Self-defined residential neighbourhoods: size variations and correlates across five European urban regions.

The neighbourhood is recognized as an important unit of analysis in research on the relation between obesogenic environments and development of obesity. One important challenge is to define the limits of the residential neighbourhood, as perceived by study participants themselves, in order to improve our understanding of the interaction between contextual features and patterns of obesity. An innovative tool was developed in the framework of the SPOTLIGHT project to identify the boundaries of neighbourhoods as defined by participants in five European urban regions. The aims of this study were (i) to describe self-defined neighbourhood (size and overlap with predefined residential area) according to the characteristics of the sampling administrative neighbourhoods (residential density and socioeconomic status) within the five study regions and (ii) to determine which individual or/and environmental factors are associated with variations in size of self-defined neighbourhoods. Self-defined neighbourhood size varies according to both individual factors (age, educational level, length of residence and attachment to neighbourhood) and contextual factors. These findings have consequences for how residential neighbourhoods are defined and operationalized and can inform how self-defined neighbourhoods may be used in research on associations between contextual characteristics and health outcomes such as obesity.

Neighbourhood typology based on virtual audit of environmental obesogenic characteristics.

Virtual audit (using tools such as Google Street View) can help assess multiple characteristics of the physical environment. This exposure assessment can then be associated with health outcomes such as obesity. Strengths of virtual audit include collection of large amount of data, from various geographical contexts, following standard protocols. Using data from a virtual audit of obesity-related features carried out in five urban European regions, the current study aimed to (i) describe this international virtual audit dataset and (ii) identify neighbourhood patterns that can synthesize the complexity of such data and compare patterns across regions. Data were obtained from 4,486 street segments across urban regions in Belgium, France, Hungary, the Netherlands and the UK. We used multiple factor analysis and hierarchical clustering on principal components to build a typology of neighbourhoods and to identify similar/dissimilar neighbourhoods, regardless of region. Four neighbourhood clusters emerged, which differed in terms of food environment, recreational facilities and active mobility features, i.e. the three indicators derived from factor analysis. Clusters were unequally distributed across urban regions. Neighbourhoods mostly characterized by a high level of outdoor recreational facilities were predominantly located in Greater London, whereas neighbourhoods characterized by high urban density and large amounts of food outlets were mostly located in Paris. Neighbourhoods in the Randstad conurbation, Ghent and Budapest appeared to be very similar, characterized by relatively lower residential densities, greener areas and a very low percentage of streets offering food and recreational facility items. These results provide multidimensional constructs of obesogenic characteristics that may help target at-risk neighbourhoods more effectively than isolated features.

Mismatch between perceived and objectively measured environmental obesogenic features in European neighbourhoods.

Findings from research on the association between the built environment and obesity remain equivocal but may be partly explained by differences in approaches used to characterize the built environment. Findings obtained using subjective measures may differ substantially from those measured objectively. We investigated the agreement between perceived and objectively measured obesogenic environmental features to assess (1) the extent of agreement between individual perceptions and observable characteristics of the environment and (2) the agreement between aggregated perceptions and observable characteristics, and whether this varied by type of characteristic, region or neighbourhood. Cross-sectional data from the SPOTLIGHT project (n = 6037 participants from 60 neighbourhoods in five European urban regions) were used. Residents' perceptions were self-reported, and objectively measured environmental features were obtained by a virtual audit using Google Street View. Percent agreement and Kappa statistics were calculated. The mismatch was quantified at neighbourhood level by a distance metric derived from a factor map. The extent to which the mismatch metric varied by region and neighbourhood was examined using linear regression models. Overall, agreement was moderate (agreement < 82%, kappa < 0.3) and varied by obesogenic environmental feature, region and neighbourhood. Highest agreement was found for food outlets and outdoor recreational facilities, and lowest agreement was obtained for aesthetics. In general, a better match was observed in high-residential density neighbourhoods characterized by a high density of food outlets and recreational facilities. Future studies should combine perceived and objectively measured built environment qualities to better understand the potential impact of the built environment on health, particularly in low residential density neighbourhoods.

Exploring why residents of socioeconomically deprived neighbourhoods have less favourable perceptions of their neighbourhood environment than residents of wealthy neighbourhoods.

Residents of socioeconomically deprived areas perceive their neighbourhood as less conducive to healthy behaviours than residents of more affluent areas. Whether these unfavourable perceptions are based on objective neighbourhood features or other factors is poorly understood. We examined individual and contextual correlates of socioeconomic inequalities in neighbourhood perceptions across five urban regions in Europe. Data were analysed from 5205 participants of the SPOTLIGHT survey. Participants reported perceptions of their neighbourhood environment with regard to aesthetics, safety, the presence of destinations and functionality of the neighbourhood, which were summed into an overall neighbourhood perceptions score. Multivariable multilevel regression analyses were conducted to investigate whether the following factors were associated with socioeconomic inequalities in neighbourhood perceptions: objectively observed neighbourhood features, neighbourhood social capital, exposure to the neighbourhood, self-rated health and lifestyle behaviours. Objectively observed traffic safety, aesthetics and the presence of destinations in the neighbourhood explained around 15% of differences in neighbourhood perceptions between residents of high and low neighbourhoods; levels of neighbourhood social cohesion explained around 52%. Exposure to the neighbourhood, self-rated health and lifestyle behaviours were significant correlates of neighbourhood perceptions but did not contribute to socioeconomic differences. This cross-European study provided evidence that socioeconomic differences in neighbourhood perceptions are not only associated with objective neighbourhood features but also with social cohesion. Levels of physical activity, sleep duration, self-rated health, happiness and neighbourhood preference were also associated with neighbourhood perceptions.

Self-reported health and comfort in 'modern' office buildings: first results from the European OFFICAIR study.

In the European research project OFFICAIR, a procedure was developed to determine associations between characteristics of European offices and health and comfort of office workers, through a checklist and a self-administered questionnaire including environmental, physiological, psychological, and social aspects. This procedure was applied in 167 office buildings in eight European countries (Portugal, Spain, Italy, Greece, France, Hungary, the Netherlands, and Finland) during the winter of 2011-2012. About 26 735 survey invitation e-mails were sent, and 7441 office workers were included in the survey. Among respondents who rated an overall comfort less than 4 (23%), 'noise (other than from building systems)', air 'too dry', and temperature 'too variable' were the main complaints selected. An increase of perceived control over indoor climate was positively associated with the perceived indoor environment quality. Almost one-third of office workers suffered from dry eyes and headache in the last 4 weeks. Physical building characteristics were associated with occupants' overall satisfaction (acoustical solutions, mold growth, complaints procedure, cleaning activities) and health (number of occupants, lack of operable windows, presence of carpet and cleaning activities). OFFICAIR project provides a useful database to identify stressors related to indoor environmental quality and office worker's health.

Antiviral susceptibilities and analysis of UL97 and DNA polymerase sequences of clinical cytomegalovirus isolates from immunocompromised patients.

Antiviral susceptibilities to ganciclovir, foscarnet, and cidofovir and sequencing of UL97 and DNA polymerase were done on 23 cytomegalovirus (CMV) isolates from 10 immunocompromised persons with end-organ CMV disease who were treated with ganciclovir alone or ganciclovir followed by foscarnet. Screening of UL97 for ganciclovir resistance mutations was done by restriction digest analysis. Of 14 isolates resistant to ganciclovir, 11 (79%) contained one or more UL97 mutations at codons known to confer resistance to this compound, and 10 (91%) had a concordant mutant pattern by restriction digest analysis. Of 9 isolates containing mutations in conserved regions of the DNA polymerase, 8 were resistant to ganciclovir, and 4 were cross-resistant to cidofovir. All isolates were susceptible to foscarnet. It is concluded that ganciclovir-resistant clinical CMV isolates may contain UL97 mutations, DNA polymerase mutations, or mutations in both genes. Ganciclovir therapy may select for CMV isolates that are cross-resistant to cidofovir.

The metabolic organization of the adult human liver: a comparative study of normal, fibrotic, and cirrhotic liver tissue.

Little is known about the alterations of metabolic organization of the human liver tissue in chronic liver diseases. We therefore compared the distribution of the following zonal metabolic markers in 10 samples of normal liver tissue, 10 samples of fibrotic tissue, and 22 samples of cirrhotic tissue: (a) the enzymatic activities of glucose-6-phosphatase (G6P), lactate dehydrogenase (LDH), succinate dehydrogenase (SDH), nicotinamide-adenine-dinucleotide-phosphate [NAPH] dehydrogenase (ND), beta-hydroxybutyrate dehydrogenase (HBDH), and glutamate dehydrogenase (GDH); (b) the protein glutamine synthetase (GLS); and (c) albumin messenger RNA (mRNA). The normal human hepatic lobule was characterized by the periportal predominance of G6P and SDH enzymatic activities and albumin mRNAs, the perivenous predominance of ND and GDH, the restriction of GLS to a small perivenous compartment, and the predominanc of beta-HBDH at the contact of both portal tracts and centrilobular veins. In fibrosis, the overall metabolic organization of the normal liver tissue was retained. The expression of periportal markers predominated around enlarged portal tracts and that of perivenous markers around residual centrilobular veins. GLS was constantly detected at the contact of centrilobular veins. In cirrhotic nodules, no zonation was observed for most enzymatic activities or for albumin. Only G6P usually predominated at the periphery of the nodules. GLS was constantly undetectable. No difference accordingly to the etiology of the underlying disease was observed. In conclusion, the normal human hepatic lobule presents a marked metabolic zonation, preserved in fibrotic lesions, but lost in cirrhotic nodules. The alterations of the metabolic organization observed in cirrhosis might contribute to the pathogenesis of some of the metabolic disorders associated with advanced liver disease.

Construction and validation of a specific quality of life instrument for adolescents with spine deformities.

