Ethnic differences in diabetes, cardiovascular risk factors and health care: the Amsterdam Health Survey of 2004

The prevalence of diabetes in inhabitants of Amsterdam (18 years and older) is 4%. The prevalence of diabetes is three times higher among Turkish people and four times higher among Moroccans in comparison to Dutch people. Turkish diabetes patients have a higher mean body mass index compared to Dutch diabetes patients, but Turkish and Moroccan diabetes patients are admitted to hospital less often than Dutch diabetes patients. It is important for policy makers to know the differences in disease prevalence and health care use between ethnic groups, considering the expected rise in the proportion of immigrants. These results formed contributions to this report that was brought out by the National Institute for Public Health and the Environment and in cooperation with the Amsterdam Health Monitor of the Amsterdam Health Service. Forty-three percent of the 4042 invited Amsterdam inhabitants participated in the study in 2004. Ethnic differences in health and health care use were analyzed for the age group of 18-70 years, standardized for age and gender. Turkish and Moroccan people without diabetes differed from Dutch people without diabetes on many counts. For example, Turkish and Moroccan people were more often overweight and had higher mean blood glucose levels. They visited their general practitioners more often and experienced their own health as being moderate or poor on a more frequent basis. Turkish people without diabetes experienced more serious cardiac problems than Dutch people. The prevalence of cardiovascular risk factors in diabetes patients was high among all ethnic groups. In general, cardiovascular risk factors were more frequent in Turkish diabetes patients, and to a lesser extent in Moroccan diabetes patients, compared to Dutch diabetes patients. Treatment of cardiovascular risk factors in diabetes patients is important for the prevention of or delay in cardiovascular complications.De prevalentie van diabetes bij inwoners van Amsterdam (18 jaar en ouder) wordt geschat op vier procent. Turken en Marokkanen hebben respectievelijk driemaal en viermaal vaker diabetes vergeleken met Nederlanders. Turkse diabeten zijn gemiddeld zwaarder dan Nederlandse diabeten. Turkse en Marokkaanse diabeten worden echter minder vaak opgenomen in een ziekenhuis dan Nederlandse diabeten. Een beschrijving van etniciteitverschillen in het voorkomen van ziekten en zorggebruik is van belang voor het beleid omdat immigranten een steeds groter deel van de bevolking zullen gaan uitmaken. De Amsterdamse Gezondheidsmonitor 2004 is uitgevoerd door de GGD Amsterdam in samenwerking met het RIVM. Drieenveertig procent van 4042 uitgenodigde Amsterdammers (18 jaar en ouder) heeft aan het onderzoek meegedaan. Etnische verschillen in gezondheid en zorg werden geanalyseerd voor de leeftijd 18-70 jaar, gestandaardiseerd naar leeftijd en geslacht. Turken en Marokkanen zonder diabetes verschilden op bijna alle uitkomsten van Nederlanders zonder diabetes. Turken en Marokkanen waren bijvoorbeeld gemiddeld zwaarder dan Nederlanders en zij hadden hogere gemiddelde bloedglucosewaarden. Zij gingen vaker naar de huisarts en waren minder tevreden over de eigen gezondheid. Acht procent van de Turken zonder diabetes heeft ooit een ernstige hartaandoening gehad, dit is bijna viermaal zo vaak als bij Nederlanders zonder diabetes. Risicofactoren voor hart- en vaatziekten kwamen veel voor bij diabeten uit alle etnische groepen. Turkse diabeten, en in mindere mate Marokkaanse diabeten, hadden over het algemeen een ongunstiger risicoprofiel dan Nederlandse diabeten. Behandeling van het risicoprofiel van diabetespatienten is belangrijk om het optreden van complicaties te voorkomen of uit te stellen

Principles of Stakes Fairness in Sport

Fairness in sport is not just about assigning the top prizes to the worthiest competitors. It is also about the way the prize structure itself is organised. For many sporting competitions, although it may be acceptable for winners to receive more than losers, it can seem unfair for winners to take everything and for losers to get nothing. Yet this insight leaves unanswered some difficult questions about what stakes fairness requires and which principles of stakes fairness are appropriate for particular competitions. In this article I specify a range of different principles of stakes fairness (ten in total) that could regulate sporting competitions. I also put forward a theoretical method for pairing up appropriate principles of stakes fairness with given sporting competitions. Specifically, I argue that the underlying rationales for holding sporting competitions can provide useful guides for identifying appropriate principles of stakes fairness. I then seek to clarify and work through some of the implications of this method for a sample of real world controversies over sporting prize structures. I also attempt to refine the method in response to two possible objections from indeterminacy and relativism. Finally, I compare and contrast my conclusions with more general philosophical debates about justice

Towards resolving the phosphorus chaos created by food systems

© 2019, The Author(s). The chaotic distribution and dispersal of phosphorus (P) used in food systems (defined here as disorderly disruptions to the P cycle) is harming our environment beyond acceptable limits. An analysis of P stores and flows across Europe in 2005 showed that high fertiliser P inputs relative to productive outputs was driving low system P efficiency (38 % overall). Regional P imbalance (P surplus) and system P losses were highly correlated to total system P inputs and animal densities, causing unnecessary P accumulation in soils and rivers. Reducing regional P surpluses to zero increased system P efficiency (+ 16 %) and decreased total P losses by 35 %, but required a reduction in system P inputs of ca. 40 %, largely as fertiliser. We discuss transdisciplinary and transformative solutions that tackle the P chaos by collective stakeholder actions across the entire food value chain. Lowering system P demand and better regional governance of P resources appear necessary for more efficient and sustainable food systems

