3-day Record Research Articles

Change in Atrial Fibrillation Burden over Time in Patients with Nonpermanent Atrial Fibrillation

Introduction The natural course of atrial fibrillation (AF) is not well defined. We aimed to investigate the change in AF burden over time and its associated risk factors among AF patients. Methods Fifty-four participants with recently documented paroxysmal or persistent AF were enrolled. Main exclusion criteria were permanent AF or previous catheter ablation for AF. AF burden was calculated as time in AF divided by total recording time using yearly continuous 7-day Holter-ECG recordings. A relative change ≥10% or an absolute change >0.5% in AF burden between two yearly Holter-ECG recordings was considered significant. Results Mean age was 67 years, 72% were men. The proportion of patients with no recorded AF increased from 53.7% at baseline to 78.6% (p=0.1) after 4 years of follow-up. In 7-day Holter-ECG recordings performed after baseline, 23.7% of participants had a decrease and 23.7% an increase in AF burden. In separate mixed effect models, AF burden over time was associated with prior stroke (β 42.59, 95% CI (23.40; 61.77); p < 0.0001), BNP (β 0.05, CI (0.02; 0.09); p=0.005) end-diastolic (β 0.49, CI (0.23; 0.74); p=0.0003) as well as end-systolic (β 0.25, CI (0.05; 0.46); p=0.02) left atrial volume, left atrial ejection fraction (β −0.43, CI (−0.76;−0.10); p=0.01), E-wave (β 36.67, CI (12.96; 60.38); p=0.003), and deceleration time (β −0.1, CI (−0.16; −0.05); p=0.002). In a multivariable model, a history of prior stroke (β 29.87, CI (2.61; 57.13); p=0.03) and BNP levels (β 0.05, CI (0.01; 0.08); p=0.007) remained significantly associated with AF burden. Conclusions Few patients with paroxysmal or persistent AF have AF episodes on yearly 7-day Holter-ECG recordings, and AF progression is rare. AF burden was independently associated with a history of prior stroke and BNP levels.

Promoting and maintaining urinary continence: Follow-up from a cluster-randomized trial of elderly village women in Bangladesh.

Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.

Body weight of individuals with obesity decreases after a 6-month high pasta or low pasta Mediterranean diet weight-loss intervention

Background & aimsThe effect of pasta consumption within a low-energy Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity. Methods & ResultsForty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component. ConclusionsIndependent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention.This trial was registered at clinicaltrials.gov as NCT03341650.

Assessing water intake of adults during consultation: the striking discrepancy between a prospective record, an open and a frequency question

AbstractHealth care professionals often ask their patients questions about their water intake, or water drinking frequency. The aim of the present analysis was to compare 3 questions (prospective 7-day fluid record, an open question (OQ) and a frequency question (FQ)) used to record the volumes of water drank.8159 participants (18–65 years) from Argentina, Brazil, China, Indonesia, Mexico and Uruguay completed a validated 7-day fluid intake record. For each drinking event, the volume consumed was recorded. On day 8, participants answered the following questions: “On average, what is your daily intake of water? (Tap water, bottled still and/or sparkling water)” and “How often do you consume drinking water (tap water, bottled still and sparking water): at least once a day or several times a day?”.When asked about the amount of water consumed, 63–76% of participants in all countries, except for Uruguay and Indonesia, estimated their water intake to be 1–2L to 2–3 L/day, 75–88% of participants reported drinking less than 1L of water/day in the record. In Uruguay, 74% of participants reported in the OQ drinking less than 0.4 L/day and 8% drinking 2–3 L/day, while the 7-day record showed that 56% drank less than 0.4 L/day, 2% drank 2–3 L/day and 32% drank 0.4 L/day. In Indonesia, 17% of participants didn't know how much they drank when asked the OQ. Moreover, 7% estimated drinking ≥ 3 L/day when asked the OQ while only 21% recorded this amount. When comparing water intake reported through the FQ and the 7-day record, 34–75% of participants accurately reported drinking water at least once a day. Nevertheless, in Indonesia, where the mean water intake was high (2.16 L/day), only 1% of participants reported drinking water at least once a day but actually drank water less frequently. In the other countries, where the mean water intake was lower (0.49–0.76L/day in Uruguay and Brazil respectively), 20–42% of participants reported drinking water at least once a day but actually drank water less frequently.Despite recently recording their water intake for 7 days, it was still difficult for adults to estimate how much and how often they drank when asked a single question. These results suggest a lack of awareness in adults of frequency and volume of water intake and illustrate the need for quick, valid methods that health care professionals can use to assess water intake.

