la synthèse de JA. Cependant les mécanismes régulant l'activation de la biosynthèse de JA ne sont pas encore connus. C'est pour cette raison que dans ce travail, nous avons caractérisé chez Arabidopsis thaliana (l'Arabette des Dames) un mutant fou2 dont l'activité lipoxygénase est plus élevée que celle d'une plante sauvage. Les niveaux de JA sont constitutivement plus élevés et l'activation de la synthèse de JA après blessure est fortement plus induite chez fou2 que chez le type sauvage. En outre, fou2 est plus résistant au pathogène Botrytis cinerea et à la chenille Spodoptera littoralis. Afin de comprendre quel mécanisme chez fou2 génére ce phénotype, nous avons cloné le gène responsable du phénotype de fou2. Le mutant fou2 porte une mutation dans le gène d'un canal à deux pores transportant probablement du potassium, du lumen de la vacuole végétale vers le compartiment cytosolique. L'analyse du protéome de fou2 a permis d'identifier une expression plus élevée de sept protéines régulées par les JA ou le stress. La découverte de l'implication d'un canal dans le phénotype de fou2 renforce l'hypothèse que les flux de cations pourraient être impliqués dans les étapes précoces de la synthèse des JA. Nous avons également étudié le protéome et la physiologie d'une feuille blessée, Pour évaluer les changements d'expression protéique en réponse à la blessure et contrôlés par les JA, nous avons quantifié l'expression de 5937 protéines chez une plante d'Arabidopsis sauvage et chez un mutant incapable de synthétiser des JA. Parmi ces 5937 protéines, nous avons identifié 99 protéines régulées par la blessure chez le type sauvage. Nous avons observé pour 65% des protéines dont l'expression protéique changeait après blessure une bonne corrélation entre la quantité de transcrits et de protéines. Plusieurs enzymes de la voie des chorismates impliquées dans la biosynthèse des acides aminés phénoliques étaient induites par les JA après blessure. Une quantification des acides aminés a montré que les niveaux d'acides aminés phénoliques augmentaient significativement après blessure. La blessure induisait aussi des changements dans l'expression de protéines impliquées dans la réponse au stress et particulièrement au stress oxydatif. Nous avons quantifié l'état réduit et oxydé du glutathion, un tripeptide qui, sous sa forme réduite, est l'antioxydant majeur des cellules. Nous avons trouvé une quantité significativement plus élevée de glutathion oxydé chez le type sauvage blessé que chez la plante aus blessée. Ce résultat suggère que la génération d'un stress oxydatif et la proportion relative de glutathions réduits et oxydés sont contrôlés par les JA après blessure. Abstract : Plants possess a family of potent fatty acid-derived wound-response and developmental regulators: the jasmonates. These compounds are derived from the tri?unsaturated fatty acid a-linolenic-acid (18:3). Addition of an oxygen molecule to 18:3 by 13-lipoxygenases (13-LOX) initiates JA biosynthesis. Actually components regulating the activation of JA biosynthesis are poorly defined. Therefore we characterized in Arabidopsis thaliana the fatty acid Qxygenation upregulated 2 (fou2) mutant, which was previously isolated in a screen for mutants with an enhanced 13-LOX activity. As a consequence of this increased 13-LOX activity, JA levels in fou2 are higher than in wild type (WT) and wounding strongly increased JA biosynthesis compared to WT. fou2 was more resistant to the fungus Botrytis cinerea and the generalist caterpillar Spodaptera littomlis, The fou2 mutant carries a missense mutation in the Two Pore Channel 1 gene (TPCJ), which encodes a vacuolar cation channel transporting probably K* into the cytosol. Patchclamp analysis of fou2 vacuolar membranes showed faster time-dependent conductivity and activation of the mutated channel at lower membrane potentials than wild-type. Proteomic analysis of fou2 leaves identified increased levels of seven biotic stress- and JA- inducible proteins. The discovery of the implication of a channel in the fou2 phenotype strenghtens the hypothesis that cation fluxes might be implicated in early steps of JA synthesis. We further concentrated on the proteome and leaf physiology in the region proximal to wounds in Arabidopsis using the WT and the aos JA-biosynthesis deficient mutant in order to find JA- induced proteins changes. We used two successive proteomic methods to assess protein changes in response to wounding Arabidopsis leaves, two dimensional electrophoresis (2DE) and linear trap quadrupole ion-trap mass spectrometry. In total 5937 proteins were quantified. We identified 99 wound-regulated proteins in the WT. Most these proteins were also wound-regulated at the transcript level showing a good correlation between transcript and protein abundance. We identified several wound-regulated enzymes involved in amino acid biosynthesis and confirmed this result by amino acid quantification. Proteins involved in stress reponses were upregulated, particularly in redox species regulation. We found a significantly higher quantity of oxidized glutathione in wounded WT relative to wounded aos leaves. This result suggests that levels of reduced glutathione are controlled by JA after wounding.

