Socioeconomic determinants of health. The contribution of nutrition to inequalities in health

Social class differences in health are seen at all ages, with lower socioeconomic groups having greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including lack of breast feeding, smoking, physical inactivity, obesity, hypertension, and poor diet are clustered in the lower socioeconomic groups. The diet of the lower socioeconomic groups provides cheap energy from foods such as meat products, full cream milk, fats, sugars, preserves, potatoes, and cereals but has little intake of vegetables, fruit, and wholewheat bread. This type of diet is lower in essential nutrients such as calcium, iron, magnesium, folate, and vitamin C than that of the higher socioeconomic groups. New nutritional knowledge on the protective role of antioxidants and other dietary factors suggests that there is scope for enormous health gain if a diet rich in vegetables, fruit, unrefined cereal, fish, and small quantities of quality vegetable oils could be more accessible to poor people.     

Pathophysiologic theories in the etiology of Meniere's disease

The etiology of the attacks of vertigo that occur in Meniere's disease is discussed in this article. None of the current theories remain tenable in view of recent findings concerning the physiology and pathophysiology of the cochlea and endolymphatic sac. A new theory suggests that a narrowed duct becomes obstructed by debris that is cleared by a combination of the secretion of hydrophillic proteins within the sac and a hormone, saccin, that increases the volume of endolymph within the cochlea. It is proposed that the sudden restoration of longitudinal flow initiates the attacks of vertigo.     

Is diurnal variation of mood associated with parasympathetic activity?

70 patients older than 50 years (mean age: 60.2 years) underwent a CD-spondylodesis from 1987 to 1991 for degenerative changes of the lumbar spine, and were followed for 2 years. 88.2% improved, but only 47.1% showed a good-to-excellent result. Patients with fair and poor outcomes had had significantly more operations on the lumbar spine (p < 0.001), had a greater extent of preoperative lumbar kyphosis (p < 0.05), motor weakness (p < 0.05), had less vertebral slips (p < 0.01), had less posterior distraction postoperatively (p < 0.001), and had a greater extent of postoperative motor weakness compared to patients with good-to-excellent outcomes. Age, sex, duration of back/leg pain, taking of analgetic drugs, preoperative pain status, profession, range of walking, time of operation, number of fused segments, blood loss, blood transfusion, postoperative profile of the spine did not show any significant influence upon clinical results. Already at 6-months-follow-up there was significant difference of the clinical outcome (p < 0.001), making improvement of a then fair or poor result unlikely.     

Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication

Cilostazol is an antiplatelet agent and vasodilator marketed in Japan for treatment of ischemic symptoms of peripheral vascular disease. It is currently being evaluated in the United States for treatment of symptomatic intermittent claudication (IC). Cilostazol has been shown to improve walking distance in patients with IC. In addition to its reported vasodilator and antiplatelet effects, cilostazol has been proposed to have beneficial effects on plasma lipoproteins. We examined the effect of cilostazol versus placebo on plasma lipoproteins in 189 patients with IC. After 12 weeks of therapy with 100 mg cilostazol BID, plasma triglycerides decreased 15% (P<0.001). Cilostazol also increased plasma high density lipoprotein cholesterol (HDL-C) (10%) and apolipoprotein (apo) A1 (5.7%) significantly (P<0.001 and P<0.01, respectively). Both HDL3 and HDL2 subfractions were increased by cilostazol; however, the greatest percentage increase was observed in HDL2. Individuals with baseline hypertriglyceridemia (>140 mg/dL) experienced the greatest changes in both HDL-C and triglycerides with cilostazol treatment. In that subset of patients, HDL-C was increased 12.2% and triglycerides were decreased 23%. With cilostazol, there was a trend (3%) toward decreased apoB as well as increased apoA1, resulting in a significant (9.8%, P<0.002) increase in the apoA1 to apoB ratio. Low density lipoprotein cholesterol and lipoprotein(a) concentrations were unaffected. Cilostazol treatment resulted in a 35% increase in treadmill walking time (P=0.0015) and a 9.03% increase in ankle-brachial index (P<0.001). These results indicate that in addition to improving the symptoms of IC, cilostazol also favorably modifies plasma lipoproteins in patients with peripheral arterial disease. The mechanism of this effect is currently unknown.     

High resolution sonographic determination of the normal dimensions of the intracranial extraaxial compartment in the newborn infant

Prominence of the extraaxial space occasionally is encountered in infants referred for ultrasonography to exclude hydrocephalus. The interpretation of this finding can be problematic. We examined the width of the extraaxial compartment in 82 normal newborn infants. Scanning technique was optimized for viewing the near field, and the extraaxial space was measured over the cerebral convexities. Correlation was made with demographic variables. Measurements varied from 0 to 3.3 mm (mean, 1.6 mm), with slight negative linear relationship to gestational age. We conclude that small amounts of extraaxial fluid, up to 3.3 mm in width on scans, are common and normal in newborn infants.     

Lumbosacral movement in the sit-and-reach and in Cailliet's protective-hamstring stretch

STUDY DESIGN: This study analyzed movement characteristics of subjects as they performed two different hamstring stretching activities. OBJECTIVES: The study determined if there were differences in lumbosacral movement as the subjects performed the two stretches. SUMMARY OF BACKGROUND DATA: Cailliet contends that his protective hamstring stretch is less apt to be stressful to the structures of the spine than is a more commonly done sit-and-reach stretching activity. No previous biomechanical investigation has tested his contention. METHODS: Lumbosacral movement was measured with an Ady-Hall lumbar monitor as 40 university students (20 males, 20 females) performed a popular sit-and-reach test and a sit-and-reach test that subscribed to Cailliet's protective hamstring stretch protocol. RESULTS: Lumbosacral movement was almost identical in the two stretching activities. CONCLUSIONS: If lumbosacral movement is the only criterion to consider in evaluating the safety of these two stretching activities, it makes little difference which activity is chosen. If moment of inertia were the dependent variable rather than lumbosacral movement, possibly one activity may be less stressful to the structures of the spine than the other.