Evaluation of point-of-care tests for detecting microalbuminuria in diabetic patients

Background: Microalbuminuria, the presence of low levels of albumin in the urine, indicates renal damage and is recognised as a risk factor for the progression of renal and cardiovascular disease. Several international scientific bodies recommend microalbuminuria screening. Point-of-care testing (POCT) of microalbuminuria allows immediate identification of risk, and monitoring of treatment effects. In this study, two POCT instruments were evaluated as microalbuminuria screening methods. Method: Spot urine specimens from diabetic patients were analysed with the quantitative HemoCue® urine albumin analyser (n = 245), and the semiquantitative Clinitek® microalbumin urine dipstick (n = 204). These results were compared to the respective data for laboratory-determined albumin (nephelometry), creatinine (modified Jaffe) and albumin-to-creatinine ratio (ACR). Results: Linear regression analysis demonstrated a good correlation for the HemoCue® urine albumin with the laboratorydetermined albumin concentration (y = 0.8557x + 0.2487y, r = 0.97). The sensitivities for the HemoCue® and Clinitek® POCT systems were 79.6% and 83.8%, and the specificities 97.1% and 93.8% respectively. Positive and negative predictive values for the HemoCue® were 95.6% and 85.8%, and were 88.6% and 91.0% the Clinitek®. The repeatability of both instruments was excellent. Both instruments are easy to use, and more cost-effective than the laboratory methods for albumin and ACR. Conclusion: Both the HemoCue® and the Clinitek® microalbumin POCT systems for albuminuria are easy to use and inexpensive, and are adequately accurate as a screening method. Although the HemoCue® POCT system measures only urine albumin concentration, its sensitivity and specificity compared well with that of the Clinitek® POCT system, which determines the ACR.Keywords: microalbuminuria, point-of-care testing, HemoCue®, Clinitek®, urinary albumin excretio

Effect of desferrioxamine on reperfusion damage of rat heart mitochondria

Ischaemia of the myocardium leads to necrosis unless oxygen supply is restored but it has only recently been realised that reperfusion is not without danger. The greatest rate ofmyocardial damage, as measured by mitochondrial function, occurred during the first 5 minutes of reperfusion in rat hearts subjected to normothermic ischaemic cardiac arrest. Addition of desferrioxamine to the perfusate after 5 minutes of reperfusion did not reverse the mitochondrial damage. It is therefore concluded that desferrioxamine prevents mitochondrial damage caused by ischaemia-reperlusion but does not reverse the damage already present

Die spore van Raka: oor herskrywing en kanonisering (Deel 1)

Every literary system possesses a canon with the classical canon as the most stable and simultaneously the one with the most restrictive access. Writers and texts can only maintain their position within the canon through continuous rewriting: critical rewriting by literary critics (as shapers of taste and gate-keepers) and creative rewriting by fellow writers. In this study the critical rewriting (and rerealisation) of one of the most acclaimed and seminal texts in Afrikaans literature, Raka (1941), by N. P. van Wyk Louw is scrutinized. Since its publication this verse epic has been firmly entrenched in the classical Afrikaans literary canon and its continuous rewriting / rerealisation can act as a case study of how a literary “masterpiece” is dependent on institutional relationships, relevant characteristics and strategic position-taking within a literary field in order to retain this status. Against the backdrop of a theoretical framework set out in part one of this study, the specifics of Raka’s rewriting / rerealisation is discussed in the second part

Energy and nutrient intakes of young children in the UK:Findings from the Gemini twin cohort

Data on the diets of young children in the UK are limited, despite growing evidence of the importance of early diet for long-term health. We used the largest contemporary dietary data set to describe the intake of 21-month-old children in the UK. Parents of 2336 children aged 21 months from the UK Gemini twin cohort completed 3-d diet diaries in 2008/2009. Family background information was obtained from questionnaires completed 8 months after birth. Mean total daily intakes of energy, macronutrients (g and %E) and micronutrients from food and beverages, including and excluding supplements, were derived. Comparisons with UK dietary reference values (DRV) were made using t tests and general linear regression models, respectively. Daily energy intake (kJ), protein (g) and most micronutrients exceeded DRV, except for vitamin D and Fe, where 96 or 84 % and 70 or 6 % of children did not achieve the reference nutrient intake or lower reference nutrient intake (LRNI), respectively, even with supplementation. These findings reflect similar observations in the smaller sample of children aged 18–36 months in the National Diet and Nutrition Survey. At a population level, young children in the UK are exceeding recommended daily intakes of energy and protein, potentially increasing their risk of obesity. The majority of children are not meeting the LRNI for vitamin D, largely reflecting inadequate use of the supplements recommended at this age. Parents may need more guidance on how to achieve healthy energy and nutrient intakes for young children

