Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study

We studied the occurrence of nocturnal enuresis (bedwetting) after the age of 4 years, using a questionnaire in a well-defined population, the Finnish Twin Cohort, which consists of 11,220 subjects aged 33-60 years, including 1298 monozygotic and 2419 dizygotic twin pairs. Structural equation modeling techniques were used to estimate variance components to compare different genetic models. Females reported enuresis in childhood "often" in 3.4% (males in 4.0%) and "sometimes" in 5.7% (8.0%). As adults, females had experienced enuresis "weekly" in 0.3% (males in 0.2%) and "monthly" in 0.07% (0.1%). Those who had experienced enuresis in childhood had had "at least sometimes" enuresis as adults in 5.4% of males and in 5.5% of females. Among those who reported they never had experienced enuresis as adults, 70.8% of males and in 77.9% of females had never experienced enuresis in childhood. For enuresis in childhood, the probandwise concordance rate was 0.43 for monozygotic and 0.19 for dizygotic pairs, and in adults 0.25 and 0, respectively. The proportion of total phenotypic variance attributed to genetic influences (due to dominance) was 67% in males (95% confidence interval 57-76%) and 70% in females (61-78%) in childhood enuresis. In conclusion, nocturnal enuresis is common in childhood and rare in adulthood. Our results confirm the central role of genetic liability in enuresis.     

Relation of obesity to insulin secretion and clearance in adolescents: the Bogalusa Heart Study

OBJECTIVE: Earlier we found elevated insulin levels in obese children and adolescents. The present study examines whether alterations in insulin secretion and/or clearance contribute to hyperinsulinemia in obese adolescents. METHODS: Fasting circulating insulin and C-peptide concentrations were examined in 1157 adolescents, aged 11-18 y, from a biracial (black/white) community. In this epidemiologic study, plasma C-peptide was used as a noninvasive measure of insulin secretion by beta cells, C-peptide to insulin ratio as an indicator of hepatic insulin extraction, and insulin to glucose ratio as a measure of insulin sensitivity. Body mass index (BMI) was used as an index of obesity, since it is strongly associated with insulin levels and the C-peptide to insulin ratio more so than with measures of skinfolds and percent body fatness. RESULTS: Obese individuals (BMI > 90th P) had higher levels of plasma insulin (23.7 mu/ml vs 11.7 mu/ml), C-peptide (2.7 ng/ml vs 1.7 ng/ml), and insulin to glucose ratio (0.29 vs 0.15), and lower C-peptide to insulin ratio (0.13 vs 0.16) than non-obese adolescents (all P < 0.001). Elevated C-peptide and decreased C-peptide to insulin ratio were noted in subjects with both obesity and hyperinsulinemia (insulin > 90th P) versus those without these conditions (P < 0.001). Individuals with obesity and low insulin clearance (C-peptide/insulin < 10th P) had 18-fold higher prevalence of hyperinsulinemia versus those without these conditions. Although black adolescents, despite their lower percent body fat, had higher insulin and lower C-peptide and C-peptide to insulin ratio than their white counterparts, BMI related positively to insulin and C-peptide, and inversely with C-peptide to insulin ratio in both races. CONCLUSIONS: These data suggest that both increased insulin secretion and decreased insulin clearance contribute to hyperinsulinema in obese adolescents.     

Studies of blood pressures in children, ages 5-14 years, in a total biracial community: the Bogalusa Heart Study

Blood pressure, height, weight, maturation, triceps skinfold thickness, serum lipids, and hemoglobin were measured as risk factors for coronary artery disease in 3,524 children (93% of the eligible population) in Bogalusa, Louisiana. Nine blood pressures were taken on each child by trained observers with mercury sphygmomanometers (Baumanometer) and Physiometrics automatic recorders in a rigid randomized design in a relaxed atmosphere with other children present. The pressures observed were low compared to reported data. Black children had significantly higher blood pressures than white children. This difference, starting before age 10, was largest in the children in the upper five percent of the pressure ranks. Stepwise multiple regression analysis revealed that this racial differnce was significant when measured by an automatic recorder. Body size, expressed by height and by weight/height3 index, was a strong determinant of blood pressure level. Other positive determinants were blood hemoglobin and external maturation.     

Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts

OBJECTIVE: To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences. DESIGN AND SETTING: Cross-sectional survey of young adults in Bogalusa, La. SUBJECTS: Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white). STATISTICS: Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity. RESULTS: Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast. APPLICATIONS: Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.     

