Cibenzoline for treatment of ventricular arrhythmias: A double-blind placebo-controlled study

Cibenzoline, a new class I antiarrhythmic drug, was administered to 24 patients with frequent (> 30/h) premature ventricular complexes. Three patients discontinued the medication because of epigastric distress before repeat ambulatory electrocardiography. Of the remaining 21 patients, 13 responded to 130 mg twice daily by more than 75% suppression of premature ventricular complex frequency and 6 additional patients responded to 160 mg twice daily during an open-label titration phase. Events of ventricular tachycardia (≥3 beats) were totally suppressed in 9 of 10 patients and markedly diminished in the 1 remaining patient. During a doubleblind placebo-controlled crossover phase in 16 patients (21 patients minus 2 nonresponders and 3 who developed side effects), cibenzoline suppressed the number of premature ventricular complexes per 24 hours (4,075 ± 868 to 1,758 ± 1,089, p = 0.02), the number of events of ventricular tachycardia (31 ± 30 to 2 ± 0, p = 0.01) and the number of premature ventricular complex pairs (61 ± 28 to 25 ± 21, p = 0.01). Cibenzoline plasma concentration was 59 to 421 ng/ml in responders and higher (387,758 and 852 ng/ml, respectively) in the three subjects with side effects (right bundle branch block in one, hypotension in one, gastrointestinal upset and central nervous system complaints in one). Cibenzoline plasma concentration correlated with PR interval (r = 0.55, p = 0.0106) and corrected QT interval (r = 0.58, p = 0.0054). Further clinical investigation of this new antiarrhythmic agent is needed

Assessing Communication Practice during Clinical Trial Recruitment and Consent: The Clinical Trial Communication Inventory (CTCI)

The development and evaluation of training programs with the potential to improve informed consent and accrual to clinical trials depend heavily on the ability to measure outcomes of these trainings. In this chapter, we present the development of an instrument, the clinical trial communication inventory (CTCI). Data were collected from 87 clinical research professionals at three academic medical centers, which were analyzed using factor analytic methods and reliability testing procedures. This testing resulted in eight subscales representing verbal, nonverbal, and privacy protection behaviors. While the final CTCI instrument would benefit from further validity testing, it represents a resource that can be used to evaluate future trainings of research professionals

The Prevalence of Lesbian, Gay, Bisexual, and Transgender Health Education and Training in Emergency Medicine Residency Programs: What Do We Know?

Background The Institute of Medicine, The Joint Commission, and the U.S. Department of Health and Human Services all have recently highlighted the need for cultural competency and provider education on lesbian, gay, bisexual, and transgender ( LGBT ) health. Forty percent of LGBT patients cite lack of provider education as a barrier to care. Only a few hours of medical school curriculum are devoted to LGBT education, and little is known about LGBT graduate medical education. Objectives The objective of this study was to perform a needs assessment to determine to what degree LGBT health is taught in emergency medicine ( EM ) residency programs and to determine whether program demographics affect inclusion of LGBT health topics. Methods An anonymous survey link was sent to EM residency program directors ( PD s) via the Council of Emergency Medicine Residency Directors listserv. The 12‐item descriptive survey asked the number of actual and desired hours of instruction on LGBT health in the past year. Perceived barriers to LGBT health education and program demographics were also sought. Results There were 124 responses to the survey out of a potential response from 160 programs (response rate of 78%). Twenty‐six percent of the respondents reported that they have ever presented a specific LGBT lecture, and 33% have incorporated topics affecting LGBT health in the didactic curriculum. EM programs presented anywhere from 0 to 8 hours on LGBT health, averaging 45 minutes of instruction in the past year (median = 0 minutes, interquartile range [ IQR ] = 0 to 60 minutes), and PD s support inclusion of anywhere from 0 to 10 hours of dedicated time to LGBT health, with an average of 2.2 hours (median = 2 hours, IQR  = 1 to 3.5 hours) recommended. The majority of respondents have LGBT faculty (64.2%) and residents (56.2%) in their programs. The presence of LGBT faculty and previous LGBT education were associated with a greater number of desired hours on LGBT health. Conclusions The majority of EM residency programs have not presented curricula specific to LGBT health, although PD s desire inclusion of these topics. Further curriculum development is needed to better serve LGBT patients. Resumen Introducción El Institute of Medicine, la Joint Commission y el Department of Health and Human Services han subrayado recientemente la necesidad en la competencia cultural y la educación sanitaria de los profesionales sanitarios sobre lesbianas, gays, bisexuales y transexuales ( LGBT ). El 40% de los pacientes LGBT reconoce una falta de formación de los sanitarios como una barrera en la atención médica. Sólo unas pocas horas del programa universitario de medicina está dedicada a la formación en LGBT , y se sabe poco sobre la formación médica de postgrado sobre LGBT . Objetivos El objetivo de este estudio fue evaluar qué grado de formación sanitaria sobre LGBT se enseña en los programas de residencia de Medicina de Urgencias y Emergencias ( MUE ) y determinar si las características de las personas que realizan el programa afectan a la inclusión de temas sanitarios sobre LGBT . Metodología Se envió un enlace de encuesta anónima a los directores del programa de residencia de la MUE a través de la lista del servidor del Council of Emergency Medicine Residency Directors. La encuesta descriptiva de 12 ítems preguntó el número de horas reales y deseadas de formación saniataria sobre LGBT en el pasado año. También se buscaron las barreras percibidas para la educación sanitaria sobre LGBT y la demografía del programa. Resultados Hubo 124 respuestas a la encuesta de una respuesta potencial de 160 programas (porcentaje de respuesta del 78%). Un 26% de los encuestados contest que nunca había presentado una clase específica sobre LGBT , y un 33% ha incorporado temas que afectan a la salud de LGBT en el plan de estudios. Los programas de MUE presentaron en cualquier lugar de 0–8 horas de formación sanitaria sobre LGBT , con un promedio de 45 minutos de formación en el pasado año (mediana de 0 minutos, RIC 0 a 60 minutos), y los directores del programa apoyan la inclusión en cualquier lugar de 0 a 10 horas de tiempo dedicado a la formacion sanitaria sobre LGBT , con un promedio recomendado de 2,2 horas (mediana 2, RIC de 1 a 3,5 horas). La mayoría de los encuestados tienen profesores (64,2%) y residentes (56,2%) LGBT en sus programas. La presencia de profesores LGBT y la formación sanitaria previa sobre LGBT se asociaron con un mayor número de horas deseadas sobre formación sanitaria sobre LGBT . Conclusiones La mayoría de los programas de residencia en MUE no ha presentado un plan de estudios específico para formación sanitaria sobre LGBT , aunque los directores del programa desean la inclusión de estos temas. Es necesario el desarrollo de un programa futuro para atender mejor a los pacientes LGBT .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106813/1/acem12368.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/106813/2/acem12368-sup-0001-DataSupplementS1.pd