Fluid intake patterns of adults: results of six Liq.In7 national cross-sectional surveys

AbstractDietary patterns provide valuable information for the development of public health policies. Despite increasing interest in the role of fluids in health and disease there are limited data on drinking patterns in adults. The aim of this analysis was to identify and characterize patterns of fluid intake in adults in cross-sectional surveys in China, Indonesia, Argentina, Brazil, Mexico and Uruguay.Data on fluid intake volume and type amongst 8159 adults (46% male) were collected using a validated 7-day fluid specific record (Liq.In7). A cluster analysis (partitioning around k-medoids algorithm) was used to identify relatively distinct clusters of subjects based on eight fluid types (water, milk and its derivatives, hot beverages (HB), sugar sweetened beverages (SSB), 100% fruit juices, artificial/non-nutritive sweetened beverages, alcoholic beverages, other beverages). Subjects were categorized according to total daily fluid intake as low (&lt; 1500 mL/d), medium (&gt; 1500- &lt; 3000mL/d), high (&gt; 3000mL- &lt; 4000mL/d) or very high (&gt; 4000mL/d). The clusters were characterized according to country of residence, socio-demographics and lifestyle factors.The eight interpretable clusters identified were: (1) low drinkers – SSB (n = 2450), (2) low drinkers – HB (n = 1589), (3) medium drinkers - water (n = 1306), (4) medium drinkers – HB and SSB (n = 892), (5) medium drinkers - SSB (n = 262), (6) high drinkers – water (n = 817), (7) high drinkers – water &amp; SSB (n = 313) and (8) very high drinkers – water (n = 530). Country of residence was the dominant characteristic in all clusters. In cluster #1 34% of subjects were resident in Mexico (v test 21), 43% of cluster #2 lived in China (v test 21.4). 47% of cluster #4 lived in Argentina (v test 24.2) with 30% living in Uruguay (v test 19.7), (v test 8). Cluster #3 was characterized by residence in Indonesia (v test 23.6) as were clusters #6 (v test 28.5), cluster #7 (v test 8.2) and cluster #8 (v test 24.5). To a lesser extent cluster #7 (high drinkers – water &amp; SSB) was characterised by residence in Mexico (v test 3.6). In cluster #5, 51% and 30% lived in Mexico and Argentina, respectively; with 60% of this cluster being male.Fluid intake patterns (clusters) varied according to the different countries. This information highlights the need to tailor interventions aimed at improving fluid intake behaviour and health to the specific adult populations.

Evaluating the Validity of a Food Frequency Questionnaire in Comparison with a 7-Day Dietary Record for Measuring Dietary Intake in a Population of Survivors of Colorectal Cancer

BackgroundFood frequency questionnaires (FFQs) are a commonly used method to assess dietary intake in epidemiological studies. It is important to evaluate the validity of FFQs in the population of interest. ObjectiveTo evaluate the validity of an FFQ for measuring dietary intake in survivors of colorectal cancer (CRC), relative to a 7-day dietary record. DesignDietary intake was assessed 1 year after the end of CRC treatment. Participants first completed a 7-day dietary record and 2 weeks later a 253-item FFQ that measured intake in the preceding month. Participants/settingData were used from a subsample of participants (n=100) enrolled in an ongoing prospective study (EnCoRe study) in the Netherlands, from 2015 to 2018. Main outcome measuresEstimated intakes of total energy, 19 nutrients, and 20 food groups as well as scoring adherence to the dietary recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) were compared between both dietary assessment methods. Statistical analyses performedMeans and standard deviations, Spearman rank correlations corrected for within-person variation and total energy, and κ agreement between quintiles were assessed. ResultsThe median Spearman correlation corrected for within-person variation for nutrients and total energy was 0.60. Correlations >0.50 were found for 15 of 19 nutrients, with highest agreement for vitamin B-12 (0.74), polysaccharides (0.75), and alcohol (0.91). On average, 73% (range=60% to 84%) of participants were classified into the exact same or adjacent nutrient quintile. The median Spearman correlation corrected for within-person variation for food groups was 0.62. Correlations >0.50 were found for 17 of 20 food groups, with highest agreement for cereals and cereal products (0.96), fish (0.96), and potatoes (0.99). The Spearman correlation between total scores of the WCRF/AICR dietary recommendations was 0.53. ConclusionsRelative to a 7-day dietary record, the validity of an FFQ for measuring dietary intake among survivors of CRC appeared moderate to good for most nutrients and food groups.

Vaccine cold chain in general practices: A prospective study in 75 refrigerators (Keep Cool study).