Distribution and correlates of serum high-density lipoprotein subclasses (LpA-I and LpA-I:A-II) in children from a biracial community. The Bogalusa Heart Study

High-density lipoprotein (HDL) subclasses are considered to differ in terms of antiatherogenic potential. Therefore, the distribution and correlates of serum lipoprotein A-I (LpA-I) and LpA-I:A-II were examined in a random community-based subsample of black (n = 1,021) and white (n = 1,087) children aged 5 to 17 years. Black children had significantly higher LpA-I levels than white children. With respect to LpA-I:A-II, prepubertal (age 5 to 10 years) black males and pubertal (age 11 to 17 years) white children showed significantly higher values than their counterparts. With the exception of the LpA-I:A-II difference among prepubertal males, the observed black-white difference was independent of the racial differential in serum triglycerides, a metabolic correlate of HDL. A significant sex differential (males > females) was noted among blacks and whites for both HDL subclasses, with the exception of LpA-I levels at the pubertal age. Among the pubertal age group, a male-female crossover trend (females > males) in LpA-I levels was apparent after age 14. Sexual maturation and age were the major factors (negative) contributing to the variability in the levels of HDL subclasses among race-sex groups; adiposity (negative), insulin (negative), alcohol intake (positive), and oral contraceptive use (positive) emerged as minor but significant predictor variables. In terms of a relation to other lipoprotein variables, LpA-I compared with LpA-I:A-II correlated much more strongly with HDL cholesterol. Unlike LpA-I, LpA-I:A-II was associated significantly (positively) with low-density lipoprotein (LDL) cholesterol. These findings are indicative of intrinsic metabolic differences among the race-sex groups early in life, resulting in variability in the HDL subclass pattern and attendant antiatherogenic potential.     

Characteristics of young offspring of type 2 diabetic parents in a biracial (black-white) community-based sample: the Bogalusa Heart Study

The impact of race (black-white) and family history of type 2 diabetes mellitus on metabolic characteristics in early life was examined in a community-based sample from Bogalusa, LA. Study subjects included offspring of type 2 diabetics (n = 53, 47% black) and nondiabetics (n = 52, 40% black), with the mean age of each group ranging from 14.2 to 15.6 years. Offspring were given a 1-hour oral glucose tolerance test. Measures of body fatness such as body weight, body-mass index (BMI; weight/height2), and triceps and subscapular thicknesses were significantly higher only in white offspring of diabetics versus nondiabetics; measures of abdominal fat (waist circumference and waist-to-hip ratio) were significantly higher among offspring of diabetics of both races. Among the measures of glucose homeostasis, basal glucose, insulin, insulin-to-C-peptide ratio (a measure of hepatic insulin extraction), insulin resistance index (derived from basal glucose and insulin levels), and glucose response after glucose challenge were higher in the offspring of diabetics of both races. The differences in insulin-to-C-peptide ratio and glucose response remained significant after adjusting for BMI; further, these two variables were independently associated with parental diabetes in both races. Waist-to-hip ratio, glucose response, C-peptide response (a measure of insulin secretion) were lower, and basal insulin-to-C-peptide ratio and postglucose suppression of free fatty acids greater in blacks versus whites, regardless of status of parental diabetes. Black-white differences in postglucose suppression of free fatty acids disappeared after adjusting for BMI. Thus, blacks and whites with parental type 2 diabetes show multiple abnormalities in parameters governing glucose homeostasis early in life, and some of these traits differ between the races, regardless of status of parental diabetes.     

Influence of apolipoprotein E polymorphism on the tracking of childhood levels of serum lipids and apolipoproteins over a 6-year period. The Bogalusa Heart Study

