Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.

[Does cataract surgery increase the risk of exudative age-related macular degeneration? Results from a large retrospective case-control study]

BACKGROUND: Many epidemiological studies indicate a positive correlation between cataract surgery and the subsequent progression of age-related macular degeneration (AMD). Such a correlation would have far-reaching consequences. However, in epidemiological studies it is difficult to determine the significance of a single risk factor, such as cataract surgery. PATIENTS AND METHODS: We performed a retrospective case-control study of patients with new onset exudative age-related macular degeneration to determine if cataract surgery was a predisposing factor. A total of 1496 eyes were included in the study: 984 cases with new onset of exudative AMD and 512 control eyes with early signs of age-related maculopathy. Lens status (phakic or pseudophakic) was determined for each eye. RESULTS: There was no significant difference in lens status between study and control group (227/984 [23.1 %] vs. 112/512 [21.8 %] pseudophakic, p = 0.6487; OR = 1.071; 95 % CI = 0.8284-1.384). In cases with bilateral pseudophakia (n = 64) no statistically significant difference of the interval between cataract surgery in either eye and the onset of exudative AMD in the study eye was found (225.9 +/- 170.4 vs. 209.9 +/- 158.2 weeks, p = 0.27). CONCLUSIONS: Our results provide evidence that cataract surgery is not a major risk factor for the development of exudative AMD.

Intermediate results of health related quality of life after vertical banded gastroplasty

OBJECTIVES: The purpose of this study is to evaluate (a) health-related quality of life (HRQL) after vertical banded gastroplasty (VBG) (Mason) and (b) predictors of HRQL. SUBJECTS: Eighty-two consecutive patients were assessed preoperatively and then after 6, 12 and 24 months. Patients filled out questionnaires for subjective appraisal of HRQL (physical well-being, mood, physical performance, perceived health, social support and coping/adjustment). RESULTS: The greatest improvement in weight and HRQL was seen within 6 months of surgery. Twenty-four months after VBG weight reduction (P<0.05), perceived health (P<0.05), physical well-being (P<0.05), physical performance (P<0.05), mood (P<0.05), coping/adjustment (P<0.05) continued to be better than before surgery. Preoperative binge eating was the most important predictor of HRQL. CONCLUSION: Two years after VBG weight loss and a significant improvement of HRQL can be found. HRQL and weight loss are not associated in terms of outcome, indicating that weight loss alone may not be enough to improve HRQL.

Correction of erosion after suburethral sling insertion for stress incontinence: results and related sexual function

BACKGROUND: Suburethral slings are commonly used for the surgical treatment of female stress incontinence; occasionally they can cause erosion and dyspareunia. OBJECTIVES: The primary aim of this study is to determine the outcome after reclosure of the vaginal epithelium for suburethral sling erosion. Sexual function was assessed before and after intervention using the Female Sexual Function Index (FSFI) questionnaire. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective case-controlled study in which, between December 2005 and December 2007, we included patients who were referred to the Department of Urogynaecology because of vaginal erosion after suburethral sling insertion for urinary stress incontinence. For evaluation of sexual function, all patients filled in an FSFI questionnaire before intervention and at follow-up. All patients underwent gynaecological examination including colposcopy, and the site and size of the defect were noted. INTERVENTION: The edge of the vaginal epithelium was trimmed, mobilized, and closed with interrupted vertical Vicryl mattress sutures in a single layer. MEASUREMENTS: FSFI questionnaire and clinical findings. RESULTS AND LIMITATIONS: Twenty-one patients were included in the study. Eighteen patients with larger defects were operated on, and three defects healed after topical application of estrogen cream. In 16 patients, the defect had healed at follow-up; two patients with persisting defects were brought back to surgery and the procedure was repeated, paying particular attention to tension-free adaptation of vaginal tissue. In one patient, partial sling removal was performed after the second failed intervention. The domains of desire (p<0.0001), arousal (p<0.0003), lubrication (p<0.0001), satisfaction (p<0.0130), and pain (p<0.0001) improved significantly. Orgasm remained unchanged (p=0.4130; all two-tailed t-test). CONCLUSION: Suburethral erosion can be treated effectively by resuturing. Sexual function is improved in regard to desire, arousal, lubrication, satisfaction, and pain, but not orgasm. In septic patients and patients with a history of radiation, grossly infected tissue, or severe pain, excision of the mesh needs to be considered.