IntroductionProtecting vaccines from freeze damage is considered one of the most poorly addressed problems in vaccine management. Freezing may impair the potency especially of adsorbed vaccines. The Keep Cool study aims at ensuring optimal vaccine storage conditions in general practices. This publication analyses the baseline data using standardised temperature recordings.MethodsThis prospective study in German general practices analysed 7-day temperature recordings of refrigerators used for vaccine storage. Temperatures were recorded continuously using a standardised data logger with an accuracy of ±0.4 °C. The prevalence rates of refrigerators within the target range (2 to 8 °C) and of those reaching critically low temperatures (≤0 °C) were calculated. In addition, the cumulative time and the duration of single episodes beyond the target range were computed. To assess for structural deficits, the prevalence of refrigerators with a cycling of >5 °C was determined. Generalised linear mixed models were applied to analyse correlating factors between the dependent variables ‘within temperature range’ and ‘reaching critically low temperatures’ with practice characteristics.ResultsThe study included 64 of 168 practices (38.1% response rate) with 75 refrigerators. The prevalence of refrigerators with temperatures within the target range was 32.0% (n = 24), and 14.7% (n = 11) reached critically low temperatures <0 °C. 44.0% of refrigerators (n = 33) showed temperatures >8 °C and 28.0% (n = 21) <2 °C. Of the 168 hours recorded per refrigerator, the average cumulative time >8 °C was 49 hours, <2 °C 75 hours and ≤0 °C 74 hours. The longest consecutive period of critically low temperatures was 168 hours (mean: 39±53). The prevalence of refrigerators with a cycling range of >5 °C was 29.3%.ConclusionGiven the importance of immunisation, the results of our study call for action, as two-thirds of the refrigerators exhibited cold chain breaches and 15% reached critically low temperatures threatening vaccine potency.

Vulnerability to bipolar disorder is linked to sleep and sleepiness

Sleep impairments are a hallmark of acute bipolar disorder (BD) episodes and are present even in the euthymic state. Studying healthy subjects who are vulnerable to BD can improve our understanding of whether sleep impairment is a predisposing factor. Therefore, we investigated whether vulnerability to BD, dimensionally assessed by the hypomanic personality scale (HPS), is associated with sleep disturbances in healthy subjects. We analyzed participants from a population-based cohort who had completed the HPS and had either a 7-day actigraphy recording or a Pittsburgh sleep quality index (PSQI) assessment. In addition, subjects had to be free of confounding diseases or medications. This resulted in 771 subjects for actigraphy and 1766 for PSQI analyses. We found strong evidence that higher HPS scores are associated with greater intraindividual sleep variability, more disturbed sleep and more daytime sleepiness. In addition, factor analyses revealed that core hypomanic features were especially associated with self-reported sleep impairments. Results support the assumption of disturbed sleep as a possibly predisposing factor for BD and suggest sleep improvement as a potential early prevention target.

You Are What You Eat: Microplastics Are Identified in Feces of Male Young Adults Living in Beijing

Background: Microplastics have been widely detected in environment, even in water systems and food, and become a severe global threat to sustainable development. However, few studies have investigated the presence of microplastics in humans. This study identified and quantified the microplastic content in human feces. Methods: In total, 26 male students aged 18-25 years were recruited in Beijing, China. Anthropometric measurements, including height and weight, were collected. A self-administered 7-day 24-h fluid intake record was used to document fluid intake, and food intake was recorded 3 days before the collection of feces. Newly excreted feces were collected by participants using a sterile fecal collector. Microplastics in the remaining fecal residues were measured using Fourier transform microinfrared spectroscopy after pretreatment. Eight types of microplastic were identified and analyzed. Findings: The fecal samples of 23 (95·5%) participants tested positive for microplastics. Among these 23 samples, the abundance of microplastic varied from 1 particle/g to 36 particles/g, and the mass of microplastics ranged from 0·01 to 14·6 mg. Qualitative analysis of the microplastic indicated the presence of one to eight types of microplastic in each sample, with the relative mass abundance ratio of polypropylene (PP) being the highest at 61·0%. PP was found in 95·8% of fecal samples. Compared with the participants in the high-abundance group, those in the low-abundance-group consumed more bottled water and beverages (1071 vs 840 mL, Z = -2·078, p = 0·038). Interpretation: Various types of microplastic were detected in human feces, with the highest proportion being PP. Participants with more microplastics in their feces consumed more bottled water and beverages. More studies should explore the possibility of detecting microplastics in the human body, possible sources of microplastics, and the effects of microplastics on human health. Funding: There is no funding. Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The study protocol and instruments were reviewed and approved by the Institutional Review Committee of Peking University. The ethical approval project identification code is No. IR1052-19051. The study was conducted according to the guidelines of the Declaration of Helsinki. Prior to the study, all participants read and signed informed consent forms.