This study was designed to test the hypothesis that in the in vivo dog heart, increases in cyclic (c) GMP and also decreases in cAMP induced by intracoronary administration of acetylcholine are associated with depressed myocardial function. In 10 open-chest anesthetized dogs, 0.5 microgram.kg-1.min-1 of acetylcholine was infused into the left anterior descending coronary artery. The intracoronary infusion of acetylcholine was continued simultaneously with 0.1 microgram.kg-1.min-1 of isoproterenol. Regional segment work was calculated as the integrated product of force (auxotonic force transducer) and segment shortening (sonomicrometry). Regional myocardial O2 consumption was calculated from blood flow measurements and regional O2 saturations. Competitive radioligand binding assays were used to determine the intracellular level of cAMP and cGMP in the myocardium. Local intracoronary infusion of acetylcholine significantly reduced regional segment work (from 36.7 +/- 6.5 to 19.1 +/- 3.7 x 10(-3) J/min) and O2 consumption (from 6.4 +/- 0.8 to 3.8 +/- 0.7 mL O2.min-1.100 g-1). This was related to a decrease in cAMP levels (from 364 +/- 25 to 262 +/- 17 pmol/100 g) and an increase in cGMP levels (from 1.34 +/- 0.06 to 1.78 +/- 0.15 pmol/100 g). When isoproterenol (0.1 microgram.kg-1.min-1) was added to the acetylcholine infusion line, cAMP levels tripled to 769 +/- 84 pmol/100 g, while O2 consumption rose to 6.6 +/- 1.4 mL O2.min-1.100 g-1. However, regional work was only partially restored (25.7 +/- 4.8 x 10(-3) J/min). Thus, both cAMP decrements and cGMP elevation occurred together with the negative inotropic effect of acetylcholine, and increased cAMP alone (produced by isoproterenol) did not fully overcome the acetylcholine effect. This was associated with elevated intracellular levels of cGMP.     

The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment

OBJECTIVE: To examine whether secular trends in risk factor levels and improvements in treatment can account for the observed decline in coronary heart disease mortality in the United States from 1980 to 1990 and to analyze the proportional contribution of these changes. DATA SOURCES: Literature review, US statistics, health surveys, and ongoing clinical trials. STUDY SELECTION: Data representative of the US situation nationwide reported in adequate detail. DATA EXTRACTION: A computer-simulation state-transition model of the US population between the ages of 35 and 84 years was developed to forecast coronary mortality. The input variables were estimated such that the combination of values led to an adequate agreement with reported coronary mortality figures. Subsequently, secular trends were modeled. DATA SYNTHESIS: Actual coronary mortality in 1990 was 34% (127,000 deaths) lower than would be predicted if risk factor levels, case-fatality rates, and event rates in those with and without coronary disease remained the same as in 1980. When secular changes in these factors were included in the model, predicted coronary mortality in 1990 was within 3% (10,000 deaths) of the observed mortality and explained 92% of the decline; only 25% of the decline was explained by primary prevention, while 29% was explained by secondary reduction in risk factors in patients with coronary disease and 43% by other improvements in treatment in patients with coronary disease. CONCLUSIONS: These results suggest that primary and secondary risk factor reductions explain about 50% of the striking decline in coronary mortality in the United States between 1980 and 1990 but that more than 70% of the overall decline in mortality has occurred among patients with coronary disease.     

Surveillance of multiresistant bacteria: justification, role of the laboratory, indicators, and recent French data]

This work demonstrates similarities between epididymal basal cells and macrophages in the mouse. Light microscopic studies of the postnatal development of the murine epididymis showed that basal cells were not present before days 12, 14 and 16 in the cauda, caput and corpus epididymis, respectively. An increase in cell number per unit length of tubule perimeter was demonstrated in all segments between days 20 and 27, when testicular fluid and spermatozoa start entering the epididymis. In the adult, there were more basal cells per unit perimeter in the cauda than caput or corpus epididymis. Conspicuous and consistent expression by basal cells of antigens detected by antibodies against tissue-fixed macrophages (F4/80) and mature macrophages (Mac-1) occurred only after they became established within the epithelium. Basal cells in the cauda epididymis did not display either antigen in the adult, although they persisted in the caput region. Such developmental patterns are compatible with the hypothesis that basal cells play a role in immune defence against sperm autoantigens.     