Residential Proximity to Agricultural Pesticide Use and Incidence of Breast Cancer in California, 1988–1997

California is the largest agricultural state in the United States and home to some of the world’s highest breast cancer rates. The objective of our study was to evaluate whether California breast cancer rates were elevated in areas with recent high agricultural pesticide use. We identified population-based invasive breast cancer cases from the California Cancer Registry for 1988–1997. We used California’s pesticide use reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential. Using 1990 and 2000 U.S. Census data, we derived age- and race-specific population counts for the time period of interest. We used a geographic information system to aggregate cases, population counts, and pesticide use data for all block groups in the state. To evaluate whether breast cancer rates were related to recent agricultural pesticide use, we computed rate ratios and 95% confidence intervals using Poisson regression models, adjusting for age, race/ethnicity, and neighborhood socioeconomic status and urbanization. This ecologic (aggregative) analysis included 176,302 invasive breast cancer cases and 70,968,598 person-years of observation. The rate ratios did not significantly differ from 1 for any of the selected pesticide categories or individual agents. The results from this study provide no evidence that California women living in areas of recent, high agricultural pesticide use experience higher rates of breast cancer

QTL and candidate gene mapping for polyphenolic composition in apple fruit

<p>Abstract</p> <p>Background</p> <p>The polyphenolic products of the phenylpropanoid pathway, including proanthocyanidins, anthocyanins and flavonols, possess antioxidant properties that may provide health benefits. To investigate the genetic architecture of control of their biosynthesis in apple fruit, various polyphenolic compounds were quantified in progeny from a 'Royal Gala' × 'Braeburn' apple population segregating for antioxidant content, using ultra high performance liquid chromatography of extracts derived from fruit cortex and skin.</p> <p>Results</p> <p>Construction of genetic maps for 'Royal Gala' and 'Braeburn' enabled detection of 79 quantitative trait loci (QTL) for content of 17 fruit polyphenolic compounds. Seven QTL clusters were stable across two years of harvest and included QTLs for content of flavanols, flavonols, anthocyanins and hydroxycinnamic acids. Alignment of the parental genetic maps with the apple whole genome sequence <it>in silico </it>enabled screening for co-segregation with the QTLs of a range of candidate genes coding for enzymes in the polyphenolic biosynthetic pathway. This co-location was confirmed by genetic mapping of markers derived from the gene sequences. <it>Leucoanthocyanidin reductase </it>(<it>LAR1</it>) co-located with a QTL cluster for the fruit flavanols catechin, epicatechin, procyanidin dimer and five unknown procyanidin oligomers identified near the top of linkage group (LG) 16, while <it>hydroxy cinnamate/quinate transferase </it>(<it>HCT</it>/<it>HQT</it>) co-located with a QTL for chlorogenic acid concentration mapping near the bottom of LG 17.</p> <p>Conclusion</p> <p>We conclude that <it>LAR1 </it>and <it>HCT</it>/<it>HQT </it>are likely to influence the concentration of these compounds in apple fruit and provide useful allele-specific markers for marker assisted selection of trees bearing fruit with healthy attributes.</p

Genome-wide analyses identify SCN5A as a susceptibility locus for premature atrial contraction frequency.

