The effect of school intervention programs on the body mass index of adolescents: a systematic review with meta-analysis.

Effective obesity interventions in adolescent populations have been identified as an immediate priority action to stem the increasing prevalence of adult obesity. The purpose of this meta-analysis was to make a quantitative analysis of the impact of school-based interventions on body mass index during adolescence. Studies were retrieved from PubMed, Scopus, Science Direct and Web of Science databases. Results were pooled using a random-effects model with 95% confidence interval considered statistically significant. Of the 18 798 possible relevant articles identified, 12 articles were included in this meta-analysis. The global result showed a low magnitude effect, though it was statistically significant (N = 14 428), global e.s. = -0.055, P = 0.004 (95% CI = -0.092, -0.017). Heterogeneity was low among the studies (I2 = 9.017%). The funnel plot showed no evidence of publication bias. The rank-correlation test of Begg (P = 0.45641) and Egger's regression (P = 0.19459) confirmed the absence of bias. This meta-analysis reported a significant effect favoring the interventions; however, future research are needed since the reported the evidence was of low magnitude, with the studies following a substantial range of approaches and mostly had a modest methodological quality.

Indicador compuesto en salud: riesgo de transmisión del virus de la rabia / Health composite indicator: risk of transmission of rabies virus

RESUMEN Objetivo Diseñar un indicador compuesto en salud sobre el riesgo de transmisión del virus de la rabia, en el departamento del Meta. Materiales y Métodos Estudio ecológico, exploratorio. Se tomaron los datos de fuentes secundarias procedentes de las bases de datos de la secretaría de salud departamental del Meta e Instituto Colombiano Agropecuario de los años 2009 a 2014. El indicador compuesto en salud, se creó a partir de la normalización (logX) de los datos y selección de las medidas para la elaboración de tres índices temáticos en los 29 municipios del departamento, los cuales fueron integrados mediante la metodología de agregación y cuya distribución se reflejó en un mapeo geográfico con la zonificación del riesgo de transmisión del virus de la rabia a nivel departamental. Resultados En la clasificación del indicador compuesto en salud sobre el riesgo de transmisión de la rabia, el nivel alto corresponde al 34% de los municipios del departamento; en el nivel medio se ubica el 17% y en el nivel bajo el 28%. Los municipios sin riesgo son La Macarena, Mapiripán, Vistahermosa, Villavicencio, Puerto Concordia, Granada y Puerto Rico, representando el 21%. Conclusión El nivel alto del indicador compuesto en salud sobre el riesgo de transmisión del virus de la rabia, se ubica en municipios de la subregión del Río Meta, subregión cordillera y subregión del alto Ariari; caracterizados por altas concentraciones de animales, disminución de la cobertura de vacunación antirrábica y la confirmación circulante del virus.(AU)

ABSTRACT Objective To design a composite health indicator on the risk of rabies virus transmission in the department of Meta, Colombia. Materials and Methods Ecological, exploratory study. Data from secondary sources were collected from the databases of the Meta Department of Health and the Colombian Agricultural Institute (ICA) for the period 2009 - 2014. The composite health indicator was created based on the normalization (logX) of the data and the selection of measures for the elaboration of three thematic indexes in the 29 municipalities of the department. They were integrated by means of the aggregation method, and their distribution was reflected in a geographical mapping with the zoning of the risk for rabies virus transmission in the department. Results In the classification of the composite health indicator on the risk of rabies transmission, the high level corresponds to 34% of the municipalities of the department, the middle level involves 17%, the low level, 28%. The municipalities without risk are La Macarena, Mapiripán, Vistahermosa, Villavicencio, Puerto Concordia, Granada and Puerto Rico, representing 21%. Conclusion The high level of the composite health indicator on the risk of rabies virus transmission is found in municipalities of the Meta River sub-region, the Cordillera sub-region and the upper Ariari sub-region. These areas are characterized by high concentrations of animals, decreased coverage of rabies vaccination and circulating confirmation of the virus.(AU)

[Health composite indicator: risk of transmission of rabies virus]. / Indicador compuesto en salud: riesgo de transmisión del virus de la rabia.