Time resolved construction of a bimodal laccolith (Torres del Paine, Patagonia)

Granitic and mafic magma pulses were sequentially accreted in the spectacularly exposed shallow crustal Torres del Paine laccolith, in southern Patagonia. This 12.5 Ma pluton forms a composite intrusion with a subvertical feeding system in the west and a laccolith in the east. A key unknown in the formation of sill complexes is how individual magma pulses are assembled over time and the geometry and localization of their feeding system. High resolution zircon CA-ID-TIMS U-Pb dating shows that the laccolith grew first by under-accretion of granitic sills over 90 +/- 30 ka, linked to a `sheet-like' feeding system, followed by underplating of mafic sills after similar to 20 ka of quiescence. In the mafic sills complex, individual sills were injected by over-accretion during 41 +/- 11 ka. Our data show that successive granitic and mafic magmas emplacement generated a volume of similar to 88 km(3) in 162 +/- 11 ka. (C) 2012 Elsevier B.V. All rights reserved.

Immunological response to re-infections with clones of the Colombian strain of Trypanosoma cruzi with different degrees of virulence: influence on pathological features during chronic infection in mice

Re-infections with Trypanosoma cruzi are an aggravating factor for Chagas disease morbidity. The Colombian strain of T. cruzirepresents multiclonal populations formed by clonally propagating organisms with different tropisms and degrees of virulence. In the present study, the influence of successive inoculations with clones of the Colombian strain, exhibiting different degrees of virulence, on chronic myocarditis and the humoral and cellular immune responses (Col-C1 high virulence, Col-C8 medium virulence and Col-C5 low virulence) were demonstrated. Mice from three groups with a single infection were evaluated during the acute (14th-30th day) and chronic phases for 175 days. An immunofluorescence assay, ELISA and delayed type hypersensitivity (DTH) cutaneous test were also performed. Mice with a triple infection were studied on the 115th-175th days following first inoculation. The levels of IgM and IgG2a were higher in the animals with a triple infection. DTH showed a higher intensity in the inflammatory infiltrate based on the morphometric analysis during a 48 h period of the triple infection and at 24 h with a single infection. The histopathology of the heart demonstrated significant exacerbation of cardiac inflammatory lesions confirmed by the morphometric test. The humoral responses indicate a reaction to the triple infection, even with clones of the same strain.

Anàlisi cronològica de la pesca al Port de Llançà: període 1977-1996

A partir del buidatge exhaustiu dels fulls de subhasta del peix i de les fitxes tècniques de les embarcacions de la Confraria del Port de Llançà, es fa una anàlisi cronològica qualitativa i quantitativa dels darrers vint anys de pesca. La flota, inicialment constituïda per barques d'arrossegament i de pesca artesanal (palangre petit i tresmail), ha anat evolucionant, i ha quedat bàsicament constituïda actualment pel ròssec i el palangre de fons, que ha substituit progressivament la pesca artesanal. Les pesqueries, notablement multiespecífiques els primers anys, van donar pas, bàsicament amb la incorporació del radar, a una pesca molt més selectiva, dominada essencialment per la captura de lluç entre els anys 1980 i 1985. La progressiva incorporació del palangre de fons fa que a partir del 1986 es tendeixi novament cap a una captura més multiespecífica, perd amb canvis qualitatius importants en la composició d'espècies capturades en relació amb els primers anys

Revision of the genus acrochordiceras hyatt, 1877 (Ammonoidea, Middle Triassic): Morphology, biometry, biostratigraphy and intra-specific variability

