Bone mineral density in Jamaican men on androgen deprivation therapy for prostate cancer

<p>Abstract</p> <p>Background</p> <p>Androgen deprivation therapy (ADT) has been reported to reduce the bone mineral density (BMD) in men with prostate cancer (CaP). However, Afro-Caribbeans are under-represented in most studies. The aim was to determine the effect of androgen deprivation therapy (ADT) on the bone mineral density (BMD) of men with prostate cancer in Jamaica.</p> <p>Methods</p> <p>The study consisted of 346 Jamaican men, over 40 years of age: 133 ADT treated CaP cases (group 1), 43 hormone-naïve CaP controls (group 2) and 170 hormone naïve controls without CaP (group 3). Exclusion criteria included metastatic disease, bisphosphonate therapy or metabolic disease affecting BMD. BMD was measured with a calcaneal ultrasound and expressed in S.D. units relative to young adult men (T score), according to the World Health Organization definition. Patient weight, height and BMI were assessed.</p> <p>Results</p> <p>Mean ± sd, age of patients in group 1 (75± 7.4 yrs) was significantly greater than groups 2 and 3 (67 ± 8.1 yrs; 65±12.0 yrs). There was no significant difference in weight and BMI between the 3 groups. . The types of ADT (% of cases, median duration in months with IQR) included LHRH (Luteinizing hormone releasing hormone) analogues (28.6%, 17.9, IQR 20.4), oestrogens (9.8%, 60.5, IQR 45.6) anti-androgens (11.3%, 3.3, IQR 15.2) and orchiectomy (15.7%, 43.4, IQR 63.9). Unadjusted t score of group 1, mean ± sd, (-1.6± 1.5) was significantly less than group 2 (-0.9±1.1) and group 3 (-0.7±1.4), p <0.001. Ninety three (69.9%), 20 (45%) and 75 (42%) of patients in groups 1, 2 and 3 respectively were classified as either osteopenic or osteoporotic (p<0.001). Adjusting for age, there was a significant difference in t scores between groups 1 and 2 as well as between groups 1 and 3 (p<0.001). Compared with oestrogen therapy and adjusting for duration of therapy, the odds of low bone mineral density (osteopenia or osteoporosis) with LHRH analogue was 4.5 (95%CI, 14.3 to 3.4); with anti-androgens was 5.9 (95%CI, 32.7 to 5); with orchiectomy was 7.3 (95%CI, 30 to 5.8) and multiple drugs was 9.2 ((95%CI, 31 to 7.1).</p> <p>Conclusions</p> <p>ADT is associated with lower BMD in Jamaican men on hormonal therapy for prostate cancer.</p

The personal and contextual contributors to school belongingness among primary school students

School belongingness has gained currency among educators and school health professionals as an important determinant of adolescent health. The current cross-sectional study presents the 15 most significant personal and contextual factors that collectively explain 66.4% (two-thirds) of the variability in 12-year old students' perceptions of belongingness in primary school. The study is part of a larger longitudinal study investigating the factors associated with student adjustment in the transition from primary to secondary school. The study found that girls and students with disabilities had higher school belongingness scores than boys, and their typically developing counterparts respectively; and explained 2.5% of the variability in school belongingness. The majority (47.1% out of 66.4%) of the variability in school belongingness was explained by student personal factors, such as social acceptance, physical appearance competence, coping skills, and social affiliation motivation; followed by parental expectations (3% out of 66.4%), and school-based factors (13.9% out of 66.4%) such as, classroom involvement, task-goal structure, autonomy provision, cultural pluralism, and absence of bullying. Each of the identified contributors of primary school belongingness can be shaped through interventions, system changes, or policy reforms

Paleodistributions and Comparative Molecular Phylogeography of Leafcutter Ants (Atta spp.) Provide New Insight into the Origins of Amazonian Diversity

The evolutionary basis for high species diversity in tropical regions of the world remains unresolved. Much research has focused on the biogeography of speciation in the Amazon Basin, which harbors the greatest diversity of terrestrial life. The leading hypotheses on allopatric diversification of Amazonian taxa are the Pleistocene refugia, marine incursion, and riverine barrier hypotheses. Recent advances in the fields of phylogeography and species-distribution modeling permit a modern re-evaluation of these hypotheses. Our approach combines comparative, molecular phylogeographic analyses using mitochondrial DNA sequence data with paleodistribution modeling of species ranges at the last glacial maximum (LGM) to test these hypotheses for three co-distributed species of leafcutter ants (Atta spp.). The cumulative results of all tests reject every prediction of the riverine barrier hypothesis, but are unable to reject several predictions of the Pleistocene refugia and marine incursion hypotheses. Coalescent dating analyses suggest that population structure formed recently (Pleistocene-Pliocene), but are unable to reject the possibility that Miocene events may be responsible for structuring populations in two of the three species examined. The available data therefore suggest that either marine incursions in the Miocene or climate changes during the Pleistocene—or both—have shaped the population structure of the three species examined. Our results also reconceptualize the traditional Pleistocene refugia hypothesis, and offer a novel framework for future research into the area