OBJECTIVE: To design a composite health indicator on the risk of rabies virus transmission in the department of Meta, Colombia. MATERIALS AND METHODS: Ecological, exploratory study. Data from secondary sources were collected from the databases of the Meta Department of Health and the Colombian Agricultural Institute (ICA) for the period 2009 - 2014. The composite health indicator was created based on the normalization (logX) of the data and the selection of measures for the elaboration of three thematic indexes in the 29 municipalities of the department. They were integrated by means of the aggregation method, and their distribution was reflected in a geographical mapping with the zoning of the risk for rabies virus transmission in the department. RESULTS: In the classification of the composite health indicator on the risk of rabies transmission, the high level corresponds to 34% of the municipalities of the department, the middle level involves 17%, the low level, 28%. The municipalities without risk are La Macarena, Mapiripán, Vistahermosa, Villavicencio, Puerto Concordia, Granada and Puerto Rico, representing 21%. CONCLUSION: The high level of the composite health indicator on the risk of rabies virus transmission is found in municipalities of the Meta River sub-region, the Cordillera sub-region and the upper Ariari sub-region. These areas are characterized by high concentrations of animals, decreased coverage of rabies vaccination and circulating confirmation of the virus.

OBJETIVO: Diseñar un indicador compuesto en salud sobre el riesgo de transmisión del virus de la rabia, en el departamento del Meta. MATERIALES Y MÉTODOS: Estudio ecológico, exploratorio. Se tomaron los datos de fuentes secundarias procedentes de las bases de datos de la secretaría de salud departamental del Meta e Instituto Colombiano Agropecuario de los años 2009 a 2014. El indicador compuesto en salud, se creó a partir de la normalización (logX) de los datos y selección de las medidas para la elaboración de tres índices temáticos en los 29 municipios del departamento, los cuales fueron integrados mediante la metodología de agregación y cuya distribución se reflejó en un mapeo geográfico con la zonificación del riesgo de transmisión del virus de la rabia a nivel departamental. RESULTADOS: En la clasificación del indicador compuesto en salud sobre el riesgo de transmisión de la rabia, el nivel alto corresponde al 34% de los municipios del departamento; en el nivel medio se ubica el 17% y en el nivel bajo el 28%. Los municipios sin riesgo son La Macarena, Mapiripán, Vistahermosa, Villavicencio, Puerto Concordia, Granada y Puerto Rico, representando el 21%. CONCLUSIÓN: El nivel alto del indicador compuesto en salud sobre el riesgo de transmisión del virus de la rabia, se ubica en municipios de la subregión del Río Meta, subregión cordillera y subregión del alto Ariari; caracterizados por altas concentraciones de animales, disminución de la cobertura de vacunación antirrábica y la confirmación circulante del virus.

Effect of copper hydroxide sprays for citrus canker control on wild-type Escherichia coli.

AIMS: To show that application of copper hydroxide citrus sprays mixed with field source water (possibly contaminated) will not support Escherichia coli on plant surfaces. Environmental stresses of transient phyllosphere bacteria and presence of copper will eradicate these bacteria before harvest. METHODS AND RESULTS: Studies were performed in vitro with bacteria grown in broth and then subjected to field spray copper hydroxide concentrations in the broth and on citrus leaves. Escherichia coli exposed to copper hydroxide in vitro were eradicated from the broth within 6-8 h depending on the broth pH. Even with near neutral pH (7·2), cells began to die immediately after exposure to copper. No E. coli survived on leaf surfaces sprayed with copper. CONCLUSIONS: Copper field sprays mixed with water that may contain E. coli can help eliminate E. coli from plant surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY: HACCP mandates are becoming more restrictive because of the increased illness resulting from food pathogens on fresh produce. Use of potable water in fields, a proposed mandate, is not feasible for large grove owners. These data show that copper sprays aimed at reducing citrus canker also affect E. coli and may help to ease water quality mandates.

1/f Noise in sliding friction under wear conditions: the role of debris.

It has been shown that the friction force time series in sliding friction under wear conditions is self-similar and has a 1/f power spectrum. Albeit a variety of models, mostly inspired in the field of earthquakes, has been explored, an important factor was overlooked: the role of debris. This Letter describes sliding friction experiments on steel with alumina pins, carried out with and without debris blowing, that prove the role of loose debris in determining the 1/f character of the friction force. A damped-forced harmonic oscillator with two friction terms, one purely random and another inversely proportional to the amount of loose debris, calculated by means of a modified sandpile model, is proposed to describe the dynamics of friction under wear conditions.

A simple method for screening antimicrobial compounds with application to plant disease and fruit quality.

AIMS: It is often difficult to extrapolate information from a Petri dish and apply it to commercial applications as with antimicrobial assays. Often large volumes of commodities are used for a virtually untested protocol and result in an unnecessary expenditure of time and materials. An intermediate method, where experimental compounds could be tested directly on a specific commodity without expending large quantities of either sample or compound, would be practical and economical. METHODS AND RESULTS: A method was developed that employs the use of a small experimental chamber in which pieces of natural materials (e.g. fruit) can be tested with antimicrobial compounds. This method uses a type of autoclavable incubation chamber with a filter paper base, hydrating sponge pieces and a sterile glass sample platform. The chamber offers a sterile, controlled environment and can be manipulated to serve a number of studies. CONCLUSION: The chamber results are more analogous to what happens on whole fruit than the Petri dish. SIGNIFICANCE AND IMPACT OF THE STUDY: This method is presently used to screen for antimicrobial compounds and treatments needed to control serious economic pests compromising Florida's agriculture.

Debris and 1/f noise in sliding friction dynamics under wear conditions.

Friction force time series showing irregular fluctuations have been since long considered one of the possible stick-slip regimes in sliding friction. However, it has not been until recently that a 1/f power spectrum in friction force time series derived from sliding friction experiments under wear conditions has been identified. A variety of models, mostly inspired in the field of earthquakes, has been explored, without reaching a fully satisfactory explanation of that behavior. Recently, the present authors have reported results of sliding friction experiments on steel with alumina pins, carried out with and without debris blowing, that proved the role of loose debris in determining the 1/f character of the friction force. A damped-forced harmonic oscillator with two friction terms was proposed to describe the dynamics of friction under wear conditions: one purely random, which accounts for surface roughness, and another inversely proportional to the amount of loose debris that was calculated by means of a modified sand-pile model. This paper presents a full discussion of the experiments that allowed to reach that conclusion and of the model proposed to rationalize the results. In addition, the results of experiments devised to understand the transition from friction with debris to friction without debris (experiment initiated without blowing and after some time switching on blowing) and vice versa are reported. The results of further studies of the wear track are presented, namely, the variation in the track width with sliding distance and results of chemical analyses and surface roughness measurements of the track, for both with or without debris blowing experiments. These additional data give further support to the crucial role of debris in the 1/f character of the friction force.

Management of pain from heel lance with lidocaine-prilocaine (EMLA) cream: is it safe and efficacious in preterm infants?

Hospitalized preterm infants undergo multiple painful heel lances. A two-phase, randomized, controlled trial was undertaken to determine the safety and efficacy of lidocaine-prilocaine 5% cream (EMLA, Astra Pharmaceuticals, L.P, Westborough, MA) for relieving pain from heel lance. One hundred twenty infants were randomly assigned to receive 0.5 g of EMLA or placebo cream for 30 minutes (Phase 1) or 60 minutes (Phase 2) before a routine heel lance. Efficacy was assessed using the Premature Infant Pain Profile (PIPP). Safety was determined by methemoglobin concentration 8 hours after EMLA application and by clinical signs of methemoglobinemia. No significant differences existed on PIPP scores between EMLA and placebo groups in Phase 1 (p < .480) or Phase 2 (p < .831). No infant had any clinical signs of methemoglobinemia. The mean methemoglobin concentration was 1.19% (.47). Approximately 10% of infants had minor skin reactions, and approximately 20% of EMLA-treated infants had blanching at the application site. The authors conclude that EMLA is safe but not efficacious for relieving pain from heel lance in preterm infants.

Deconjugation of bilirubin-IX alpha glucuronides: a physiologic role of hepatic microsomal beta-glucuronidase.

beta-Glucuronidase is an acid hydrolase located in both the lysosomal and microsomal compartments of the hepatocyte. The function of the latter remains undefined. We postulated that microsomal beta-glucuronidase may be responsible for the deconjugation of bilirubin-IX alpha glucuronides which are synthesized primarily in the hepatic microsomal compartment. We utilized two unique congenic strains of mice to characterize the role of hepatic beta-glucuronidase in the metabolism and disposition of bilirubin-IX alpha; the first exhibited less than 1% of total hepatic beta-glucuronidase activity (ATM), the second lacked only the microsomal enzyme activity (AT1). The biliary excretion of bilirubin-IX alpha conjugates was quantitated using reverse-phase high performance liquid chromatography. Under basal conditions, there was a 2-fold increase in the biliary excretion of bilirubin-IX alpha monoglucuronides and total glucuronides in the AT1 and ATM mutants compared to the normal controls. When the plasma bilirubin-IX alpha level was increased to approximately 7 mg/dl to simulate hyperbilirubinemia, by intravenous administration of [14C]bilirubin-IX alpha, mathematical modeling of the biliary excretion curves of bilirubin-IX alpha glucuronides revealed qualitative differences between control and mutant animals, whereas both mutant groups were similar. Collectively, these data demonstrate that microsomal beta-glucuronidase modulates the net rate of bilirubin-IX alpha glucuronidation and glucuronide excretion in bile, under both basal and hyperbilirubinemic conditions, and that lysosomal beta-glucuronidase has no such effects. Hepatic microsomal beta-glucuronidase appears likely to influence the biliary excretion and hence the hepatic elimination of endogenous and xenobiotic substrates (e.g. carcinogens) which undergo hepatic glucuronidation.

