Soup Kettle Topics: Miscellany

Title: A New Model for the Origins of Chronic Disease
Author: Barker, D. J.; 2001)
Journal: Med Health Care Philos; V. 4; Issue: 1; Pages: 31-5

Abstract: Living things are often plastic during their early development and are moulded by the environment. Many human fetuses have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension.
Notes: Journal Article
Review, Tutorial
Author Address: MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton, SO16 6YD, UK.

Title: Three Views of Genetics: The Enthusiast, the Visionary, and the Sceptic. Interview by Tessa Richards
Author: Burn, J.; Duff, G.; Holtzman, N.; (Date: Apr 28, 2001)
Journal: Bmj; V. 322; Issue: 7293; Pages: 1016

Notes: Interview

Title:Glucagon Useful in Pediatric Asthma Treatment
Year: 2000
Reporter: Cengislier, Interview with Reha
Newspaper: Reuters Health
City: Westport
Notes: Glucagon treatment may be an alternative to metered-dose inhaler salbutamol as a bronchodilator in the treatment of acute asthma in children.
Issue Date: March 28, 2000
Type of Article: Turkish researchers report in the Winter 1999 issue of Pediatric Asthma, Allergy and Immunology.

Title: Effect of Environmental Manipulation in Pregnancy and Early Life on Respiratory Symptoms and Atopy During First Year of Life: A Randomised Trial
Author: Custovic, A.; Simpson, B. M.; Simpson, A.; Kissen, P.; Woodcock, A.; (Date: Jul 21, 2001)
Journal: Lancet; V. 358; Issue: 9277; Pages: 188-93

Abstract: BACKGROUND: Asthma places huge demands on health-care services, and its prevalence is increasing. Reduction of exposure to environmental allergens could offer a realistic chance for primary prevention. Our aim was to ascertain whether or not living in a low-allergen environment reduces the risk of asthma and atopic diseases in infants. METHODS: We assigned infants to four risk groups according to parental atopic status. We enrolled 291 high-risk couples (both parents atopic, no pets) into a prospective, prenatally randomised, cohort study, and allocated them to environmental manipulation, in which measures to reduce prenatal and postnatal allergen exposure were undertaken (active HRA) (n=145) or no intervention (control HRC) (n=146). Two further prospective groups were studied: 161 high-risk infants with pets in the home (HRP group) and 168 low-risk infants, whose parents were both non-atopic (LR group). The main outcome measures were signs and symptoms of atopic disease at 1 year of age. FINDINGS: 103 families dropped out or were lost to follow up. At age 1 year we followed-up 133 HRA, 118 HRC, 140 HRP, and 126 LR infants. Children in the HRA group were less likely to have respiratory symptoms during the first year of life than those in the HRC group. The most pronounced differences were in the relative risks for severe wheeze with shortness of breath (relative risk 0.44 [95% CI 0.20-1.00]), prescribed medication for the treatment of wheezy attacks (0.58 [0.36-0.95]), and wheezing after vigorous playing, crying, or exertion (0.18 [0.04-0.79]). Probability of respiratory symptoms in HRC and HRP infants was similar, whereas it was much lower in the LR than in the HRC group. Cat ownership was significantly associated with sensitisation to cats (24.6 [3.04-199.05]; p=0.003). INTERPRETATION: Environmental manipulation reduces some respiratory symptoms in the first year of life in high-risk infants. Further follow up is needed, however, to ascertain whether living in a low-allergen environment reduces allergy and asthma in later life.
Notes: Clinical Trial
Journal Article
Randomized Controlled Trial
Author Address: North West Lung Centre, Wythenshawe Hospital, M23 9LT, Manchester, UK.