Impact of FODMAP Content Restrictions on the Quality of Diet for Patients with Celiac Disease on a Gluten-Free Diet.

Restrictive diets as gluten-free (GFD) or reduced in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) are used to improve gastrointestinal (GI) symptoms in sensitive individuals. Aiming at comparing the nutritional quality and effects of a regular GFD regimen (R-GFD) and a low-FODMAP GFD (LF-GFD), in 46 celiac patients with persistent GI symptoms we conducted a randomized, double-blind intervention-controlled study. Patients received a personalized diet, either a strict GFD (n = 21) or a LF-GFD (n = 25) for 21 days. A validated food-frequency questionnaire before intervention and a 7-day weighed-food record after the intervention assessed the diets. Patients were 41.1 ± 10.1 years (mean ± SD), 94% women, with mean BMI 21.8 ± 2.9 kg/m2. On day 21, patients on R-GFD still showed poor nutritional adequacy compared to dietary recommendations, with decreased energy intake, even though an improvement in carbohydrates and folates was observed (all p < 0.025). In both groups, intake of iron, calcium, vitamin D, sodium and folates did not meet daily recommendations. As expected, consumption of legumes and grains was lower and that of fruits was higher in the LF-GFD group than in the R-GFD one (all p < 0.05). The nutritional quality of both diets was not different. When restrictive diets are useful to improve the persistent GI symptoms, careful nutritional surveillance and counseling is mandatory.

Evaluation of median urinary iodine concentration cut-off for defining iodine deficiency in pregnant women after a long term USI in China

BackgroundThe WHO/UNICEF/ICCIDD define iodine deficiency during pregnancy as median urinary iodine concentration (MUIC) ≤ 150 μg/L. China implemented universal salt iodization (USI) in 1995, and recent surveillance showed nationwide elimination of iodine deficiency disorders (IDD). Data from 2014 showed that the MUIC in 19,500 pregnant women was 154.6 μg/L and 145 μg/L in 9000 pregnant women in 2015. However, symptoms of iodine deficiency were absent. Our study sought to evaluate whether MUIC below 150 μg/L affects thyroid function of Chinese pregnant women and their newborns in Chinese context.MethodsWe screened 103 women with normal thyroid function and MUIC lower than 150 μg/L during week 6 of pregnancy at Peking Union Medical College Hospital. Patient demographics and dietary salt intake were recorded. Subjects were followed at 12, 24, and 32 gestational weeks. At each visit, a 3-day dietary record, drinking water samples, and edible salt samples were collected and analyzed for total dietary iodine intake. Additionally, 24-h urine iodine and creatinine were measured. Blood tests assessed thyroid function in both mothers and newborns.ResultsOf 103 pregnant women enrolled, 79 completed all follow-up visits. Most subjects maintained normal thyroid function throughout pregnancy. However, 19 had thyroid dysfunction based on thyroid stimulating hormone and free thyroxine levels. The median serum iodine was 71 μg/L (95% CI: 44, 109). The median thyroglobulin was < 13 μg/L. values above this level indicate iodine deficiency in pregnant women. The median dietary iodine intake during pregnancy, derived from the 3-day record and measures of water and salt, was 231.17 μg/d. Assuming 90% urinary iodine excretion (UIE), 200.11 μg/d UIE means the 222.34 μg iodine loss per day, suggesting that subjects had a positive iodine balance throughout pregnancy. All neonatal blood samples showed TSH levels lower than 10 mIU/L, indicating normal thyroid function. No significant difference was found among gestational weeks for urinary iodine, and the MUIC in subjects who completed 3 follow-up visits was 107.41 μg/L.ConclusionTwenty years after implementing USI, expectant Chinese mothers with MUIC of 107.4 μg/L, less than the WHO’s 150 μg/L benchmark, maintained thyroid function in both themselves and their newborn babies.

Lifestyle advice follow-up improves dietary consumption and cardiometabolic risk in type 2 diabetes patients treated with oral antidiabetics

