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Abstract

Objective

To examine the effects of various maternal and neonatal perinatal factors on the child’s body mass index (BMI) and physical fitness at school-age.

Methods

Data from two registries, the SLOfit database (a national surveillance system of children’s motor and physical development) and Slovenian National Perinatal Information System (NPIS) were analysed. Perinatal data for 2,929 children born in 2008 were linked to results of SLOfit testing of these children in 2016. Linear regression analysis was used to assess the potential relationship between several perinatal factors (very preterm birth, birth mass, maternal age, hypertensive disorders of pregnancy, gestational diabetes, parity, plurality, maternal pre-pregnancy BMI, mode of delivery, presentation, Apgar score at 5 minutes, and admission to a neonatal intensive care unit (NICU)) and child’s BMI or child’s physical fitness index (PFI) at the age of eight years. We also included child’s school grade and maternal educational level in the analysis. A p value <0.05 was considered statistically significant.

Results

Children born to mothers with lower pre-pregnancy BMI and higher education had lower BMI and higher PFI (p<0.001) at school-age. Physical fitness was also inversely associated with nulliparity (p<0.001) and NICU admission (p=0.020).

Conclusions

Among all perinatal factors studied, higher maternal education and lower pre-pregnancy BMI seem to be the most significant determinants of child’s BMI and physical fitness at school-age.

Abstract

Introduction

There is currently a strong scientific evidence about the negative health consequences of physical inactivity. One of the potential tools for promoting physical activity at the institutional level of the Ecological model is to create conditions and settings that would enable pupils, students and employees engage in some form of physical activity. However, physical activities as a subject are being eliminated from the study programs at Slovak universities. The purpose of the study was to find current evidence about the level of structured physical activity and health-related variables in university students in Košice.

Material and methods

The sample consisted of 1,993 or, more precisely, 1,398 students who attended two universities in Košice. To collect data, students completed a questionnaire and were tested for body height, body weight, circumferential measures and percentage body fat.

Results

The university students did not sufficiently engage in a structured physical activity. A large number of students had either low or high values of percentage body fat and BMI and high WHR values.

Conclusions

Our findings have shown that the research into physical activity of university students should receive more attention.

Abstract

Background: The prevalence of overweight and obesity among children has increased dramatically in recent decades. The survey examined overweight and obesity in the population of boys and girls from Ljubljana, the capital of Slovenia, aged seven through fourteen from 1991 to 2011.

Methods: An annually repeated cross-sectional study of data from the national SLOFIT monitoring system was used. The body mass index cut-off points of the International Obesity Task Force were used to identify the prevalence of overweight and obesity. Multinomial logistic regression was used for modelling the probability of overweight and obesity as a function of time (year of measurement), sex and age of subjects.

Results: In 1991-2011 period, the odds for overweight and obesity among primary school children (n = 376,719) increased every year by 1.7% (95% CI: 1.6-1.9) and 3.7% (3.4-4%) respectively. Boys have 1.17 (95% CI: 1.15-1.20) times higher odds of becoming overweight and 1.39 (95% CI: 1.35-1.44) times higher odds of becoming obese than girls. In comparison to the reference group (age of 14), the highest odds for overweight were found at the ages of nine and ten (1.39; 95% CI: 1.34-1.44), while for the obesity the highest odds were at the age of eight (2.01; 95% CI: 1.86-2.16).

Conclusion: From 1991 to 2011, overweight and obesity clearly became more prevalent in children from Ljubljana. This trend has been more obvious among boys than girls. In comparison to 14-year-old boys and girls, the highest odds for excessive weight were found below the age of 10.

Lipid Profile of Healthy Women During Normal Pregnancy

The four basic lipid indexes (Chol, Trig, HDL-C and LDL-C) increase during pregnancy, following different rates of increase. Among the four analytes triglycerides show the largest increase and HDL-C the smallest. All analyte values are raised during the 40 weeks of pregnancy, except HDL-C which is stabilized during the second trimester. After delivery the values decrease, except LDL-C which remains steady (for some weeks) before starting to fall following the others. In this study the relations between the four lipid indexes and some predisposing factors (age, gestational age, nationality, body mass index, profession, smoking and diabetes during pregnancy) were investigated. The sample consisted of 413 pregnant women, mainly Greeks and Albanians. After regression analysis it was proved that the only common predisposing factor was the gestational age. Triglycerides and total cholesterol are also influenced by the women's age. The lipid indexes showed no important difference between the pregnant women in the first trimester and the non-pregnant women. On the contrary, there was a statistical difference between the pregnant women in the second and third trimester and between them and the women in the first trimester. The percentages of increase between first and second trimester were: Chol: 38%, Trig: 115%, HDL-C: 30%, LDL-C: 33%. The percentages of increase between first and third trimester were: Chol: 65%, Trig: 208%, HDL-C: 26%, LDLC: 64%.