The family Acrochordiceratidae Arthaber, 1911 ranges in age from latest Spathian to the middle/late Anisian boundary, and it represents a major component of ammonoid faunas during that time. The middle Anisian genus Acrochordiceras Hyatt, 1877 is the most widespread taxon of the family and occurs abundantly worldwide within the low paleolatitude belt. However, there is a profusion of species names available for Acrochordiceras. This excessive diversity at the species level essentially results from the fact that sufficiently large samples were not available, thus leading to a typological approach to its taxonomy. Based on new extensive collections obtained from the Anisian (Middle Triassic) Fossil Hill Member (Star Peak Group, north-west Nevada) for which a high resolution biostratigraphic frame is available, the taxonomy and biostratigraphy of the genus Acrochordiceras Hyatt, 1877 is herein revised with respect to its intra-specific variation. Morphological and biometric studies (c. 550 bedrock-controlled specimens were measured) show that only one species occurs in each stratigraphic level. Continuous ranges of intra-specific variation of studied specimens enable us to synonymize Haydenites Diener, 1907, Silesiacrochordiceras Diener, 1916 and Epacrochordiceras Spath, 1934 with Acrochordiceras Hyatt, 1877. Three stratigraphically successive species are herein recognized in the low paleolatitude middle Anisian faunas from Nevada: A. hatschekii (Diener, 1907), A. hyatti Meek, 1877 and A. carolinae Mojsisovics, 1882. Moreover, an assessment of intra-specific variation of the adult size range does not support recognition of a dimorphic pair (Acrochordiceras and Epacrochordiceras) as previously suggested by other workers (Epacrochordiceras is the compressed and weakly ornamented end-member variant of Acrochordiceras). The successive middle Anisian species of Acrochordiceras form an anagenetic lineage characterized by increasing involution, adult size and intra-specific variation. This taxonomic revision based on new bedrock-controlled collections is thus an important prerequisite before studying the evolution of the group.

Apport de la psychanalyse en oncogénétique prédictive

La médecine prédictive évalue la probabilité que des personnes portant des mutations génétiques constitutionnelles puissent développer une maladie donnée, comme par exemple une tumeur maligne (oncogénétique). Dans le cas des prédispositions génétiques au cancer, des mesures particulières de surveillance et de prévention sont discutées en fonction de l'évaluation des risques et des résultats de l'analyse génétique, y compris certains traitements préventifs allant, à l'extrême, jusqu'à l'intervention chirurgicale prophylactique (ex : mastectomie et/ou ovariectomie). Cette étude est basée sur une interprétation psychanalytique du récit de sujets ayant entrepris une démarche en oncogénétique et vise à analyser l'impact psychique : a) du résultat de l'analyse génétique et b) de la construction de l'arbre généalogique. Elle a été conduite dans l'Unité d'oncogénétique et de prévention des cancers (UOPC) du Service d'oncologie des Hôpitaux Universitaires de Genève (HUG). L'UOPC assure des consultations de conseil génétique spécialisé pour les personnes ayant des antécédents personnels et/ou familiaux de maladies tumorales suggestifs de l'existence de prédispositions génétiques au cancer. La population de cette étude comprend 125 sujets suivis lors des différentes étapes du dépistage, pour un total de 289 consultations et 50 entretiens individuels. Cette recherche montre que les sujets asymptomatiques réélaborent de façon personnelle, soit le résultat génétique (négatif ou positif), soit l'acte de prédiction. En revanche, ceux qui ont développé un cancer expriment des sentiments d'angoisse, comme s'ils subissaient les effets d'un destin inéluctable qui s'est effectivement réalisé. Par ailleurs, l'arbre généalogique est réinterprété de façon personnelle, laissant apparaître des aspects refoulés ou niés qui peuvent resurgir. Lorsque d'autres membres de la famille sont sollicités pour préciser les liens génétiques et/ou être soumis en première intention à l'analyse génétique, le sujet exprime sa difficulté de dépendre d'autres personnes pour connaître son propre statut biologique. D'une façon générale, on constate que là où la médecine prédictive réalise son acte de prévision, le sujet répond de façon imprévisible. Dans l'optique de la psychanalyse, cette imprévisibilité est liée aux aspects du « désir inconscient ». Cette étude montre aussi qu'on ne peut pas considérer le dépistage génétique comme étant la cause directe du traumatisme. L'effort doit porter sur le fait que le sujet puisse se réapproprier ce qui lui arrive, et exprimer progressivement sa souffrance spécifique en jeu dans le processus de prédiction pour créer un écart entre la vérité médicale et la sienne. L'espace de la parole devient ainsi le lieu d'un travail privilégié. La psychanalyse opère donc pour que le résultat génétique se détache de l'acte de prédiction, c'est-à-dire qu'il redevienne un moment de la vie du sujet qui puisse s'articuler comme sa propre histoire personnelle. The aim of predictive medicine is to assess the probability that individuals carrying germ-line mutations will develop certain diseases, for instance cancer (oncogenetics). In predictive oncology, particular surveillance and prevention measures are discussed with these patients in relation to risk assessment and results of genetic testing, including preventive care which can, in extremes cases, lead to prophylactic surgery (i.e. mastectomy and/or ovariectomy). This study is based on a psychoanalytic interpretation of subjects' narration of the oncogenetic process and aims at analyzing the psychological impact of a) genetic testing and b) the construction of the family tree. It was carried out at the Oncogenetics and cancer prevention unit (Unité d'oncogénétique et de prévention des cancers) from the Geneva University Hospitals (Hôpitaux Universitaires de Genève, HUG) which organizes genetic counselling for individuals having personal and/or family history suggestive of genetic predisposition to cancer. The study population comprises 125 patients followed during the successive steps of genetic counselling, for a total of 289 consultations and 50 personal interviews. This research shows that asymptomatic subjects re-elaborate in a personal way either the results of genetic testing (negative or positive) or the act of prediction. Conversely, those having developed cancer express feelings of anguish, as if they were undergoing the effects of a destiny which effectively happened. Its sight remains a difficult step of the oncogenetic process, as psychological aspects which were repressed or denied can re-appear. When some family members are solicited to help reconstructing the genetic relationships, sometimes being themselves submitted first to genetic testing, the study subject expresses the difficulty to depend on other persons to learn more about his own biological status. In this study, we observe that, in parallel to predictions delivered by the process of predictive medicine, the subject actually answers unpredictably. With a psychoanalytic perspective, this unpredictability is related to an "unconscious desire". We also find that we cannot consider that genetic screening is a direct cause of psychological trauma. Our efforts must rely on allowing the subject to re-appropriate himself what is happening, to let him progressively express his own suffering of the prediction in order to create a gap between the medical reality and his own. In this process, "speech" is needed to let this happening. Psychoanalysis works in such a way that the genetic testing's result becomes distinct from the act of prediction, a moment of the subject's life expressed as his own personal history.