Time domains of the hypoxic ventilatory response in ectothermic vertebrates

Over a decade has passed since Powell et al. (Respir Physiol 112:123–134, 1998) described and defined the time domains of the hypoxic ventilatory response (HVR) in adult mammals. These time domains, however, have yet to receive much attention in other vertebrate groups. The initial, acute HVR of fish, amphibians and reptiles serves to minimize the imbalance between oxygen supply and demand. If the hypoxia is sustained, a suite of secondary adjustments occur giving rise to a more long-term balance (acclimatization) that allows the behaviors of normal life. These secondary responses can change over time as a function of the nature of the stimulus (the pattern and intensity of the hypoxic exposure). To add to the complexity of this process, hypoxia can also lead to metabolic suppression (the hypoxic metabolic response) and the magnitude of this is also time dependent. Unlike the original review of Powell et al. (Respir Physiol 112:123–134, 1998) that only considered the HVR in adult animals, we also consider relevant developmental time points where information is available. Finally, in amphibians and reptiles with incompletely divided hearts the magnitude of the ventilatory response will be modulated by hypoxia-induced changes in intra-cardiac shunting that also improve the match between O2 supply and demand, and these too change in a time-dependent fashion. While the current literature on this topic is reviewed here, it is noted that this area has received little attention. We attempt to redefine time domains in a more ‘holistic’ fashion that better accommodates research on ectotherms. If we are to distinguish between the genetic, developmental and environmental influences underlying the various ventilatory responses to hypoxia, however, we must design future experiments with time domains in mind

Body Mass Index and Prostate Specific Antigen Levels in Jamaican Men

Objective: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. Methods: Men, 40−79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. Results: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of sub-jects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17(0.07)) but the effect became of borderline significance after adjusting for age. Conclusions: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results. Keywords: Black, Caribbean, prostate cancer, PSA, obesity "Índice de Masa Corporal y Niveles de Antígeno Prostático Específico en los Hombres Jamaicanos' RESUMEN Objetivo: Investigar la relación entre el índice de masa corporal (IMC) y los niveles de antígeno prostático específico (PSA) en los hombres jamaicanos. Métodos: Hombres en edades de 40–79 años, que asistían a clínicas de urología privadas en Kingston, Jamaica, fueron reclutados para un estudio de caso-control sobre el papel de los factores dietéticos y el estilo de vida en el cáncer de próstata. Entrevistadores especializados administraron las encuestas y midieron el peso y la altura usando técnicas estandarizadas. Las muestras de sangre para PSA fueron medidas en un laboratorio central usando como método de inmunoensayo enzimático de micropartícula. La biopsia de la próstata fue usada para confirmar el cáncer de la próstata. Se usó la regresión multivariable lineal para examinar por separado la relación entre IMC y PSA en los casos y los controles. Resultados: Se evaluaron los datos de 501 hombres (233 casos y 263 controles). Treinta y cinco por ciento de los sujetos tenían sobrepeso y el 13% eran obesos. Entre los casos, el PSA promedio fue 35.3 ng/dL en el peso normal, 26.1 ng/dL en el sobrepeso, y 14.5 ng/dL en los obesos (p = 0.02). En los controles, el PSA promedio fue 2.0 ng/dL en el peso normal, 1.3 ng/dL en el sobrepeso y 1.1 ng/dl en los obesos (p = 0.01). Entre los casos, el IMC estaba asociado negativamente con el PSA (B(SE) por 5 kg/m2 (diferencia de IMC = -0.51(0.13); p < 0.01) y permaneció significativo después del ajuste por edad, actividad sexual, hábito de fumar, uso de estatinas, y grado de tumor. En los controles, el IMC también estaba inversamente relacionado con el PSA (B(SE) por 5 kg/m2 de diferencia -0.17 (0.07)) pero el efecto alcanzó importancia significativa limítrofe tras el ajuste por edad. Conclusiones: El antígeno prostático específico guarda una relación inversa con el índice de masa corporal en los hombres jamaicanos con cáncer de próstata. Los médicos deben considerar esta asociación al interpretar los resultados del PSA. Palabras claves: Hombre negro, caribeño, cáncer de próstata, PSA, obesida

The happy obese child

OBJECTIVE: Firstly, is the negative psychological effect of obesity also present in the whole population of obese and overweight children? Secondly, what tools could be recommended to measure the psychological effects of obesity? DESIGN: Review. METHODS: Quality of life or self-esteem is often used in evaluating the psychological effects of obesity. Test instruments used have been instruments for measuring quality of life such as the pediatric quality of life inventory (PedsQL) or the KINDL (R) instrument, and measurements of self-esteem, such as 'ITIA' ('I think I am) and the Self-Perception Profile for Children. RESULTS: The obese child studied in community samples has better quality of life and self-esteem than obese children from clinical samples. CONCLUSION: Psychosocial factors seem to be more important than the functional limitations of obesity itself. This means that we might help the obese child better by social support to a minor part of the population than to focus on the child's obesity as a cause of psychological problems. A happy obese child might have greater resources to cope with the problem than previously thought