STUDY DESIGN: The development and construction of a specific instrument for measuring quality of life in adolescents with spine deformities was investigated. OBJECTIVES: To assess the validity and reliability of the Quality of Life Profile for Spine Deformities. SUMMARY OF BACKGROUND DATA: An 88-item questionnaire was self-administered to 174 patients ranging in age from 10 to 20 years with spine deformities. Items were rated on a five-point Likert scale. Higher scores means high level of impairment in quality of life. Age, gender, menarche or voice change, salient symptoms in the medical record, ordinary parameters on physical examination, and measurements on standard anteroposterior and lateral radiographs were recorded. The retest was done 10 days after the initial administration in a subsample of 35 patients. METHODS: The test-retest reliability was analyzed calculating the intraclass correlation coefficient. Internal consistency was measured with the Cronbach's alpha method. Factor analysis was used to obtain a reduced number of variables. Construct validity was assessed using the principal components model of factor analysis based on the correlation matrix and using the varimax computer algorithm for orthogonal rotation. Discriminant validity was assessed using the Kruskal-Wallis test. RESULTS: The Quality of Life Profile for Spine Deformities contained 21 items and five factors in conceptual terms labeled psychosocial functioning, sleep disturbances, back pain, body image, and back flexibility. The overall questionnaire score showed an internal consistency of 0.88 and a test-retest correlation of 0.91. Patients with structural curves showed significantly higher scores in all dimensions of the Quality of Life Profile for Spine Deformities except for the subscale of body image than patients with postural curves. When patients were grouped according to the symptom of back pain, those with backache had a significantly higher quality of life overalls score and scores in the dimensions of sleep disturbances and pain. Brace-treated patients showed statistically significant differences in the quality of life overall score and scores in the dimensions of psychosocial functioning and back flexibility. CONCLUSIONS: The instrument developed for measuring quality of life in patients with spine deformities during the period of bone growth has validity, internal consistency, and high test-retest reliability. The conceptualization of quality of life of the Quality of Life Profile for Spine Deformity includes psychosocial dimensions and pain and function.

[Possibility of a TSH-Screening method for detection of hypothyroidism in the newborn (author's transl)]. / Möglichkeit einer TSH-Screening-Methode zur Entdeckung der Hypothyreose bei Neugeborenen.

In congenital hypothyroidism the TSH level reaches at age 5 days values about 100-times of the normal. Due to this fact, and having a good RIA-method for TSH in the own lab at hand, the possibility of TSH-determination in dried wholeblood on a filter-paper was examined. Control studies with normal blood-samples proved that the values of dried-blood samples had sufficient accuracy. On the 5th day of life the normal TSH-values were below 20 muU/ml while values above 100 muU/ml were suspicious for hypothyroidism. In 1200 newborns the TSH-screening was performed in combination with the routine Guthrie-test. Among them one child with a value above 100 muU/ml proved to have hypothyroidism. The results show that the determination of TSH in dried blood is possible, and that the method described is a useful tool for the early diagnosis of primary hypothyroidism.

[Radioimmunologic determination of TSH in dried blood stains: a possible screening method for the diagnosis of hypothyroidism in new born infants]. / Radioimmunologischer Nachweis von TSH in getrockneten Blutstropfen: mögliche Screening-Methode zur Entdeckung der Hypothyreose bei Nuegeborenen

By a modification of the radioimmunoassay of TSH in plasma, a method has been introduced for the measurement of TSH in dried blood spotted on filter paper. On incubation of filter paper discs (6.5 mm diameter, corresponding to approx. 10 mul blood) for 38 hs has the lower limit of detection was 10 muU/ml TSH 68/38. In 100 blood samples, TSH was measured in plasma as well as in dried blood; the results were comparable and showed complete agreement in patients with high TSH concentrations suffering from primary hypothyroidism. In 16 out of 72 newborn children examined during the first 8 hs of life. TSH was slightly elevated. It would appear that our method is sensitive enough for detection of the physiological postnatal rise in TSH. Among 1400 infants in whom Tsh was measured on the 5th or 6th day simultaneously with routine screening for phenylketonuria (PKU), we found 1 case with markedly elevated TSH levels of greater than 100 muU/ml. The child suffered from congenital goiter. The results of our study show that the measurement of TSH in dried blood spots is possible without particular difficulty. Becasue of the simplicity of blood-sampling, the stability of the TSH, the relatively low cost and the low number of false positive results, this method seems to be suitable for screening of new born infants. It could be carried out conveniently in combination with the screening program for metabolic diseases, which covers practically 100% of infants born in Switzerland. Congenital hypothyroidism is a relatively frequent disease (1:3000-1:7000) in which early commencement of treatment is of great importance for mental development. It would therefore be desirable for all infants to be screened during the first days of life for congenital hypothyroidism.

Rupture of the diaphragm caused by blunt trauma.

Our experience with 27 patients who sustained traumatic laceration of the diaphragm caused by blunt forces is described. Automobile accident were the most frequent cause of rupture and young adult males the most vulnerable. The left hemidiaphragm is most frequently injured, but with sufficient force significant tears in the right hemidiaphragm will occur. Most of these patients sustained injury to multiple organ systems. The preoperative diagnosis of traumatic diaphragmatic hernia is based on a high index of suspicion, close and continued observation of the patient, and correct interpretation of roentgenograms of the chest. The mortality rate is high, owing to the magnitude of the injuries.