Evaluation of University of Wisconsin cold-storage solution in warm hypoxic perfusion of rat liver: the addition of fructose reduces injury.

BACKGROUND: University of Wisconsin cold-storage solution (UW solution) has markedly improved organ preservation for liver transplantation. However, the efficacy of this solution in preserving hepatocyte viability during warm ischemia is undefined; hence, the effects of UW solution on warm hypoxic injury in the isolated perfused rat liver were examined. METHODS: Livers were perfused using a modified protocol that included a period of hypoxic perfusion with isosmotic Krebs' solution at the end of each experiment. Hepatic injury was evaluated by aspartate aminotransferase (AST) release into the perfusate and the trypan blue perfusion technique. RESULTS: Although UW solution appeared to decrease hepatic injury during hypoxic perfusion, as reflected by low AST release, perfusion with UW solution led to hepatocyte shrinkage and cessation of bile flow even under oxygenated conditions. UW solution did not protect against warm hypoxic injury, as assessed by AST release into the perfusate (182 +/- 15 U/mL, mean +/- SD) or trypan blue staining of the dead hepatocyte nuclei (56% +/- 5%). However, the addition of fructose to UW solution resulted in a significant decrease in AST release (66 +/- 15 U/mL) and parenchymal cell death (39% +/- 7%). CONCLUSIONS: These data suggest that the addition of fructose or other gluconeogenic substrates may complement the overall hepatoprotective effects of UW solution, particularly during periods of warm hypoxia.

Hypoxic liver injury and the ameliorating effects of fructose: the "glucose paradox" revisited.

It has been independently postulated that nutritional status is a modulator of the hepatic injury response to hypoxia and that glucose may be a poor substrate for hepatocellular metabolism. This study provides data linking these two concepts within the framework of metabolic zonation of the liver. With the use of a hypoxically perfused isolated rat liver model, cellular injury, as reflected by aspartate aminotransferase (AST) release, was significantly greater in the liver of fasted (mean AST 489 U/g liver at 3 h) than fed (40 U/g) animals. The extent of injury during hypoxia was decreased to a comparable degree in fasted livers perfused with Wisconsin solution (27 U/g) or 20 mM fructose (51 U/g). Perfusion with (11.5 mM) glucose plus insulin provided no hepatoprotection (791 U/g); however, supraphysiological amounts of glucose (100 mM) with (310 U/g) or without (321 U/g) insulin (10 U) or dihydroxyacetone (220 U/g) provided a modest reduction in AST release. Cellular injury measured by trypan blue uptake showed a marked zonal pattern, with upstream regions incurring greater parenchymal and nonparenchymal injury than downstream areas. These data that indicate that exogenous glucose is poorly utilized as an energy substrate by the liver during hypoxia are consistent with data from the fasted-refed rat model, suggesting a "glucose paradox" in the liver. The findings also suggest that low levels of oxygen are an important factor mediating "hypoxic" liver injury.

Hepatic microsomal bilirubin UDP-glucuronosyltransferase. The kinetics of bilirubin mono- and diglucuronide synthesis.

Hepatic biotransformation of bilirubin to the hydrophilic species bilirubin mono- (BMG) and diglucuronide (BDG) by microsomal bilirubin UDP-glucuronosyl-transferase (GT) is a prerequisite for its physiologic excretion into bile. The reaction mechanism of bilirubin-GT and the access of bilirubin and BMG (the intermediate substrate) to the active site of bilirubin-GT are undefined. Highly purified [14C]bilirubin and [3H] BMG were coincubated with rat liver microsomes, and the initial rates of radiolabeled bilirubin glucuronide synthesis were measured. Although these substrates differ markedly in their hydrophilicity, no significant differences were observed in [14C]- and [3H]BDG rates of formation from equimolar [14C]bilirubin and [3H] BMG, in the absence or presence of soluble binding proteins (albumin and hepatic cytosol). In further kinetic studies, [14C]bilirubin and [3H]BMG exhibited mutually competitive inhibition of [3H]- and [14C]BDG synthesis, respectively, and [3H]BMG also inhibited [14C]BMG formation. Finally, unlabeled BMG and BDG inhibited the glucuronidation of [14C]bilirubin, with all three pigments yielding virtual Michaelis-Menten dissociation constants in the 10-20 microM range. These findings indicate that: 1) bilirubin-GT follows Michaelis-Menten kinetics for both bilirubin and BMG glucuronidation over the range of substrate concentrations employed; 2) the findings are consistent with a single active site for the enzymatic synthesis of both BMG and BDG; 3) bilirubin, BMG, and BDG bind competitively to this active site with comparable affinities; and 4) access of both bilirubin and BMG substrates to the enzymatic active site is reduced by soluble binding proteins.