The Relationship between Media and Political Agendas : Variations across Decision-Making Phases

Previous studies have demonstrated that the extent to which media coverage influences the issue priorities of policy makers is contingent on the type of issue, media, and political agenda. This article contends that the relationship between media and political agendas varies across the phases of the decision-making process. Based on a comprehensive dataset on issue attention in media coverage and various policy-making channels covering the years 1996-2003, the article analyses the level of media coverage and, more importantly, the distribution and correspondence of issue attention between media and political agendas across the four successive phases of the decision-making process (initiation, preparatory, parliamentary, and referendum phases) in Switzerland. Despite inversely distributed levels of attention for successive decision-making phases, both media and political agendas are concentrated on fewer issues in the initiation and referendum phases, and they are more strongly correlated in the most decisive stages of the process, that is, the preparatory and referendum phases.

Synorogenic extension in the Tethyan Himalaya documented by structural studies and the Kubler index, Lachung La area, NW India

Tectonic observations in the Tethyan Himalaya reveal an important extensional event that succeeds the emplacement of SW-verging nappes. A major thrust, called the Kum Tso Thrust, has been backfolded and reactivated by normal faulting associated with this event. Measurements of the Kubler index, coupled with characterization of clay-size paragenesis show the effect of normal faulting on the regional metamorphic zonation and indicate that important extension zones, like the Sarchu-Lachung La Normal Fault Zone (SLFZ), exist within the Tethyan Himalaya. Diagenetic limestones from within the SLFZ are characterized by the occurrence of mixed-layered clay phases, kaolinite and an illite with a 001 peak >0.4 Delta degrees2 theta. This zone is bordered by two anchizonal-to-epizonal zones, where illite peaks become narrower. Further to the NE the successive appearance of biotite, chloritoid, garnet and garnet-staurolite-kyanite assemblapes testifies to an increase in metamorphic grade. The cataclastic samples from the normal faults contain kaolinite, smectite and a `broad' illite, indicating that extension occurs under diagenetic conditions.