Physical-Biological Oceanographic Coupling Influencing Phytoplankton and Primary Production in the South China Sea

Two cruises were carried out in the summer and winter of 1998 to study coupled physical-chemical-biological processes in the South China Sea and their effects on phytoplankton stock and production. The results clearly show that the seasonal distributions of phytoplankton were closely related to the coupled processes driven by the East Asian Monsoon. Summer southwesterly monsoon induced upwelling along the China and Vietnam coasts. Several mesoscale cyclonic cold eddies and anticyclonic warm pools were identified in both seasons. In the summer, the upwelling and cold eddies, both associated with rich nutrients, low dissolved oxygen ( DO), high chlorophyll a (Chl a) and primary production ( PP), were found in the areas off the coast of central Vietnam, southeast of Hainan Island and north of the Sunda shelf, whereas in the winter they form a cold trough over the deep basin aligning from southwest to northeast. The warm pools with poor nutrients, high DO, low Chl a, and PP were found in the areas southeast of Vietnam, east of Hainan, and west of Luzon during the summer, and a northwestward warm jet from the Sulu Sea with properties similar to the warm pools was encountered during the winter. The phytoplankton stock and primary production were lower in summer due to nutrient depletion near the surface, particularly PO4. This phosphorus depletion resulted in phytoplankton species succession from diatoms to dinoflagellates and cyanophytes. A strong subsurface Chl a maximum, dominated by photosynthetic picoplankton, was found to contribute significantly to phytoplankton stocks and production.

Effects of Surface Forcing on Interannual Variability of the Fall Phytoplankton Bloom in the Gulf of Maine Revealed Using a Process-Oriented Model

SeaWiFS (Sea-viewing Wide Field-of-view Sensor) chlorophyll data revealed strong interannual variability in fall phytoplankton dynamics in the Gulf of Maine, with 3 general features in any one year: (1) rapid chlorophyll increases in response to storm events in fall; (2) gradual chlorophyll increases in response to seasonal wind-and cooling-induced mixing that gradually deepens the mixed layer; and (3) the absence of any observable fall bloom. We applied a mixed-layer box model and a 1-dimensional physical-biological numerical model to examine the influence of physical forcing (surface wind, heat flux, and freshening) on the mixed-layer dynamics and its impact on the entrainment of deep-water nutrients and thus on the appearance of fall bloom. The model results suggest that during early fall, the surface mixed-layer depth is controlled by both wind-and cooling-induced mixing. Strong interannual variability in mixed-layer depth has a direct impact on short-and long-term vertical nutrient fluxes and thus the fall bloom. Phytoplankton concentrations over time are sensitive to initial pre-bloom profiles of nutrients. The strength of the initial stratification can affect the modeled phytoplankton concentration, while the timing of intermittent freshening events is related to the significant interannual variability of fall blooms.

(Table 1) Results of measurements of production characteristics of phytoplankton and some physical parameters of the environment in the northeastern Norwegian Sea in July 1995

From July 4 to 18,1995 surface chlorophyll a concentrations (C_cs) and integral primary production (C_ps) were studied in the northeastern part of the Norwegian Sea (73°42'N; 13°16'E), over a test area where an accident of the nuclear submarine Komsomolets had taken place. It was found that during this interval C_cs decreased by factor of about 3.3 (from 0.78 to 0.24 mg/m**3); average chlorophyll concentration within the photo-synthetic layer (C_cl) decreased by factor of about 3.5 (from 0.97 to 0.28 mg/m**3). The value of C_ps in the water column varied slightly (from 445 to 539 mg C/m**2 per day), since decrease in C_cl was compensated both by 1.5-fold growth of the photosynthetic layer thickness (from 40 to 60 m) and by 2.1-fold increase in its average assimilation number (from 0.58 to 1.20 mg C/mg chl a per hour). Monthly averages of C_ps were obtained from published data on seasonal C_cs changes and on the level of incident solar irradiation. They were found to be less than 100 mg C/m**2 per day in March and October and 100-500 mg C/m**2 per day in April-June. Annual primary production calculated from above values was equal to 105 g C/m**2.

Open Ocean and coastal phytoplankton communities of of Western Antarctic Peninsula and Drake Passage waters