Environmental Influences on Children's Physical Activity: Quantitative Estimates Using a Twin Design

Twin studies offer a 'natural experiment' that can estimate the magnitude of environmental and genetic effects on a target phenotype. We hypothesised that fidgetiness and enjoyment of activity would be heritable but that objectively-measured daily activity would show a strong shared environmental effect.In a sample of 9-12 year-old same-sex twin pairs (234 individuals; 57 MZ, 60 DZ pairs) we assessed three dimensions of physical activity: i) objectively-measured physical activity using accelerometry, ii) 'fidgetiness' using a standard psychometric scale, and iii) enjoyment of physical activity from both parent ratings and children's self-reports. Shared environment effects explained the majority (73%) of the variance in objectively-measured total physical activity (95% confidence intervals (CI): 0.63-0.81) with a smaller unshared environmental effect (27%; CI: 0.19-0.37) and no significant genetic effect. In contrast, fidgetiness was primarily under genetic control, with additive genetic effects explaining 75% (CI: 62-84%) of the variance, as was parent's report of children's enjoyment of low 74% (CI: 61-82%), medium 80% (CI: 71-86%), and high impact activity (85%; CI: 78-90%), and children's expressed activity preferences (60%, CI: 42-72%).Consistent with our hypothesis, the shared environment was the dominant influence on children's day-to-day activity levels. This finding gives a strong impetus to research into the specific environmental characteristics influencing children's activity, and supports the value of interventions focused on home or school environments

Sleep and nighttime energy consumption in early childhood:A population-based cohort study

BACKGROUND: Shorter sleep is a risk factor for weight gain in young children. Experimental studies show that sleep deprivation is associated with higher nighttime energy intake, but no studies have examined the patterning of energy intake in relation to nighttime sleep duration in young children. OBJECTIVES: The objectives of the study were to test the hypothesis that shorter‐sleeping children would show higher nighttime energy intake and to examine whether the additional calories were from drinks, snacks or meals. METHODS: Participants were 1278 families from the Gemini twin cohort, using data from one child per family selected at random to avoid clustering effects. Nighttime sleep duration was measured at 16 months of age using the Brief Infant Sleep Questionnaire. Energy intake by time of day and eating episode (meal, snack, drink) were derived from 3‐day diet diaries completed when children were 21 months. RESULTS: Consistent with our hypothesis, shorter‐sleeping children consumed more calories at night only (linear trend P < 0.001), with those sleeping <10 h consuming on average 120 calories (15.2% of daily intake) more at night than those sleeping ≥13 h. The majority of nighttime intake was from milk drinks. Associations remained after adjusting for age, sex, birth weight, gestational age, maternal education, weight and daytime sleep. CONCLUSIONS: Shorter‐sleeping, young children consume more calories, predominantly at night, and from milk drinks. Parents should be aware that providing milk drinks at night may contribute to excess intake. This provides a clear target for intervention that may help address associations between sleep and weight observed in later childhood

Parental Reports of Infant and Child Eating Behaviors are not Affected by Their Beliefs About Their Twins’ Zygosity

Parental perception of zygosity might bias heritability estimates derived from parent rated twin data. This is the first study to examine if similarities in parental reports of their young twins’ behavior were biased by beliefs about their zygosity. Data were from Gemini, a British birth cohort of 2402 twins born in 2007. Zygosity was assessed twice, using both DNA and a validated parent report questionnaire at 8 (SD = 2.1) and 29 months (SD = 3.3). 220/731 (8 months) and 119/453 (29 months) monozygotic (MZ) pairs were misclassified as dizygotic (DZ) by parents; whereas only 6/797 (8 months) and 2/445 (29 months) DZ pairs were misclassified as MZ. Intraclass correlations for parent reported eating behaviors (four measured at 8 months; five at 16 months) were of the same magnitude for correctly classified and misclassified MZ pairs, suggesting that parental zygosity perception does not influence reporting on eating behaviors of their young twins

Meal size is a critical driver of weight gain in early childhood

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain