Activation of a novel natriuretic endocrine system in humans with heart failure

Proguanylin and prouroguanylin are the inactive precursors of guanylin and uroguanylin, natriuretic peptides involved in the regulation of sodium balance. Urinary uroguanylin levels have been found previously to be elevated in patients with HF (heart failure). The aim of the present study was to investigate whether plasma proguanylin and prouroguanylin levels are increased in patients with HF and to evaluate their relationship with cardiac and renal function. In this prospective observational study, we recruited 243 patients with HF (151 men) and 72 healthy controls. In patients with HF, plasma levels of proguanylin [median, 7.2 (range, 0.9–79.0) μg/l] and prouroguanylin [8.3 (1.7–53.0 μg/l)] were both significantly (P<0.0005) higher compared with levels in healthy controls [5.5 (0.4–22.3 μg/l) for proguanylin and 6.3 (2.5–16.9) μg/l for prouroguanylin]. In patients with HF, increased age, a history of hypertension, diabetes and atrial fibrillation, use of diuretics, a higher NYHA (New York Heart Association) class and a lower eGFR (estimated glomerular filtration rate) were significant univariate predictors of proguanylin and prouroguanylin levels. In multivariate analysis, a history of hypertension and low eGFR both had strong independent associations with proguanylin and prouroguanylin levels. Proguanylin and prouroguanylin varied significantly between NYHA class with a trend of increasing plasma concentrations with worsening severity of symptoms. In conclusion, plasma proguanylin and prouroguanylin are elevated in patients with HF. Elevated plasma proguanylin and prouroguanylin levels are associated with hypertension, renal impairment and increasing severity of HF. This novel endocrine system may contribute to the pathophysiology of HF

Assessing outcomes of alcohol-related brain damage (ARBD): What should we be measuring?

The recent move towards outcomes-focused assessment in health and social care has made it important to identify which outcomes are relevant to alcohol-related brain damage (ARBD). Clinical outcomes guidance for ARBD is currently absent from policy documentation. Thus, the aim of this review is to evaluate the current evidence base to determine recommendations for the measurement of ARBD outcomes. A total of 71 separate references were identified through a systematic online database and hand search. The screening and exclusion strategy left 7 articles to be included in this review. The findings indicate that research into ARBD has focussed on a number of outcome domains, including type of accommodation and provision of support; drinking status; employment status; number of deaths; mental health and psychiatric symptoms; activities of daily living; social functioning; and cognitive functioning. The identified outcomes suggest that practitioners should focus on a comprehensive range of clinical outcomes for ARBD service users. Nevertheless, the paucity of the existing evidence base makes it difficult to make clinical recommendations for the measurement of ARBD outcomes. Further research is necessary to shed light on long term outcomes for people with ARBD and to increase the strength of the evidence in this area

Estimates of the prevalence of rheumatic diseases in the population of Tecumseh, Michigan, 1959-60

