The global burden attributable to low bone mineral density.

INTRODUCTION: The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors by calculating disability-adjusted life years (DALYs). Osteoporosis was not considered as a disease, and bone mineral density (BMD) was analysed as a risk factor for fractures, which formed part of the health burden due to falls. OBJECTIVES: To calculate (1) the global distribution of BMD, (2) its population attributable fraction (PAF) for fractures and subsequently for falls, and (3) the number of DALYs due to BMD. METHODS: A systematic review was performed seeking population-based studies in which BMD was measured by dual-energy X-ray absorptiometry at the femoral neck in people aged 50 years and over. Age- and sex-specific mean ± SD BMD values (g/cm(2)) were extracted from eligible studies. Comparative risk assessment methodology was used to calculate PAFs of BMD for fractures. The theoretical minimum risk exposure distribution was estimated as the age- and sex-specific 90th centile from the Third National Health and Nutrition Examination Survey (NHANES III). Relative risks of fractures were obtained from a previous meta-analysis. Hospital data were used to calculate the fraction of the health burden of falls that was due to fractures. RESULTS: Global deaths and DALYs attributable to low BMD increased from 103 000 and 3 125 000 in 1990 to 188 000 and 5 216 000 in 2010, respectively. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). Around one-third of falls-related deaths were attributable to low BMD. CONCLUSIONS: Low BMD is responsible for a growing global health burden, only partially representative of the real burden of osteoporosis.

Foraminiferal assemblages in Biscayne Bay, Florida, USA: responses to urban and agricultural influence in a subtropical estuary.

This study assessed foraminiferal assemblages in Biscayne Bay, Florida, a heavily utilized estuary, interpreting changes over the past 65 years and providing a baseline for future comparisons. Analyses of foraminiferal data at the genus level revealed three distinct biotopes. The assemblage from the northern bay was characterized by stress-tolerant taxa, especially Ammonia, present in low abundances ( approximately 2.0 x 10(3) foraminifers/gram) though relatively high diversity ( approximately 19 genera/sample). The southwestern margin of the bay was dominated by Ammonia and Quinqueloculina, an assemblage characterized by the lowest diversities ( approximately 12 genera/sample) and highest abundances ( approximately 1.1 x 10(4) foraminifers/gram), influenced by both reduced salinity and elevated organic-carbon concentrations. A diverse assemblage of smaller miliolids and rotaliids ( approximately 26 genera/sample) characterized the open-bay assemblage, which also had a significant component ( approximately 10%) of taxa that host algal endosymbionts. In the past 65 years, populations of symbiont-bearing taxa, which are indicators of normal-marine conditions, have decreased while stress-tolerant taxa, especially Ammonia spp., have increased in predominance.

Nicotine skin patch treatment increases abstinence, decreases withdrawal symptoms, and attenuates rewarding effects of smoking.

A variety of studies have shown that nicotine skin patches are effective in promoting smoking cessation. This study replicated this effect, in addition, nicotine skin patches were found to decrease a variety of withdrawal effects, including craving for cigarettes, negative affect, hypoarousal, and increased appetite. This study also assessed the depressive symptoms shown by smokers before and after they quit smoking. Control subjects showed a significant increase in depressive symptoms after smoking cessation, whereas the subjects given the nicotine skin patch were not as affected. If the subjects slipped and smoked a cigarette during the time they were wearing the patch, they were asked to rate the effects of that cigarette. These "slip" cigarettes were rated significantly lower in satisfaction and good taste by subjects in the nicotine patch group than by controls. The nicotine skin patch may improve smoking cessation rates both by reducing nicotine withdrawal effects and by reducing the reward of slips back to smoking. This latter effect may prove to be effective in preventing slips from turning into relapses.

Clinical trials using ascorbic acid aerosol to aid smoking cessation.

Sensory aspects of cigarette smoke are important for providing smoking satisfaction. In previous studies, we have found that substitution of the sensory cues of smoking with a citric acid aerosol significantly reduces craving for cigarettes and enhances smoking reduction and cessation with people trying to quit smoking cigarettes. In the current study, we conducted two clinical smoking cessation trials using an ascorbic acid aerosol as a sensory substitute. The cigarette substitute consisted of a cigarette-sized tube which delivered a fine aerosol of ascorbic acid (approx. 1 mg/puff, up to a maximum of 300 mg/day). Study 1 examined the overall effectiveness of the ascorbic acid smoking substitute device. One group of subjects which used the device and received clinical counseling was compared with another group which received only clinical counseling. The group using the device showed significantly greater abstinence rates at 3 weeks post-cessation. After the subjects stopped using the device, no difference in abstinence was detected. Study 2 was conducted to focus specifically on the role of tracheobronchial sensations in relieving craving for cigarettes. Two closely matched ascorbic acid delivery systems were compared. One device delivered fine particles of ascorbic acid that were targeted to reach the trachea, while the other delivered coarser particles of ascorbic acid that were not expected to reach the trachea or lower airways. An initial enhancement in smoking reduction was found for subjects using the fine particle device relative to those using the coarse particle device. However, by the end of treatment (5 weeks) both groups showed similar degrees of smoking reduction. For those who were abstinent from smoking at the end of treatment, craving for cigarettes and negative mood were both significantly lower for those using the fine particle device. Also, hunger for food was significantly lower in the fine particle device group. These results suggest that ascorbic acid delivered from a cigarette substitute may be effective in reducing smoking and promoting smoking abstinence.