Problematika Visokih Odmerkov Metotreksata pri Onkoloških Bolnikih

Izhodišča: Metotreksat v visokih odmerkih je edini citostatik v onkologiji, ki mu rutinsko določamo serumske koncentracije, saj je v visokih odmerkih potencialno smrten. Uporablja se za zdravljenje osteosarkomov in ne-Hodgkinovih limfomov. Ker so bile serumske koncentracije metotreksata pri bolnikih na Onkološkem inštitutu pogosto povišane, nas je zanimalo, kateri parametri jih zvišujejo.

Bolniki in metode: V analizo smo vključili vse bolnike, ki so v enem letu prejeli metotreksat v visokih odmerkih, ne glede na to, ali so bile serumske koncentracije metotreksata povišane ali normalne. Gre za 20 bolnikov, ki so skupaj prejeli 55 visokodoznih terapij metotreksata. Pregledali smo, ali na serumske koncentracije metotreksata vplivajo parametri, kot so proizvajalec metotreksata, pripravljalec infuzije, indeks telesne mase, starost pacienta, očistek kreatinina, ocenjeni očistek kreatinina, pH urina, sočasna kemoterapija s prokarbazinom, sočasna terapija z omeprazolom, acetilsalicilno kislino in nesteroidnimi antirevmatiki. Medsebojne vplive smo statistično ovrednotili s X2-testom.

Rezultati: Med 55 visokoodmernimi terapijami smo pri 28 terapijah ugotovili vsaj eno povišano koncentracijo metotreksata. Ugotovili smo, da so bile koncentracije metotreksata v serumu bolnikov z limfomi značilno povišane pri starejših bolnikih, pri bolnikih z višjim indeksom telesne mase, z očistkom kreatinina pod 100ml/min, in v primeru, da so bolniki sočasno z metotreksatom jemali prokarbazin ali omeprazol.

Zaključki: Da bi se izognili neželenim učinkom visokoodmerne kemoterapije, bi bilo treba skrbno prilagoditi visoki odmerek metotreksata glede na pomembnejše dejavnike, ki lahko zvišajo njegovo koncentracijo, in preprečiti interakcije z drugimi zdravili.

Izvleček

Izhodišča: Bolezni srca in ožilja (BSO) predstavljajo vodilni vzrok smrti v večini evropskih držav, njihovo preprečevanje pa predstavlja pomembno nalogo osnovnega zdravstvenega varstva. Ocena dejavnikov tveganja in usmerjene preventivne aktivnosti so posebej pomembne pri visokoogroženih bolnikih. Pomembno je poznati tudi dejavnike, ki vplivajo na uspešnost preventive teh bolezni.

Metode: V presečno raziskavo je bilo z naključnim stratificiranim vzorčenjem vključenih 36 slovenskih ambulant. Vsaka ambulanta je iz registra visokoogroženih vključila 30 bolnikov, ki so izpolnili vprašalnik o življenjskem slogu, kakovosti življenja, samooceni zdravja in o uporabi zdravstvenih storitev. Vir podatkov o dejavnikih tveganja BSO so bile kartoteke bolnikov, z vprašalnikom o ambulanti pa so bila pridobljena vprašanja o obremenjenosti, projektih kakovosti, izobraževanju, informacijski tehnologiji, o preventivnih aktivnostih.

Rezultati: Sodelovalo je 871 bolnikov iz 36 ambulant (80,6 % predvidenega vzorca), starih 62,4 leta (SD±8,6). 22,4 % je bilo kadilcev; priporočeno raven aerobne telesne aktivnosti je vzdrževalo 330 (48,8 %) sodelujočih, najmanj urejen dejavnik tveganja pa je bil indeks telesne mase (29,3kg/m2). V multivariatnem modelu so vsi dejavniki (ambulante, bolniki in zdravniki) statistično značilno napovedali urejenost dejavnikov tveganja (p<0,005, F=2,7, R2 =0,087). Neodvisne spremenljivke bolje urejenih dejavnikov tveganja so bile: ženski spol, višja starost in višja izobrazba bolnika, uporaba informacijskega sistema v ambulanti, organizacija srčno-žilne preventive in zdravnikova profesionalna aktivnost v projektih preventive.

Zaključki: Urejenost dejavnikov tveganja je v največji meri odvisna od značilnosti ambulante, predvsem organizacije na področju preventive, ter od strokovne aktivnosti zdravnika. Vplivajo tudi nekatere splošne značilnosti bolnika. Pomembni so še drugi dejavniki, ki niso bili vključeni v model.

