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PubMed2005

Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex.

BACKGROUND: We present a large European population-based study of thyroid function, performed in a population with longstanding borderline sufficient iodine intake. METHODS: The Nijmegen Biomedical Study is a population-based survey conducted in the eastern part of The Netherlands. Randomly selected inhabitants received a postal questionnaire on lifestyle and medical history, which was filled out by 9371 individuals (41.7%). We measured serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and anti-thyroperoxidase antibodies (TPOAbs) in 6434 responders. A reference population of 5167 individuals was selected by excluding those at risk for thyroid disease. RESULTS: Overt thyrotoxicosis was found in 0.4% of the total population and subclinical thyrotoxicosis in 0.8%. Overt hypothyroidism was found in 0.4% and subclinical hypothyroidism in 4.0%. In individuals older than 60 years, mean FT4 concentrations increased with age. Mean TSH decreased with age, from 1.46 mIU/L at 18-24 years to 1.07 mIU/L after 85 years. The mean TSH in the total population did not differ from the mean TSH in the reference population; the exclusion of those at risk for thyroid disease, however, lowered the upper limit of the TSH reference interval considerably. In the total population, 8.6% of males and 18.5% of females had positive TPOAbs. The presence of TPOAbs was associated with abnormally high and low TSH concentrations. CONCLUSION: In inhabitants of the eastern part of The Netherlands, serum TSH gradually decreases with age, whereas after age 60, serum FT4 increases, possibly because of the development of thyroid autonomy after longstanding borderline sufficient iodine intake.

Adolescent↗
PubMed1991

Required reading. Federal Disabilities Act increases litigation risks for providers.

The Americans with Disabilities Act of 1990 (ADA) is considered the most sweeping civil rights legislation since the Civil Rights Act of 1964. The two parts of the ADA that apply most directly to healthcare providers are the prohibitions on employment discrimination and the requirements for provision of services to persons with disabilities. The ADA states that a person's disability should not be an adverse factor in employment decisions. Employers must make "reasonable accommodations" to the qualified person's known impairment so that person can perform his or her job more easily. The ADA also prohibits private entities from discriminating against persons with disabilities in the full and equal enjoyment of services (i.e., "public accommodations"). Providers will have an affirmative duty to remove (in existing buildings) architectural elements proven to be barriers to persons with disabilities. Public access requirements apply to new building construction as well. Healthcare providers must also install wheelchair lifts in shuttle bus systems they operate. Healthcare providers, both as employers and providers of public services, now have just a matter of months in which to respond to these new requirements. Planning efforts to ensure compliance should begin immediately.

Architectural Accessibility↗
PubMed1994

Susceptibility to adjuvant arthritis: relative importance of adrenal activity and bacterial flora.

Previous studies on the regulation of bacterial-induced arthritis in rats have focused on endocrine aspects as well as differences in T cell immunity against bacterial epitopes. We analysed the role of both adrenal activity and bacterial flora in determining susceptibility to bacterial-induced arthritis. Outbred Wistar rats show a low incidence of adjuvant arthritis. Moderate sensitivity to adjuvant arthritis was found in a selected, stress-resistant line of the Wistar rat, whereas no arthritis was found in a stress-susceptible Wistar line. Plasma corticosterone responses after IL-1 alpha exposure were, however, identical in these two lines, excluding a direct correlation between susceptibility and corticosterone levels. In line with previous findings in germ-free (GF) F344 rats, GF Wistars also appeared highly susceptible to arthritis. We further analysed the corticosterone responses in GF and conventional (CV) rats. Administration of IL-1 alpha induced identical corticosterone responses in both CV and GF F344 rats. In addition, plasma corticosterone levels were measured around the time of onset of arthritis. Whereas no rise was seen in the arthritis-resistant CV rats, a significant increase was observed from day 14 in GF rats, at the moment of onset of arthritis. Although this corticosterone response was insufficient to prevent arthritis, it may have ameliorated disease expression in the GF F344 rats. Our data indicate that the bacterial flora, and therefore T cell tolerance, is of prime importance in determining susceptibility, whereas the activity of the hypothalamus-pituitary-adrenal (HPA) axis may modulate disease severity.

Adrenal Glands↗
PubMed2000

A moderate view on fat restriction for young children.