Title: Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment
Author: Hrobjartsson, A.; Gotzsche, P. C.; (Date: May 24, 2001)
Journal: N Engl J Med; V. 344; Issue: 21; Pages: 1594-602

Abstract: BACKGROUND: Placebo treatments have been reported to help patients with many diseases, but the quality of the evidence supporting this finding has not been rigorously evaluated. METHODS: We conducted a systematic review of clinical trials in which patients were randomly assigned to either placebo or no treatment. A placebo could be pharmacologic (e.g., a tablet), physical (e.g., a manipulation), or psychological (e.g., a conversation). RESULTS: We identified 130 trials that met our inclusion criteria. After the exclusion of 16 trials without relevant data on outcomes, there were 32 with binary outcomes (involving 3795 patients, with a median of 51 patients per trial) and 82 with continuous outcomes (involving 4730 patients, with a median of 27 patients per trial). As compared with no treatment, placebo had no significant effect on binary outcomes (pooled relative risk of an unwanted outcome with placebo, 0.95; 95 percent confidence interval, 0.88 to 1.02), regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect (pooled standardized mean difference in the value for an unwanted outcome between the placebo and untreated groups, -0.28; 95 percent confidence interval, -0.38 to -0.19), but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials. The pooled standardized mean difference was significant for the trials with subjective outcomes (-0.36; 95 percent confidence interval, -0.47 to -0.25) but not for those with objective outcomes. In 27 trials involving the treatment of pain, placebo had a beneficial effect (-0.27; 95 percent confidence interval, -0.40 to -0.15). This corresponded to a reduction in the intensity of pain of 6.5 mm on a 100-mm visual-analogue scale. CONCLUSIONS: We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.
Notes: Journal Article
Review, Academic
Author Address: Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, and the Nordic Cochrane Centre, Rigshospitalet, Denmark.

Title: Cellular Responses to Moderate and Heavy Exercise
Author: Nehlsen-Cannarella, S. L.; (Date: May, 1998)
Journal: Can J Physiol Pharmacol; V. 76; Issue: 5; Pages: 485-9

Abstract: Moderate and heavy exercise induce a multitude of changes in the neuroendocrine immune system, the net effects of which depend on various other factors including the host’s physical condition, and the intensity and duration of the exercise bout. Most investigators report that the risk of upper respiratory infection is increased following heavy exertion, but is decreased after moderate exercise. Many heavy exercise-induced changes in the host’s immune defenses are consistent with the alterations reported in classical stress studies; some consensus has been achieved in this area that heavy exertion may indeed elicit responses common to psychological forms of stress. The immunomodulation consists, most notably, of shifts in the number and function of circulating innate and adaptive immune cell populations apparently in response to the release of classical stress hormones and cytokines, and expression of selectin and adhesin molecules. Rapid trafficking of cells in and out of the blood compartment in response to exertion probably mirrors the demand for certain cell types in specific tissues, a hypothesis requiring verification in animal models and ultimately the human. Also needed are studies correlating the functional status of the circulating cells with those in the tissues.
Notes: Journal Article
Review, Tutorial
Author Address: Immunology Center, Loma Linda University Medical Center, CA 92354-2870, USA.

Title: Impact of Sleep Debt on Metabolic and Endocrine Function
Author: Spiegel, K.; Leproult, R.; Van Cauter, E.; (Date: Oct 23, 1999)
Journal: Lancet; V. 354; Issue: 9188; Pages: 1435-9

Abstract: BACKGROUND: Chronic sleep debt is becoming increasingly common and affects millions of people in more-developed countries. Sleep debt is currently believed to have no adverse effect on health. We investigated the effect of sleep debt on metabolic and endocrine functions. METHODS: We assessed carbohydrate metabolism, thyrotropic function, activity of the hypothalamo-pituitary-adrenal axis, and sympathovagal balance in 11 young men after time in bed had been restricted to 4 h per night for 6 nights. We compared the sleep-debt condition with measurements taken at the end of a sleep-recovery period when participants were allowed 12 h in bed per night for 6 nights. FINDINGS: Glucose tolerance was lower in the sleep-debt condition than in the fully rested condition (p<0.02), as were thyrotropin concentrations (p<0.01). Evening cortisol concentrations were raised (p=0.0001) and activity of the sympathetic nervous system was increased in the sleep-debt condition (p<0.02). INTERPRETATION: Sleep debt has a harmful impact on carbohydrate metabolism and endocrine function. The effects are similar to those seen in normal ageing and, therefore, sleep debt may increase the severity of age-related chronic disorders.
Notes: Clinical Trial
Controlled Clinical Trial
Journal Article
Author Address: Department of Medicine, University of Chicago, IL 60637, USA.

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