Trends in HIV-1 prevalence may not reflect trends in incidence in mature epidemics: data from the Rakai population-based cohort, Uganda

OBJECTIVES: To assess whether trends in serial HIV-1 prevalence reflect trend in HIV incidence, and to decompose the effects of HIV-1 incidence, mortality, mobility and compliance on HIV-1 prevalence in a population-based cohort. DESIGN: Two-year follow up (1990-1992) of an open cohort of all adults aged 15-59 years, resident in a sample of 31 representative community clusters in rural Rakai District, Uganda. METHODS: A detailed household enumeration was concluded at baseline and in each subsequent year. All household residents were listed, and all deaths and in- and out-migrations that occurred in the intersurvey year wee recorded. In each year, all consenting adults were interviewed and provided a serological sample; 2591 adults aged 15-59 years were enrolled at baseline. RESULTS: HIV prevalence among adults declined significantly 1990 and 1992 (23.4% at baseline, 21.8% in 1991, 20.9% in 1992; P < 0.05). Declining prevalence was also observed in subgroups, including young adults aged 15-24 years (from 20.6 to 16.2% over 3 years; P < 0.02), women of reproductive age (from 27.1 to 23.5%; P < 0.05), and pregnant women (from 25.4 to 20.0%; not significant), However, HIV incidence did not change significantly among all adults aged 15-59 years (2.1 +/- 0.4 per 100 person-years of observation (PYO) in 1990-1991 and 2.0 +/- 0.3 per 100 PYO in 1991-1992], nor in population subgroups. HIV-related mortality was high (13.5 per 100 PYO among the HIV-positive), removing more infected persons that were added by seroconversion. Net out-migration also removed substantial numbers of HIV-positive individuals. CONCLUSIONS: In this mature HIV epidemic, HIV prevalence declined in the presence of stable and incidence. HIV-related mortality contributed most to the prevalence decline. Prevalence was not an adequate surrogate measure of incidence, limiting the utility or serial prevalence measures in assessing the dynamics of the HIV epidemic and in evaluating the impact of current preventive strategies.     

Hepatitis, HIV, and the dermatologist: a risk review

The practice of dermatology has always carried with it the risk of patient-acquired infection. This review covers health risks associated with the care of HIV-infected patients and patients who are chronic carriers of hepatitis B or C virus, protection options to reduce exposure, and protocols should exposure occur. Hepatitis B continues to be a major risk to health care workers, killing approximately 200 per year. In contrast, as of 1990, only 327 total health care personnel had acquired HIV, with no deaths reported. Data are lacking regarding hepatitis C, but it appears to be an increasing concern. Needlesticks are the most common form of occupational transmission, with an infectivity rate of 30% for hepatitis B, 3% for hepatitis C, and 0.3% for HIV. Universal precautions are the cornerstones of safety. Hepatitis B vaccination, zidovudine prophylaxis, and hepatitis C therapy are discussed as postexposure recommendations are reviewed.     

Understanding the positive role of neighborhood socioeconomic advantage in achievement: The contribution of the home, child care, and school environments.

The goal of this study was to examine the mechanisms underlying associations between neighborhood socioeconomic advantage and children's achievement trajectories between ages 54 months and 15 years. Results of hierarchical linear growth models based on a diverse sample of 1,364 children indicate that neighborhood socioeconomic advantage was nonlinearly associated with youths' initial vocabulary and reading scores, such that the presence of educated, affluent professionals in the neighborhood had a favorable association with children's achievement among those in less advantaged neighborhoods until it leveled off at moderate levels of advantage. A similar tendency was observed for math achievement. The quality of the home and child care environments as well as school advantage partially explained these associations. The findings suggest that multiple environments need to be considered simultaneously for understanding neighborhood–achievement links. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implantable hearing devices for sensorineural hearing loss: a review of the audiometric data

BACKGROUND: Child fatality review (CFR) by interagency teams can contribute to the prevention of childhood deaths. We investigated the potential usefulness of Georgia's CFR, legislated in 1990 primarily to prevent death from child maltreatment, for identifying preventable deaths from injury and sudden infant death syndrome (SIDS). METHODS: Using CFR report data and death certificate data, we examined reviewed and nonreviewed childhood deaths in Georgia in 1991 and examined data by etiology, county, risk factors, and preventability. RESULTS: Injury or SIDS caused 33.2% of childhood deaths in Georgia in 1991; CFR reviewed 29.4% of these. Child fatality review was most sensitive for investigating death from intentional injury (40.5%) and SIDS (35.3%). Review teams reassigned the cause of five deaths (2.0%) to child abuse or neglect. County participation was low (31.4%). Overall, 29.0% of deaths were judged preventable. CONCLUSIONS: Georgia's CFR has potential for identifying preventable childhood deaths. Refinements in the system can increase the number and accuracy of death investigations. By participating in the system, physicians may make meaningful contributions to preventing childhood death in their own communities.