Long-term graft survival.

1. Long-term graft survival is characterized by failure rates that are essentially constant after about a year or 2. The rate has not varied appreciably among cohorts defined in terms of transplant year. 2. Transplants with an excellent clinical course throughout the first 3 months (about 2-thirds of cadaver-donor first transplants) have substantially better long-term graft survival than those with a less favorable early course. 3. Having an excellent early clinical course did not remove the effects of the several factors related to long-term survival. 4. Use of cyclosporine did not relate to long-term survival. 5. Factors related to short-term graft survival (1 year), generally related to long-term survival and in the same direction. Cyclosporine use was a major exception. 6. The dominant factor for long-term survival was tissue matching as reflected in donor categories: HLA-identical sibling, parent, and cadaver. 7. Black recipients had a decidedly poorer long-term survival than recipients of other races/ethnicities. 8. Transplant center was a dominant factor in long-term graft survival. 9. Multivariable analysis did not materially alter the findings obtained from factors considered separately. This was attributable to the sensitivity associated with small standard errors resulting from the large number of cadaver-donor transplants and the combination of smaller numbers and longer survival of living-related transplants.

Report on 604 six-antigen-matched transplants.

1. Two-year 6-antigen-matched graft survival was 82% for first grafts and 72% for second grafts compared to 72% and 60% for the controls. 2. Six-antigen-matched transplants had longer mean ischemia times and recipients had higher levels of antibodies but the effect of these factors was insignificant compared to their effect on the controls. 3. One reason for transplant loss among the 6-antigen-matched recipients was inadequate transplant size. When kidneys from young or old donors were transplanted into heavy recipients, graft survival was 74% compared to 88% for median-age donors. 4. Six-antigen-matched transplants with common phenotypes (greater than 4 cases) had 2-year graft survival of 87% compared to 76% for those which occurred only once. 5. Difficulties in tissue typing certain antigens was shown to have an effect. Six-antigen-matched transplants with antigens defined by at least 80% of the tissue typing laboratories had 89% 1-year graft survival compared to 73% for those with antigens which were more difficult to define. 6. There were fewer homozygous donors and more regraft transplants than expected.

Overview and epitope matching.

1. Kidney graft survival rates have stabilized over the past 4 years, suggesting that gains achieved with CsA have plateaued. The overall 1-year graft survival is 77% for first cadaver donor transplants, 90% for parental donors, and 93% for HLA-identical sibling donors. Patient survival for all categories is now over 95%. 2. The UNOS 6-antigen match program has resulted in outstanding graft survivals. Of 88 kidneys which were transplanted into first graft recipients, the 6-antigen match kidney had a 1-year graft survival of 91% compared to 74% for the contralateral kidney transplanted locally (p less than 0.008). 3. In highly sensitized patients with more than 80% PRA the shipped 6-antigen matched kidney had a 91% 1-year graft survival rate compared to 72% survival in comparable control patients from the registry (p less than 0.005). In patients with less than 80% PRA, 6-antigen matched kidneys had 90% 1-year graft survival compared to 80% in controls (p less than 0.00001). 4. The spread of 1-year graft survival rates at 68 centers that performed more than 100 transplants was 63-94%. The cumulative graft survival of 6-antigen matches performed at 129 different centers was 90%. Thus, the strong center effect was neutralized by the use of matched transplants. 5. In contrast to the 1% of patients who would receive O-B,DR mismatched transplants on a random basis, if kidneys were shared in the national pool, 74% could receive such a transplant. We therefore propose that a keep one-share one policy be adopted for all kidneys harvested in the United States. If no 0-B,DR mismatched patient is available, both kidneys will be kept by the harvesting center. Since 63% of kidneys are currently being shared with other centers for various reasons, the 75% sharing suggested by the new system should not impose a hardship on transplant centers. The UNOS payback agreement will be replaced by this agreement by which shipping will be done only to achieve excellent matches. 6. In order to achieve a better method of excluding the worst mismatches, an attempt was made to develop a new method of mismatching using amino acid sequences of the HLA specificities. Donor and recipient types can be converted to amino acid sequences and the mismatching done on the basis of amino acids of mismatch at each residue or position. For each residue, specific combinations of amino acid substitutions were examined individually to determine their effect on graft survival. From these studies, a list of "immunogenic" amino acids was prepared, and graft survival was then computed for increasing numbers of amino acids of mismatch.(ABSTRACT TRUNCATED AT 400 WORDS)