Evaluation of two HbA1c point-of-care analyzers.

BACKGROUND Measurement of HbA1c is the most important parameter to assess glycemic control in diabetic patients. Different point-of-care devices for HbA1c are available. The aim of this study was to evaluate two point-of-care testing (POCT) analyzers (DCA Vantage from Siemens and Afinion from Axis-Shield). We studied the bias and precision as well as interference from carbamylated hemoglobin. METHODS Bias of the POCT analyzers was obtained by measuring 53 blood samples from diabetic patients with a wide range of HbA1c, 4%-14% (20-130 mmol/mol), and comparing the results with those obtained by the laboratory method: HPLC HA 8160 Menarini. Precision was performed by 20 successive determinations of two samples with low 4.2% (22 mmol/mol) and high 9.5% (80 mmol/mol) HbA1c values. The possible interference from carbamylated hemoglobin was studied using 25 samples from patients with chronic renal failure. RESULTS The means of the differences between measurements performed by each POCT analyzer and the laboratory method (95% confidence interval) were: 0.28% (p<0.005) (0.10-0.44) for DCA and 0.27% (p<0.001) (0.19-0.35) for Afinion. Correlation coefficients were: r=0.973 for DCA, and r=0.991 for Afinion. The mean bias observed by using samples from chronic renal failure patients were 0.2 (range -0.4, 0.4) for DCA and 0.2 (-0.2, 0.5) for Afinion. Imprecision results were: CV=3.1% (high HbA1c) and 2.97% (low HbA1c) for DCA, CV=1.95% (high HbA1c) and 2.66% (low HbA1c) for Afinion. CONCLUSIONS Both POCT analyzers for HbA1c show good correlation with the laboratory method and acceptable precision.

(Endogenous) occupational choices and job satisfaction among recent PhD recipients: evidence from Catalonia

Drawing on data from two successive cohorts of PhD graduates, this paper analyses differences in overall job satisfaction and specific job domain satisfaction among PhDs employed in different sectors four years after completing their doctorate degrees. Covariate-adjusted job satisfaction differentials suggest that, compared to faculty members, PhD holders employed outside traditional academic and research jobs are more satisfied with the pecuniary facets of their work (principally, because of higher earnings), but significantly less satisfied with the content of their job and with how well the job matches their skills (and, in the case of public sector workers, with their prospects of promotion). The evidence regarding the overall job satisfaction of the PhD holders indicates that working in the public or private sectors is associated with less work well-being, which cannot be fully compensated by the better pecuniary facets of the job. It also appears that being employed in academia or in research centres provides almost the same perceived degree of satisfaction with the job and with its four specific domains. We also take into account the endogenous sorting of PhD holders into different occupations based on latent personal traits that might be related to job satisfaction. The selectivity-corrected job satisfaction differentials reveal the importance of self-selection based on unobservable traits, and confirm the existence of a certain penalisation for working in occupations other than academia or research, which is especially marked in the case of satisfaction with job content and job-skills match. The paper presents additional interesting evidence about the determinants of occupational choice among PhD holders, highlighting the relevance of certain academic attributes (especially PhD funding and pre-and-post-doc research mobility) in affecting the likelihood of being employed in academia, in a research centre or in other public or private sector job four years after completing their doctorate programme.

Risky single-occasion drinking: bingeing is not bingeing.

AIMS: To review the concept of binge drinking as a measure of risky single occasion drinking (RSOD), to illustrate its differential impact on selected health outcomes and to identify research gaps. METHODS: Narrative literature review with focus on conceptual and methodological differences, trajectories of RSOD and effects of RSOD on fetal outcomes, coronary heart disease (CHD) and injuries. RESULTS: Effects ascribed commonly to RSOD may often be the effects of an undifferentiated mixture of risky single occasions and regular heavy volume drinking, constituted by frequent, successive RSOD. This leads to the problem that additional risks due to RSOD are mis-specified and remain unidentified or underestimated in some cases, such as for injuries or CHD, but are probably overstated for some chronic consequences or for effects of maternal drinking on newborns. CONCLUSION: A stronger focus should be placed upon methods that can differentiate the effects of RSOD from those due to frequent occasions of heavy drinking that result in heavy volume drinking.