As dietetics professionals, rather than debating dietary prescriptions, we must make our priority evaluating whether those prescriptions can be reasonably and consistently translated into food selection and eating patterns. This is nothing new to us. We have long advised physicians about the practicality of diet prescriptions and often recommended that prescriptions be moderated. In my view, we are at our finest when we are advocates for people and their relationships with food rather than arbiters of diets. Rather than emphasizing what people should eat, we must emphasize what is possible and reasonable for them to eat. In my experience, the gap between knowing and doing will continue as long as the knowing is unrealistic. Clinical experience makes it clear that if a diet prescription is unrealistic, it will not do any good. In attempting to apply unrealistic dietary prescriptions, we do not help people. We just make them into dietary cripples. It has been extraordinarily difficult to lighten up on the particular diet prescription of the US Dietary Guidelines. Given the emphasis on preventive nutritional care and the urgency with which the messages are delivered, I and many other dietetics professionals believe our are hands tied: We must go along with the US Dietary Guidelines. If we relax our efforts to persuade people to eat in accordance with the prescription, we have been led to believe we will do them irreparable harm. The data do not support such a threat, either for children or for adults. There is enough inconsistency in the evidence linking dietary fat and heart disease to make prevention a hope, not a guarantee. Before we apply the formulas we love so well (yes, I love them too), we must consider what our attempts to apply a formula will do to people's eating attitudes and behaviors and to the feeding relationships between adults and children. People manage to feed themselves and their children, and they eat the way they do for reasons that grow out of their cultural traditions, preferences, and practicalities. Sweeping changes carry the risk of undermining serviceable foodways, so it is reasonable to recommend such changes only on an individual basis and, for the public, on the basis of compelling evidence. No such evidence exists. Because the scientific evidence for the connection between childhood diet and heart disease is debatable, it is legitimate for us to be advocates for children by recommending doing less, rather than more. "Less" in my view, does not mean doing nothing at all. It means helping families enjoy food and optimize normal eating patterns, rather than attempting to achieve a particular prescription for dietary fat.

Adult↗
PubMedDate not supplied

EORTC external quality assurance program for ER and PgR measurements: trial 1998/1999. European Organisation for Research and Treatment of Cancer.

Steroid receptor assays have clinical relevance in selecting women who would benefit from endocrine intervention. As the degree of benefit from endocrine therapy is directly related to the quantity of receptor present in the tumour, the quality of the steroid receptor assays is important. Moreover, since patients entered in multi-centre trials often include stratification based on the receptor status, receptor assays should be comparable between different institutes. ER- and PgR-assays have been evaluated in quality assessment studies for almost 20 years by the EORTC Receptor and Biomarker Study Group. During the QA trial 1998/1999 results were reported by 42 participants performing the Ligand Binding Assay (LBA) and by 39 participants using the Enzyme Immuno-Assay (EIA) kit. Each participant received a set of 12 QA vials to be analysed two at a time at two-monthly intervals. The between-laboratory CVs of ER LBA and EIA amounted to 40-50%. For PgR the between-lab CVs for the EIA method are lower as compared with LBA but still are approx. 30%. Notwithstanding the high deviation in reported values and the high between-lab CVs, the consistency of the participants over the year is acceptable, which pave the way for calibration. Indeed, after normalization of assay results the mean between-lab CVs dropped to 11% for ER LBA, 14% for ER EIA, 9% for PgR LBA and 11% for PgR EIA. Such a reduction of between-laboratory CVs is an essential requirement for the use of steroid receptor data in multicentre clinical studies.

Biomarkers, Tumor↗
PubMed2003

The prognostic value of the mitotic activity index in patients with primary breast cancer who were not treated with adjuvant systemic therapy.

BACKGROUND: At the St Gallen meeting of 2001 it was agreed to select high-risk patients for adjuvant systemic therapy by lymph node status, tumor size, age, hormone receptor status, and histological grade. In The Netherlands it was chosen to use either the histological grade or the mitotic activity index (MAI). The aim of this study was to retrospectively evaluate the independent prognostic value of the MAI in primary breast cancer patients, who were not treated with adjuvant systemic therapy, on relapse-free survival (RFS) and overall survival (OS). PATIENTS AND METHODS: The data of 137 systemically untreated patients with primary breast cancer diagnosed between 1992 and 1996, of whom MAI was assessed, were retrospectively collected. The MAI was correlated to classical prognostic factors and we determined the prognostic value of the MAI, the histological grade and other prognostic factors. RESULTS: The median observation time was 4.2 years. The MAI showed a positive correlation to lymph node status (P < 0.001) and a negative correlation to age (P = 0.005), menopausal status (P < 0.001) and the ER and PgR status (r(s) = -0.390 [ER], r(s) = -0.440 [PgR], both P < 0.001). A high MAI (> or = 15) predicted a reduced RFS and OS in the Kaplan-Meier analysis (P = 0.0070 and P = 0.0017, respectively). Also in the multivariate analysis, the MAI showed to be an independent predictor of poor RFS (P = 0.035), in addition to lymph node status. However, the MAI did not predict for OS, in contrast to tumor size and lymph node status. CONCLUSION: The present study confirms that the MAI is an independent prognostic factor for RFS, but not for OS and may be useful for daily clinical practice.

Adult↗