The lifestyle intervention is one of the most effective therapeutic options for improving glycemic control and reducing cardiovascular risk factors in patients with type 2 diabetes (T2D). The aim of this study was to investigate if monitoring of lifestyle advices could improve glycemic control and atheroma ratios in T2D patients treated with oral anti diabetics (OAD). Patients ( n = 85, sex ratio F/M, 40/45) aged 50 ± 8 years, with T2D since 9 ± 3 years and initially treated with oral anti diabetics during 8 ± 1 years, were recruited. At the beginning of the study (d0), nutritional advices (i.e. consumption of fish, fruits and vegetables diet, with 250 g of carbohydrates distributed over daily different meals) associated to 30 to 45 min walking per day, were recommended, with a follow-up at 3 (d90) and 6 months (d180). The 24-hour recall, followed by a 3-days record, and daily energy expenditure (DEE) questionnaire were realized. Serum glucose and glycated hemoglobin (HbA 1c ) were measured. Serum insulin was determined by ELISA and homeostatic model assessment insulin resistance (HOMA-IR) index was calculated. Serum total cholesterol (TC), HDL-C and triglycerides (TG) levels were measured by enzymatic colorimetric tests. Apolipoproteins Apo A-1 and Apo B level were analyzed by immuno-turbidimetric test. A significant increase of total energy intake (TEI) (MJ/24 h) was noted in T2D, at d90 and d180, compared to d0 ( P < 0.05). A negative balance (TEI-EE) was noted at d0 (−0.75 MJ),andd90 (−1.42 MJ/24 h) of lifestyle advices follow-up, whereas, a positive balance (+0.42 MJ/24 h)was observed atd180. There was no significant difference in carbohydrate intake distribution between the different meals, over the time. Compared to d0, serum glucose concentration, and HbA 1c value were reduced respectively by 19% and 35%at d90, and by 12% and 14%, at d180. Plasma insulin and HOMA-IR remained unchanged. Serum TG concentrations decreased by 36% at d90 vs. d0, and serum TC levels were lowered by 16% and 26%, at d90 and d180 respectively compared to d0. TC/HDL-C and Apo A-I/ApoB100 ratios were respectively reduced by 32% and 49% at d90, and by 57% and 68%, at d180 compared with d0. The six-month follow-up of dietary advice, associated with regular physical activity by T2D patients, improves their food consumption, HbA 1c as well as atheroma risk.

Lifestyle and cardiometabolic risk among primary school children of Oran

The increase in the prevalence of overweight and obesity among young people led to a surge in several risk factors, such as high blood pressure, dyslipidemia and abdominal adiposity, leading to metabolic syndrome and atherosclerosis. The aim of the study was to assess food consumption and physical activity level (PAL), in children on the one hand, and to evaluate the cardio-metabolic risk on the other hand. Children ( n = 222, sex-ratio F/M = 106/116) in the city of Oran, 7 to 10 years old were recruited. Dietary survey was carried out by 24 hours recall, followed by 3-day record. PAL, anthropometric parameters, and blood pressure (BP) were measured. Glycaemia, lipid profile, uric acid, albumin, creatinine, urea, leptin and adiponectin were determined in serum. Children were classified according to the body mass index (BMI) into four groups, according to the International Obesity Task Force (IOTF) references: normal-weight (NW) 63%, overweight (OW) 19%, obesity (O) 8.5%, and underweight (UW) 9.5%. Increased BMI, waist circumference ( P = 0.01) and weight ( P < 0.05) were observed in OW and O groups, compared to NW. PAL study revealed that OW were sedentary (1.40 < PAL < 1.69) and O were extremely inactive (PAL < 1.40). Dietary survey revealed a total energy intake (TEE) of 2008, 2211, 2567 and 1780 Kcal/dayfor NW, OW, O and UW, respectively. Qualitatively, lipids consumption, in particular saturated fatty acids, was high at the expense of complex carbohydrates in O. Systolic and diastolic BP were increased in OW and O groups, compared to NW ( P < 0.05) group. An increase in total cholesterol, LDL-cholesterol, triglycerides and uric acid values was observed in OW and O compared to NW groups ( P < 0.05). A positive correlation was noted between BMI and serum leptin levels ( r = 0.89: P < 0.001) on the one hand, and an inverse relationship was observed between BMI and serum adiponectin values ( r = −0.49; P < 0.01). This study highlights the presence of increased cardio-metabolic risk in overweight and obese children, requiring nutritional education, and a monitoring of their health status.

Application of a stable carbon isotope for identifying Broussonetia papyrifera pollen.

The objective of this study was to investigate whether δ13C values can be used to identify pollen specie in the atmosphere. A Burkard 7-day recording volumetric spore trap was used to collected pollens in the atmosphere in Tainan City, Taiwan, from January 2 to December 28, 2006, and a light microscope was used to identify the pollen species and concentrations. A Burkard cyclone sampler was used to collect particulate matter and an elemental analyzer with an isotope ratio mass spectrometer was used to analyze the δ13C values. Our data showed that the predominate pollen specie in the atmosphere was Broussonetia papyrifera pollen and that the annual average concentration was 27 grains/m3 (pollen season, 36; nonpollen season, 9 grains/m3). The average δ13C value was - 26.19‰ for particulate matter in the atmosphere (pollen season, - 26.00‰; nonpollen season, - 26.28‰). No significant association was observed between δ13C values and Broussonetia papyrifera pollen concentrations. However, the δ13C value in the atmosphere was associated with the levels of Broussonetia papyrifera pollen among the samples with a diameter of particulate matter smaller than 10μm at a level lower than 40μg/m3. In addition, the relative contribution of Broussonetia papyrifera pollen to the carbon in the atmosphere using a two end-member mixing models was found to be associated with the Broussonetia papyrifera pollen concentration. In summary, our study suggested that δ13C values can be applied in the assessment of Broussonetia papyrifera pollen specie under specific conditions in the atmosphere.