Abstract

Introduction. Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors’ screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings.

Method. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data.

Results. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data.

Conclusion. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

Hydroxyproline Levels in Young Adults Undergoing Muscular Stretching and Neural Mobilization

This study aimed to assess the acute effect of stretching and neural mobilization on urinary hydroxyproline (HP) levels in young adults. The sample, composed of physical therapy students from Teresina (PI), was divided into three groups: a neural mobilization group (NMG; n=15; age=22±3 years; BMI=24.75±3.09); a static stretching group (SSG; n=15; age=23±4 years; BMI: 25±4.33) and a control group (CG; n=15; age: 24±4 years; BMI: 23.91±3.09). The NMG underwent neural mobilization of the sciatic nerve while engaged in hip flexion with knee extension in a direct, oscillatory and strenuous manner for 60 seconds. The SSG performed passive static stretching, which consisted of the maintenance of a high amplitude posture, without exceeding the limits of the movement, for a period of tension ranging from four to six seconds. Urinary HP was evaluated at the baseline and 24 hours after the intervention using the colorimetric method. Repeated measures ANOVA showed significant intragroup increases in the NMG (Δ7.38 mg/24h; p=0.0001) and the SSG (Δ=3.47 mg/24h; p=0.002) and inter-group increases in the NMG (Δ%=118.89%) when compared to the SSG (Δ%=60.32%; p=0.006) and the CG (Δ%=-0.91%; p=0.0001). These results indicate that the NMG worked with tension beyond the ordinary amplitude arches of articular movement, thus causing a restructuring of collagen.

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic Syndrome

Retinol-binding protein 4 is an adipocytokine separately implicated in the development of obesity-related insulin resistance and proatherogenic lipid profile, however, its role in humans is unclear. This study was carried out to assess the role of retinol-binding protein 4 as a potential marker of metabolic syndrome in obese Asian Indians (a high-risk population for diabetes). 52 obese (BMI >23 kg/m2) Asian Indians were grouped into those with and without metabolic syndrome based on IDF criteria and compared with healthy controls. The anthropometric and biochemical parameters (fasting blood sugar, lipid profile, serum insulin, high-sensitivity C-reactive protein, and retinol-binding protein 4) were estimated. The obese groups had significantly altered adiposity indices, insulin resistance parameters (fasting blood sugar (only in the metabolic syndrome group), serum insulin, HOMA-IR and QUICKI), index of inflammation (C-reactive protein) and proatherogenic dyslipidemic profile (serum triglycerides, VLDL-cholesterol, and triglyceride/HDL-cholesterol ratio). Retinol-binding protein 4 levels were elevated in the obese groups, but were not significant. Retinol-binding protein 4 levels were correlated with anthro-pometric parameters and atherogenic lipids, while C-reactive protein was correlated with anthropometric and insulin resistance parameters in the entire group of subjects. Although these correlations were not observed in the obese groups, in the control group, retinol-binding protein 4 was correlated to the lipid parameters and C-reactive protein to adiposity indices. Thus, the role of retinol-binding protein 4 as a potential marker of metabolic syndrome is limited to the prediction of proatherogenic risk among Asian Indians.

Summary

Background: We investigated the traditional and new bio- markers as predictors of cardiovascular mortality in the func- tionally disabled elderly who are living in a community.

Methods: This prospective study included 253 participants (78.3% women) aged 65 and over who were monitored for 32 months. Receiver operating curve analysis and the Cox proportional hazard model were used to identify univariate and multivariate predictors of cardiovascular mortality. The Kaplan-Meier survival curve and Log rank test were used for survival analysis.

Results: During the study, 43.1% participants died from car- diovascular diseases. Cutoff points of multivariate predictors were used to build a score system. The risk score was positive in patients with three or more of the following predictors: albumin <40 g/L, body mass index <25 kg/m2, total serum bilirubin <10.5 (imol/L, blood urea nitrogen >6.5 mmol/L and high-sensitivity C-reactive protein >2.25 mg/L. The rel- ative risk for cardiovascular mortality for someone with a positive vs. negative score was 3.91 (95% Cl: 2.55-5.98; P< 0.001). There was no change in risk after adjustment for age; sex, traditional cardiovascular risk factors, comorbidities and a number of disabilities.

Conclusions: Presence of lo* grade inflammation, malnulri tion and early signs of renal dy sfunction are essential for car- diovascular risk among the functional disabled elderly and may be assessed using the proposed new inflammatory m3lnuhffion-renal involved score (1MRIS).