Selection at a single locus leads to widespread expansion of toxoplasma gondii lineages that are virulent in mice

The determinants of virulence are rarely defined for eukaryotic parasites such as T. gondii, a widespread parasite of mammals that also infects humans, sometimes with serious consequences. Recent laboratory studies have established that variation in a single secreted protein, a serine/threonine kinase known as ROPO18, controls whether or not mice survive infection. Here, we establish the extent and nature of variation in ROP18among a collection of parasite strains from geographically diverse regions. Compared to other genes, ROP18 showed extremely high levels of diversification and changes in expression level, which correlated with severity of infection in mice. Comparison with an out-group demonstrated that changes in the upstream region that regulates expression of ROP18 led to an historical increase in the expression and exposed the protein to diversifying selective pressure. Surprisingly, only three atypically distinct protein variants exist despite marked genetic divergence elsewhere in the genome. These three forms of ROP18 are likely adaptations for different niches in nature, and they confer markedly different virulence to mice. The widespread distribution of a single mouse-virulent allele among geographically and genetically disparate parasites may have consequences for transmission and disease in other hosts, including humans

Current whole-body MRI applications in the neurofibromatoses

ObjectivesThe Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration Whole-Body MRI (WB-MRI) Working Group reviewed the existing literature on WB-MRI, an emerging technology for assessing disease in patients with neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN), to recommend optimal image acquisition and analysis methods to enable WB-MRI as an endpoint in NF clinical trials.MethodsA systematic process was used to review all published data about WB-MRI in NF syndromes to assess diagnostic accuracy, feasibility and reproducibility, and data about specific techniques for assessment of tumor burden, characterization of neoplasms, and response to therapy.ResultsWB-MRI at 1.5T or 3.0T is feasible for image acquisition. Short tau inversion recovery (STIR) sequence is used in all investigations to date, suggesting consensus about the utility of this sequence for detection of WB tumor burden in people with NF. There are insufficient data to support a consensus statement about the optimal imaging planes (axial vs coronal) or 2D vs 3D approaches. Functional imaging, although used in some NF studies, has not been systematically applied or evaluated. There are no comparative studies between regional vs WB-MRI or evaluations of WB-MRI reproducibility.ConclusionsWB-MRI is feasible for identifying tumors using both 1.5T and 3.0T systems. The STIR sequence is a core sequence. Additional investigation is needed to define the optimal approach for volumetric analysis, the reproducibility of WB-MRI in NF, and the diagnostic performance of WB-MRI vs regional MRI

Availability of recreational resources and physical activity in adults

OBJECTIVES: Using data from a large cohort of adults aged 45 to 84 years-old, we investigated whether availability of recreational resources is related to physical activity levels. METHODS: Data from a multiethnic sample of 2723 adult residents of New York City, NY; Baltimore, Md; and Forsyth County, NC, were linked to data on locations of recreational resources. We measured the availability (density) of resources within 0.5 (0.8 km), 1, 2, and 5 miles of each participant's residence and used binomial regression to investigate associations of density with physical activity. RESULTS: After adjustment for potential confounders, individuals in the tertile of participants residing in areas with the highest density of resources were more likely to report physical activity during a typical week than were individuals in the lowest tertile. Associations between availability of recreational resources and physical activity levels were not present for the smallest area assessed (0.5 miles) but were present for areas ranging from 1 to 5 miles. These associations were slightly stronger among minority and low-income residents. CONCLUSIONS: Availability of resources may be 1 of several environmental factors that influence individuals' physical activity behaviors.http://deepblue.lib.umich.edu/bitstream/2027.42/78573/1/DiezRouxEvenson2007_AJPH.pd

Simulated effect of pneumococcal vaccination in the Netherlands on existing rules constructed in a non-vaccinated cohort predicting sequelae after bacterial meningitis

BACKGROUND: Previously two prediction rules identifying children at risk of hearing loss and academic or behavioral limitations after bacterial meningitis were developed. Streptococcus pneumoniae as causative pathogen was an important risk factor in both. Since 2006 Dutch children receive seven-valent conjugate vaccination against S. pneumoniae. The presumed effect of vaccination was simulated by excluding all children infected by S. pneumoniae with the serotypes included in the vaccine, from both previous collected cohorts (between 1990-1995). METHODS: Children infected by one of the vaccine serotypes were excluded from both original cohorts (hearing loss: 70 of 628 children; academic or behavioral limitations: 26 of 182 children). All identified risk factors were included in multivariate logistic regression models. The discriminative ability of both new models was calculated. RESULTS: The same risk factors as in the original models were significant. The discriminative ability of the original hearing loss model was 0.84 and of the new model 0.87. In the academic or behavioral limitations model it was 0.83 and 0.84 respectively. CONCLUSION: It can be assumed that the prediction rules will also be applicable on a vaccinated population. However, vaccination does not provide 100% coverage and evidence is available that serotype replacement will occur. The impact of vaccination on serotype replacement needs to be investigated, and the prediction rules must be validated externally

Hypnosis for treatment of insomnia in school-age children: a retrospective chart review

BACKGROUND: The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. METHODS: A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7–17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. RESULTS: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children