Photophysiological processes as well as uptake characteristics of iron and inorganic carbon were studied in inshore phytoplankton assemblages of the Western Antarctic Peninsula (WAP) and offshore assemblages of the Drake Passage. Chlorophyll a concentrations and primary productivity decreased from in- to offshore waters. The inverse relationship between low maximum quantum yields of photochemistry in PSII (Fv/Fm) and large sizes of functional absorption cross sections (sigma PSII) in offshore communities indicated iron-limitation. Congruently, the negative correlation between Fv/Fm values and iron uptake rates across our sampling locations suggest an overall better iron uptake capacity in iron-limited pelagic phytoplankton communities. Highest iron uptake capacities could be related to relative abundances of the haptophyte Phaeocystis antarctica. As chlorophyll a-specific concentrations of humic-like substances were similarly high in offshore and inshore stations, we suggest humic-like substances may play an important role in iron chemistry in both coastal and pelagic phytoplankton assemblages. Regarding inorganic carbon uptake kinetics, the measured maximum short-term uptake rates (Vmax(CO2)) and apparent half-saturation constants (K1/2(CO2)) did not differ between offshore and inshore phytoplankton. Moreover, Vmax(CO2) and K1/2(CO2) did not exhibit any CO2-dependent trend over the natural pCO2 range from 237 to 507 µatm. K1/2(CO2) strongly varied among the sampled phytoplankton communities, ranging between 3.5 and 35.3 µmol/L CO2. While in many of the sampled phytoplankton communities, the operation of carbon-concentrating mechanisms (CCMs) was indicated by low K1/2(CO2) values relative to ambient CO2 concentrations, some coastal sites exhibited higher values, suggesting down-regulated CCMs. Overall, our results demonstrate a complex interplay between photophysiological processes, iron and carbon uptake of phytoplankton communities of the WAP and the Drake Passage.

(Table 2) Production characteristics of phytoplankton and selected related factors at bottle sampling stations in the subtropical and tropical Atlantic Ocean

In October and November 2002, high and relatively high values of chlorophyll a concentration at the sea surface (Cchl) were observed in the English Channel (0.47 mg/m**3), in waters of the North Atlantic Current (0.25 mg/m**3 ), in the tropical and subtropical anticyclonic gyres (0.07-0.42 mg/m**3), and also in the southwestern region of the southern subtropical anticyclonic gyre (usually 0.11-0.23 mg/m**3). The central regions of the southern subtropical anticyclonic gyre (SATG) and the North Atlantic tropical gyre (NATR) were characterized by lower values of Cchl (0.02-0.08 mg/m**3 for the SATG and 0.07-0.14 mg/m**3 for the NATR). At most of the SATG stations, values of surface primary production (Cphs) varied from 2.5 to 5.5 mg C/m**3 per day and were mainly defined by fluctuations of Cchl (r = +0.78) rather than by those of the assimilation number (r = +0.54). Low assimilation activity of phytoplankton in these waters (1.3-4.6 mg chl a per hour) pointed to a lack of nutrients. Analysis of variability of their concentration and composition of photosynthetic pigments showed that, in waters north of 30°N, the growth of phytoplankton was mostly restricted by deficiency of nitrogen, while, in more southern areas, at the majority of stations (about 60%), phosphorus concentrations were minimal. At low concentrations of nitrates and nitrites, ammonium represented itself as a buffer that prevented planktonic algae from extreme degrees of nitric starvation. In tropical waters and in waters of the SATG, primary production throughout the water column varied from 240 to 380 mg C/m**2 30° per day. This level of productivity at stations with low values of C chl (<0.08 mg/m**3) was provided by a well-developed deep chlorophyll maximum and high transparency of water. Light curves of photosynthesis based on in situ measurements point to high efficiency of utilizing penetrating solar radiation by phytoplankton on cloudy days.

(Table 1) Results of measurements of productive characteristics of phytoplankton and environmental parameters in the Barents Sea in September-October 1997

The described studies were carried out in the eastern part of the sea during the end of the summer seasonal succession from September 1 to October 12, 1997. Concentration of chlorophyll a in the surface layer varied from 0.09 to 1.24 mg/m**3; it tended to increase in the southern regions (<74°N). Primary production in the water column (P_p) varied from 24 to 214 mg C/m**2/day and was on average 91 mg C/m**2/day. The low level of P_p seems to result from combination of physical and chemical environmental factors unfavorable for photosynthesis (e.g. deficiency of nutrients and low values of insolation and temperature) and intensive grazing of phytoplankton by zooplankton. The lower boundary of the photosynthetic layer in open waters was located at depth 60-75 m; irradiance there was 0.1-0.5% of incident irradiance. In deep-water regions (>200 m) the subsurface maximum of chlorophyll occurred in the layer at 20-40 m; usually this maximum resulted in formation of additional maxima of primary production.

Composition and biomass of phytoplankton in the Northwest Pacific in summer 1990

According to results of Cruise 22 of R/V Akademik Mstislav Keldysh in the Northwest Pacific in July-August 1990, picophytoplankton represented mainly by cyanobacteria (up to 90%) comprised from 70 to 99% of total phytoplankton. Nanophytoplankton constituted substantial part of total biomass (22-37%) and consisted mainly of small phytoflagellates (2-4 ?m), cryptomonades, and coccolithophorids Emiliania huxleyi. Summer species such as Neodenticula seminae prevailed among large phytoplankton. Horizontal and vertical distribution of phytoplankton groups and species was described. Taxonomy and vertical distribution were related to nutrient concentrations in the upper mixed layer.