Validation of a Self-reported Food Frequency for Overweight and Obese Children, Using Parental 3-Day Food Records

Background Many studies derive dietary information from child self-reported Food Frequency Questionnaires (FFQs). This may be subjected to misreporting, especially among overweight and obese children. Aim The aim of this study was to examine the validity of data acquired from child-reported dietary intake using a semiquantitative FFQ developed for assessing dietary habits of overweight and obese children in Greece, using parental 3-day food records of child intakes. Methods Validation analysis was based on 106 (from total 115) children (41% boys and 59% girls). Children were asked to report the frequency of their dietary intake, using the FFQ provided. Parents were asked to keep a 3-day food record for their children’s intake. Correlations and significance between methods were assessed via Spearman correlation coefficient and Wilcoxon nonparametric pairwise comparisons, respectively. Agreement between the FFQ and the 3-day record was performed using Bland-Altman method. Results Significant correlations, ranging from 0.32 to 1 (all P &lt; .05), were observed between food consumption reported in the FFQ and recorded in the 3-day dietary record. High correlation was found for fruits (ρ = 0.988), vegetables (ρ = 0.985), dairy (ρ = 0.702), meat (ρ = 0.958), fish (ρ = 0.841), starchy foods (ρ = 0.793), sweets (ρ = 1), and beverages (ρ = 0.978). Medium correlation was observed only between the consumption of legumes (ρ = 0.329). No significant differences were found between reported FFQ and 3-day dietary record for most food groups and beverages examined. Mean intake agreement was ranged from 90.6% to 98.1% (Bland-Altman). Conclusions The FFQ used appears to be a valid tool for investigating dietary intake of food among overweight and obese children.

Serotonergic pathology and disease burden in the premotor and motor phase of A53T α-synuclein parkinsonism: a cross-sectional study

Because of the highly penetrant gene mutation and clinical features consistent with idiopathic Parkinson's disease, carriers of the autosomal dominant Ala53Thr (A53T; 209G→A) point mutation in the α-synuclein (SNCA) gene are an ideal population to study the premotor phase and evolution of Parkinson's pathology. Given the known neurochemical changes in the serotonergic system and their association with symptoms of Parkinson's disease, we hypothesised that carriers of the A53T SNCA mutation might show abnormalities in the serotonergic neurotransmitter system before the diagnosis of Parkinson's disease, and that this pathology might be associated with measures of Parkinson's burden. In this cross-sectional study, we recruited carriers of the A53T SNCA mutation from specialist Movement Disorders clinics in Athens, Greece, and Salerno, Italy, and a cohort of healthy controls with no personal or family history of neurological or psychiatric disorders from London, UK (recruited via public advertisement) who were age matched to the A53T SNCA carriers. We also recruited one cohort of patients with idiopathic Parkinson's disease (cohort 1) from Movement Disorders clinics in London, UK, and retrieved data on a second cohort of such patients (cohort 2; n=40) who had been scanned with a different scanner. 7-day continuous recording of motor function was used to determine the Parkinson's disease status of the A53T carriers. To assess whether serotonergic abnormalities were present, we used [11C]DASB PET non-displaceable binding to quantify serotonin transporter density. We constructed brain topographic maps reflecting Braak stages 1-6 and used these as seed maps to calculate [11C]DASB non-displaceable binding potential in our cohort of A53T SNCA carriers. Additionally, all participants underwent a battery of clinical assessments to determine motor and non-motor symptoms and cognitive status, and [123I]FP-CIT single-photon emission CT (SPECT) to assess striatal dopamine transporter binding and MRI for volumetric analyses to assess whether pathology is associated with measures of Parkinson's disease burden. Between Sept 1, 2016, and Sept 30, 2018, we recruited 14 A53T SNCA carriers, 25 healthy controls, and 25 patients with idiopathic Parkinson's disease. Seven (50%) of 14 A53T SCNA carriers were confirmed to have motor symptoms and confirmed to have Parkinson's disease, and the absence of motor symptoms was confirmed in seven (50%) A53T SCNA carriers (ie, premotor), in whom [123I]FP-CIT SPECT confirmed the absence of striatal dopaminergic deficits. Compared with healthy controls, premotor A53T SNCA carriers showed loss of [11C]DASB non-displaceable binding potential in the ventral (p<0·0001) and dorsal (p=0·0002) raphe nuclei, caudate (p=0·00015), putamen (p=0·036), thalamus (p=0·00074), hypothalamus (p<0·0001), amygdala (p=0·0041), and brainstem (p=0·046); and in A53T SNCA carriers with Parkinson's disease this loss was extended to the hippocampus (p=0·0051), anterior (p=0·022) and posterior cingulate (p=0·036), insula (p=0·0051), frontal (p=0·0016), parietal (p=0·019), temporal (p<0·0001), and occipital (p=0·0053) cortices. A53T SNCA carriers with Parkinson's disease showed a loss of striatal [123I]FP-CIT-specific binding ratio compared with healthy controls (p<0·0001). Premotor A53T SNCA carriers had loss of [11C]DASB non-displaceable binding potential in brain areas corresponding to Braak stages 1-3, whereas [11C]DASB non-displaceable binding potential was largely preserved in areas corresponding to Braak stages 4-6. Except for one participant who was diagnosed with Parkinson's disease in the past year, all A53T SNCA carriers with Parkinson's disease had decreases in [11C]DASB non-displaceable binding potential in brain areas corresponding to Braak stages 1-6. Decreases in [11C]DASB non-displaceable binding potential in the brainstem were associated with increased Movement Disorder Score-Unified Parkinson's Disease Rating Scale total scores in all A53T SNCA carriers (r -0·66, 95% CI -0·88 to -0·20; p=0·0099), idiopathic Parkinson's disease cohort 1 (r -0·66, -0·84 to -0·36; p=0·00031), and idiopathic Parkinson's disease cohort 2 (r -0·71, -0·84 to -0·52; p<0·0001). The presence of serotonergic pathology in premotor A53T SNCA carriers preceded development of dopaminergic pathology and motor symptoms and was associated with disease burden, highlighting the potential early role of serotonergic pathology in the progression of Parkinson's disease. Our findings provide evidence that molecular imaging of serotonin transporters could be used to visualise premotor pathology of Parkinson's disease in vivo. Future work might establish whether serotonin transporter imaging is suitable as an adjunctive tool for screening and monitoring progression for individuals at risk or patients with Parkinson's disease to complement dopaminergic imaging, or as a marker of Parkinson's burden in clinical trials. Lily Safra Hope Foundation and National Institute for Health Research (NIHR) Biomedical Research Centre at King's College London.

On the Robustness of Multiscale Indices for Long-Term Monitoring in Cardiac Signals.

The identification of patients with increased risk of Sudden Cardiac Death (SCD) has been widely studied during recent decades, and several quantitative measurements have been proposed from the analysis of the electrocardiogram (ECG) stored in 1-day Holter recordings. Indices based on nonlinear dynamics of Heart Rate Variability (HRV) have shown to convey predictive information in terms of factors related with the cardiac regulation by the autonomous nervous system, and among them, multiscale methods aim to provide more complete descriptions than single-scale based measures. However, there is limited knowledge on the suitability of nonlinear measurements to characterize the cardiac dynamics in current long-term monitoring scenarios of several days. Here, we scrutinized the long-term robustness properties of three nonlinear methods for HRV characterization, namely, the Multiscale Entropy (MSE), the Multiscale Time Irreversibility (MTI), and the Multifractal Spectrum (MFS). These indices were selected because all of them have been theoretically designed to take into account the multiple time scales inherent in healthy and pathological cardiac dynamics, and they have been analyzed so far when monitoring up to 24 h of ECG signals, corresponding to about 20 time scales. We analyzed them in 7-day Holter recordings from two data sets, namely, patients with Atrial Fibrillation and with Congestive Heart Failure, by reaching up to 100 time scales. In addition, a new comparison procedure is proposed to statistically compare the poblational multiscale representations in different patient or processing conditions, in terms of the non-parametric estimation of confidence intervals for the averaged median differences. Our results show that variance reduction is actually obtained in the multiscale estimators. The MSE (MTI) exhibited the lowest (largest) bias and variance at large scales, whereas all the methods exhibited a consistent description of the large-scale processes in terms of multiscale index robustness. In all the methods, the used algorithms could turn to give some inconsistency in the multiscale profile, which was checked not to be due to the presence of artifacts, but rather with unclear origin. The reduction in standard error for several-day recordings compared to one-day recordings was more evident in MSE, whereas bias was more patently present in MFS. Our results pave the way of these techniques towards their use, with improved algorithmic implementations and nonparametric statistical tests, in long-term cardiac Holter monitoring scenarios.

Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial

Group exercise-based programmes for urinary incontinence appear to be promising low-cost interventions for women in developing countries, but no evidence exists to support whether they could be implemented or effective in such populations. We aimed to evaluate whether a group intervention that comprised pelvic floor muscle training, mobility exercises, and bladder education would be more effective than education alone, and report changes between villages (ie, clusters) rather than between individual participants. In this cluster randomised trial, we recruited women from 16 pairs of villages in Bangladesh, with each pair comprising similar villages from the same sub-district. Women aged 60-75 years were interviewed to establish eligibility. Women were eligible if they had current urinary incontinence, and were excluded if they had a third degree or higher uterine prolapse, if they were unable to walk or stand without help, or if they had insufficient intellectual capacity to understand questions and follow instructions. The villages were randomly assigned within each pair to either exercise plus education or education-only intervention by use of a random number generator from a fixed seed. Women were excluded after consenting if they lived too far from the centre of the village. The exercise intervention was a physiotherapist-led group exercise class that was held twice weekly for 12 weeks, with home exercises between classes and to 24 weeks. Both groups received bladder-health education. Participants were followed up for 24 weeks. A 3-day continence record was collected at recruitment and every 4 weeks up until 24 weeks. This record involved the participant tying a knot in ribbons worn under the clothing each time they had an episode of urinary leakage. The primary outcome was change in number of knots (recorded leakage episodes) from recruitment to 24 weeks. Safety was assessed in all participants in the exercise intervention group. The trial is registered at ClinicalTrials.gov, number NCT02453100. Between Aug 22, 2015, and July 2, 2018, of 3577 women aged 60-75 years identified, 1003 were eligible, of whom 625 consented to participate (n=335 exercise plus education villages, and n=290 in education-only villages). Of these consenting women, 46 were excluded (n=37 exercise plus education, n=9 education only) because they lived too far from the centre of the village. At week 24, 283 (95%) of 298 in the exercise plus education group and 274 (98%) of 281 in the education-only group completed a 3-day continence record. The estimate of change in number of leakage episodes between baseline and 24 weeks was -7·7 (95% CI -10·6 to -4·8) at the village level in an unadjusted model, and -6·64 (-7·95 to -5·33) in a random-effects model accounting for cluster randomisation. No adverse events were reported. A structured group-exercise intervention has the potential to manage urinary incontinence in older women in communities largely outside the reach of pharmaceutical or surgical interventions. Canadian Institutes for Health Research.

Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors.

e23053 Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.

Study on resting-state cerebral functional magnetic resonance imaging and ambulatory urodynamics monitoring in children with primary monosympt-omatic nocturnal enuresis

Objective To investigate the significance of blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and ambulatory urodynamics monitoring (AUM) to find the cause of primary monosymptomatic nocturnal enuresis (PMNE) in children. Methods Thirty-seven children with PMNE (20 males and 17 females) were selected, with a mean age of (11.3±4.1) years old.A clinical management tool, 3-day urination record, daytime BOLD-fMRI scan, conventional urodynamics (CUD) and AUM were performed respectively.Thirty-seven gender-age matched children(19 males, 18 females) who would receive surgery treatment because of upper urinary tract disease and were confirmed to have no lower urinary tract dysfunction by CUD were enrolled as controls, with a mean age of (11.1±2.9) years old, and 13 cases underwent BOLD-fMRI scanning. Results It was found that the ALFF value of the left middle frontal gyrus of PMNE was decreased and the ReHo value of the left superior occipital gyrus was increased compared with the control group by the resting BOLD-fMRI.The maximum voiding volume of PNME children was (303.11±87.48) mL, the total urine volume at night was (568.65±208.48) mL, and the nighttime bladder volume was (217.43±81.53) mL.The incidence of maximum voiding volume reduction, nocturnal polyuria and decreased nocturnal bladder volume were 24.32% and 56.76%, and 64.86%, respectively.However, AUM results showed that maximum detrusor pressure in the PMNE group was (39.22±7.78) cmH2O(1 cmH2O=0.098 kPa), which was statistically significantly higher than that in CUD (32.22±9.00) cmH2O, and the difference was statistically significant (P 0.05). Conclusions The abnormal functions of the left middle frontal gyrus and left superior occipital gyrus, nighttime DO and the decrease of bladder capacity at night are considered to be key causes of enuresis in children with PMNE.AUM and resting state BOLD-fMRI evaluations are helpful in differentiating the pathogenesis of PMNE. Key words: Enuresis; Ambulatory urodynamics monitoring; Functional magnetic resonance imaging; Resting state