Premature atrial contractions (PACs) are frequently observed on electrocardiograms and are associated with increased risks of atrial fibrillation (AF), stroke, and mortality. In this study, we aimed to identify genetic susceptibility loci for PAC frequency. We performed a genome-wide association study meta-analysis with PAC frequency obtained from ambulatory cardiac monitoring in 4,831 individuals of European ancestry. We identified a genome-wide significant locus at the SCN5A gene. The lead variant, rs7373862, located in an intron of SCN5A, was associated with an increase of 0.12 [95% CI 0.08-0.16] standard deviations of the normalized PAC frequency per risk allele. Among genetic variants previously associated with AF, there was a significant enrichment in concordance of effect for PAC frequency (n = 73/106, p = 5.1 × 10-5). However, several AF risk loci, including PITX2, were not associated with PAC frequency. These findings suggest the existence of both shared and distinct genetic mechanisms for PAC frequency and AF

Defining and measuring gender: A social determinant of health whose time has come

This paper contributes to a nascent scholarly discussion of sex and gender as determinants of health. Health is a composite of biological makeup and socioeconomic circumstances. Differences in health and illness patterns of men and women are attributable both to sex, or biology, and to gender, that is, social factors such as powerlessness, access to resources, and constrained roles. Using examples such as the greater life expectancy of women in most of the world, despite their relative social disadvantage, and the disproportionate risk of myocardial infarction amongst men, but death from MI amongst women, the independent and combined associations of sex and gender on health are explored. A model for incorporating gender into epidemiologic analyses is proposed

A controlled trial of protein enrichment of meal replacements for weight reduction with retention of lean body mass

<p>Abstract</p> <p>Background</p> <p>While high protein diets have been shown to improve satiety and retention of lean body mass (LBM), this study was designed to determine effects of a protein-enriched meal replacement (MR) on weight loss and LBM retention by comparison to an isocaloric carbohydrate-enriched MR within customized diet plans utilizing MR to achieve high protein or standard protein intakes.</p> <p>Methods</p> <p>Single blind, placebo-controlled, randomized outpatient weight loss trial in 100 obese men and women comparing two isocaloric meal plans utilizing a standard MR to which was added supplementary protein or carbohydrate powder. MR was used twice daily (one meal, one snack). One additional meal was included in the meal plan designed to achieve individualized protein intakes of either 1) 2.2 g protein/kg of LBM per day [high protein diet (HP)] or 2) 1.1 g protein/kg LBM/day standard protein diet (SP). LBM was determined using bioelectrical impedance analysis (BIA). Body weight, body composition, and lipid profiles were measured at baseline and 12 weeks.</p> <p>Results</p> <p>Eighty-five subjects completed the study. Both HP and SP MR were well tolerated, with no adverse effects. There were no differences in weight loss at 12 weeks (-4.19 ± 0.5 kg for HP group and -3.72 ± 0.7 kg for SP group, p > 0.1). Subjects in the HP group lost significantly more fat weight than the SP group (HP = -1.65 ± 0.63 kg; SP = -0.64 ± 0.79 kg, P = 0.05) as estimated by BIA. There were no significant differences in lipids nor fasting blood glucose between groups, but within the HP group a significant decrease in cholesterol and LDL cholesterol was noted at 12 weeks. This was not seen in the SP group.</p> <p>Conclusion</p> <p>Higher protein MR within a higher protein diet resulted in similar overall weight loss as the standard protein MR plan over 12 weeks. However, there was significantly more fat loss in the HP group but no significant difference in lean body mass. In this trial, subject compliance with both the standard and protein-enriched MR strategy for weight loss may have obscured any effect of increased protein on weight loss demonstrated in prior weight loss studies using whole food diets.</p

Relative Health Effects of Education, Socioeconomic Status and Domestic Gender Inequity in Sweden: A Cohort Study

Introduction: Limited existing research on gender inequities suggests that for men workplace atmosphere shapes wellbeing while women are less susceptible to socioeconomic or work status but vulnerable to home inequities. Methods: Using the 2007 Northern Swedish Cohort (n = 773) we identified relative contributions of perceived gender inequities in relationships, financial strain, and education to self-reported health to determine whether controlling for sex, examining interactions between sex and other social variables, or sex-disaggregating data yielded most information about sex differences. Results and Discussion: Men had lower education but also less financial strain, and experienced less gender inequity. Overall, low education and financial strain detracted from health. However, sex-disaggregated data showed this to be true for women, whereas for men only gender inequity at home affected health. In the relatively egalitarian Swedish environment where women more readily enter all work arenas and men often provide parenting, traditional primacy of the home environment (for women) and the work environment (for men) in shaping health is reversing such that perceived domestic gender inequity has a significant health impact on men, while for women only education and financial strain are contributory. These outcomes were identified only when data were sex-disaggregated