[Tetanus. A review of 54 cases]. / Tétano. Revisão de 54 casos.

Tetanus continues to be a frequent illness with a high rate of mortality which mainly affects the elderly. In view of this, 54 cases treated in the ICU between 1983 and 1991 were studied. The clinical support with mechanical ventilation and the use of new drugs, which allowed for a more satisfactory sedation and muscular relaxation, and which permitted the control of the autonomic overactivity, were the most determinant factors in the reduction of mortality verified in the late years of our practice.

Physical and biological properties of fluorescent dansylated bile salt derivatives: the role of steroid ring hydroxylation.

The hydroxyl groups of bile salts play a major role in determining their physical properties and physiologic behavior. To date, no fluorescent bile salt derivatives have been prepared which permit evaluation of the functional role of the steroid ring. We have prepared five fluorescent cholanoyl derivatives using a dansyl-ethylene diamine precursor linked to the sulfonyl group of taurine; N-(5-dimethylamino-1-naphthalenesulfonyl)-N'-(2-aminoethanesulf onyl)- ethylenediamine. The fluorescent dansyl-taurine was conjugated to the carboxyl group of free bile acids, enabling the labeling of the series: dehydrocholate, ursodeoxycholate, cholate, chenodeoxycholate and deoxycholate. Despite a systematic hydrophobic shift compared with the native bile salts (aqueous solubility and water:octanol partitioning), the influence of steroid ring hydroxylation was retained, with the dehydrocholate and cholate derivatives more water soluble than the dihydroxy derivatives. Similarly, the sequence of HPLC mobilities, reflecting relative hydrophilicity, was identical in the dansyl-taurine derivatives and the native taurine-conjugated bile salts. Cellular uptake of all five steroid derivatives was rapid, and partial inhibition of [3H]taurocholate uptake was observed in isolated hepatocytes. Rates of biliary excretion of the dansylated derivatives by the isolated perfused rat liver correlated closely with hydrophilicity. Collectively, these findings indicate that the influence of the hydroxyl groups is retained in this series of dansylated steroids, and that hydroxylation is a key determinant of their hepatocellular transport and biliary excretion. These fluorescent bile salt derivatives may thus serve as unique probes for investigating structure-function relationships in hepatic processing of steroid-based compounds.

Enhanced activity of the free radical producing enzyme xanthine oxidase in hypoxic rat liver. Regulation and pathophysiologic significance.

It has been widely proposed that conversion of xanthine dehydrogenase (XDH) to its free radical-producing form, xanthine oxidase (XOD), underlies ischemic/reperfusion injury, although the relationship of this conversion to hypoxia and its physiologic control have not been defined. This study details the time course and control of this enzymatic interconversion. In a functionally intact, isolated perfused rat liver model, mean % XOD activity increased as a function of both the duration (25 to 45% in 3 h) and degree (r = 0.97) of hypoxia. This process was markedly accelerated in ischemic liver by an overnight fast (45 vs. 30% at 2 h), and by imposing a short period of in vivo ischemia (cardiopulmonary arrest 72%). Moreover, only under these conditions was there a significant rise in the XOD activity due to the conformationally altered XDH molecule (XODc, 18%), as well as concomitant morphologic injury. Neither circulating white blood cells nor thrombosis appeared to contribute to the effects of in vivo ischemia on enzyme conversion. Thus, it is apparent that conversion to the free radical-producing state, with high levels of XOD activity and concurrent cellular injury, can be achieved during a relatively short period of hypoxia under certain well-defined physiologic conditions, in a time course consistent with its purported role in modulating reperfusion injury. These data also suggest that the premorbid condition of organ donors (e.g., nutritional status and relative state of hypoxia) is important in achieving optimal organ preservation.