Over 90 per cent of the more than 9000 residents of Tecumseh, Michigan participated in a program of comprehensive health examinations in 1959-1960. Included in the examination were inquiries regarding rheumatic symptoms, physical examination of the spine and peripheral joints, and the latex fixation test for rheumatoid factor and serum uric acid measurement.Joint pain or aching, joint swelling, morning stiffness, and past arthritis or rheumatism were common complaints, occurring in one-eighth to one-third of the population age 6 yr and over. The age-sex specific prevalence rates for each of these historical items rose with increasing age. Male and female rates were quite similar during the first four decades of life, but thereafter female rates were somewhat higher.The prevalence of positive latex fixation tests for rheumatoid factor was essentially the same for male and female subjects, 3.4 per cent for males and 3.35 per cent for females. The rates rose progressively from approximately one per cent in the 6-16 yr age group to almost 14 per cent for males and 9.4 per cent for females in the oldest age groups. The latex fixation test performed poorly as a case detection tool, only one-third of those respondents with positive tests having any other evidence to suggest a diagnosis of rheumatoid arthritis. Relatively high rates of latex positively occurred in individuals with a history of jaundice or infectious hepatitis and in those with evidence of emphysema or right heart failure. None of the respondents with psoriasis or pregnancy at the time of examination had positive latex tests. The prevalence of latex positivity showed a rise with increasing systolic blood pressure in persons over 30 yr of age, but appeared to be unrelated to diastolic blood pressure, serum cholesterol or serum uric acid.Prevalence rates for "definite" rheumatoid arthritis, based on the diagnostic criteria proposed by the American Rheumatism Association, were 0.4 per cent for all subjects age 6 yr and over and 0.5 per cent for all subjects age 16 yr and over. Prevalence rates for "definite" plus "probable" rheumatoid arthritis were 1.3 per cent in the age group 6 yr and over and 1.7 per cent in the age group 16 yr and over. In all diagnostic categories prevalence rates for females exceeded those for males. In the age group 16 yr and over the female to male ratio was 2.3: 1 for "definite" disease and 2.4: 1 for total suspected cases of rheumatoid arthritis. The prevalence rates for rheumatoid arthritis rose with increasing age; rates for "definite" disease rose from 0.44 per cent in the fourth decade to 0.79 per cent in the eighth decade for males and from 1.69 per cent in the fifth decade to 2.47 per cent in the eighth decade for females.The over-all prevalence rates for suspected ankylosing spondylitis, not confirmed by X-ray examination of the spine or sacroiliac joints, were 0.4 per cent for males and 0.05 per cent for females age 6 yr and over.Prevalence rates for osteoarthritis, diagnosed on the basis of physical rather than radiological examination were 2.2 per cent for males and 5.0 per cent for females age 6 yr and over. Rates were highest in the older age groups, being 20.3 per cent for males and 40.8 per cent for females in the age group 60 yr and over. The prevalence of Heberden's nodes was greater in female than in male respondents and demonstrated a similar rise with increasing age.The prevalence of "probable" gout, based on available clinical information was 0.5 per cent for male and 0.3 per cent for female subjects age 4 yr and over having serum uric acid determinations. The highest rates were observed in subjects in the age range 40-59 yr.The prevalence rates for a history of rheumatic fever and / or chorea were similar for male and female subjects age 6 yr and over, 0.8 per cent in the case of rheumatic fever and 0.1 per cent in the case of chorea. A history of chorea was not obtained among respondents under age 20. Physical evidence of rheumatic heart disease was recorded in all age groups and was slightly more prevalent in females, 0.6 per cent as compared to 0.4 per cent in males.Comparisons of the results of this investigation with those of other population studies have been made although the interpretation of any differences or similarities is inherently limited by methodological problems and observer variation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33324/1/0000720.pd

Gout. Epidemiology of gout

Gout is the most prevalent form of inflammatory arthropathy. Several studies suggest that its prevalence and incidence have risen in recent decades. Numerous risk factors for the development of gout have been established, including hyperuricaemia, genetic factors, dietary factors, alcohol consumption, metabolic syndrome, hypertension, obesity, diuretic use and chronic renal disease. Osteoarthritis predisposes to local crystal deposition. Gout appears to be an independent risk factor for all-cause mortality and cardiovascular mortality and morbidity, additional to the risk conferred by its association with traditional cardiovascular risk factors

What Happens to Whistleblowers, and Why

Whistleblowers — people who speak out in the public interest — are valuable to society, often being instrumental in opposing corruption and dangers to the public. Whistleblowers are often subject to reprisals that can have serious health, financial, career and relationship consequences. Powerful organisations have a predictable set of responses to whistleblowers, sending a message to other employees that dissent is unwelcome and avoiding dealing with the problems identified by the whistleblowers. Laws and agencies set up to protect whistleblowers are often flawed or corrupted. At a psychological level, responses to whistleblowers involve obedience to authority, groupthink and other processes. Whistleblowers need to be prepared for reprisals by collecting lots of information, not relying on official procedures and being prepared for a lengthy struggle. More education, research and action are needed to oppose corruption and support whistleblowers. Key words: whistleblowers; corruption; psychology; healt