Inclusion of fish or fish oil in weight-loss diets for young adults: effects on blood lipids.

OBJECTIVE: To assess the effects of fish (lean or oily) and fish oil consumption on blood lipid concentration during weight loss. DESIGN: Randomized, controlled 8-week trial of energy-restricted diet varying in fish and fish oil content. Subjects, 324 men and women, aged 20-40 years, body mass index 27.5-32.5 kg m(-2), from Iceland, Spain and Ireland, were randomized to one of four groups: (1) control (sunflower oil capsules, no seafood), (2) cod diet (3 x 150 g week(-1)), (3) salmon diet (3 x 150 g week(-1)), (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was similar between the groups and the capsule groups were single-blinded. MEASUREMENTS: Total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol, triacylglycerol (TG) and anthropometrics were measured at baseline and end point. RESULTS: The difference in logTG lowering between the control group and the cod diet, salmon diet and fish oil from baseline to end point was -0.036 (95% CI -0.079 to 0.006), -0.060 (-0.101 to -0.018) and -0.037 (-0.079 to 0.006), respectively. Reduction in TC was about 0.2 mmol l(-1) greater in the fish groups (cod and salmon) than in the control group, but only of borderline significance when adjusting for weight loss. HDL tended to decrease less in the diet groups consuming a significant amount of n-3 fatty acids (salmon and fish oil). CONCLUSION: Weight-loss diet including oily fish resulted in greater TG reduction than did a diet without fish or fish oil. Controlled trials using whole fish as a test meal are encouraged to be able to elucidate the role of different constituents of fish for human health.

Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content.

OBJECTIVE: To investigate the effect of including seafood and fish oils, as part of an energy-restricted diet, on weight loss in young overweight adults. DESIGN: Randomized controlled trial of energy-restricted diet varying in fish and fish oil content was followed for 8 weeks. Subjects were randomized to one of four groups: (1) control (sunflower oil capsules, no seafood); (2) lean fish (3 x 150 g portions of cod/week); (3) fatty fish (3 x 150 g portions of salmon/week); (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was similar between the groups and the capsule groups, were single-blinded. SUBJECTS: A total of 324 men and women aged 20-40 years, BMI 27.5-32.5 kg/m(2) from Iceland, Spain and Ireland. MEASUREMENTS: Anthropometric data were collected at baseline, midpoint and endpoint. Confounding factors were accounted for, with linear models, for repeated measures with two-way interactions. The most important interactions for weight loss were (diet x energy intake), (gender x diet) and (gender x initial-weight). RESULTS: An average man in the study (95 kg at baseline receiving 1600 kcal/day) was estimated to lose 3.55 kg (95% CI, 3.14-3.97) (1); 4.35 kg (95% CI, 3.94-4.75) (2); 4.50 kg (95% CI, 4.13-4.87) (3) and 4.96 kg (95% CI, 4.53-5.40) on diet (4) in 4 weeks, from baseline to midpoint. The weight-loss from midpoint to endpoint was 0.45 (0.41-0.49) times the observed weight loss from baseline to midpoint. The diets did not differ in their effect on weight loss in women. Changes in measures of body composition were in line with changes in body weight. CONCLUSION: In young, overweight men, the inclusion of either lean or fatty fish, or fish oil as part of an energy-restricted diet resulted in approximately 1 kg more weight loss after 4 weeks, than did a similar diet without seafood or supplement of marine origin. The addition of seafood to a nutritionally balanced energy-restricted diet may boost weight loss.

Efficacy of distant healing--a proposal for a four-armed randomized study (EUHEALS).

BACKGROUND: Distant healing as a treatment modality is frequently used by patients and healers. Some preliminary evidence suggests possible effects. Since patients suffering from multiple chemical sensitivity and chronic fatigue syndrome have only few effective treatment options, distant healing will be offered as a treatment within a formal trial of distant healing. DESIGN AND METHOD: A four-armed randomized trial will include 400 patients with self-attributed, environmental problems who fulfil the diagnostic criteria of severe idiopathic chronic fatigue, chronic fatigue syndrome or multiple chemical sensitivity. Patients will be recruited by specialized general practitioners and environmental clinics. They will be treated by healers distributed all over Europe, coming from various healing traditions and nationalities. Each patient will be treated by 3 healers. Healers will have no contact with the patients and will only be provided with the patient's Christian name and a photograph. The patients will be randomized to one of 4 groups in a 2 x 2 factorial design. They will either receive (distant) healing or not, and either know or not know this decision. Thereby the effects of expectation and of time can be disentangled from the specific effects of healing. OUTCOME MEASURE: Primary outcome measure will be the mental health summary scale of the MOS SF-36. The measure will be taken at the beginning and at the end of a 6- month treating or waiting period, respectively. A variety of moderator variables will be considered to evaluate which of these may be predictive of outcome.

Optimising contrast-enhanced cranial CT for detection of brain metastases.

PURPOSE: In order to optimise contrast-enhanced CT in the detection of brain metastases, we investigated how sensitivity was affected by an increase in contrast medium dose and a reduction in slice thickness. MATERIAL AND METHODS: A total of 198 cases of known primary malignancy with suspected brain metastases were investigated in three consecutive contrast-enhanced CT examinations. The first was a standard CT examination with an injection of 100 ml contrast medium (300 mg I/ml) and a slice thickness of 10 mm. A further 100 ml contrast medium was given and the second examination was performed immediately afterwards with the same slice thickness as the first. This was followed by the third examination, which used a slice thickness of 5 mm. The standard contrast-enhanced CT images were compared with the double-dose images and with the images of reduced slice thickness (5 mm instead of 10 mm). RESULTS: The double-dose images demonstrated an 8-18% increase in the number of brain metastases detected compared to the standard contrast-enhanced CT; the images of the 5-mm-thick slices showed a further 22-33% increase. The comparison between the standard contrast-enhanced CT images and the images with both thinner slices and the double dose of contrast medium demonstrated a 32-55% increase in the number of metastases detected. CONCLUSION: A considerable increase in sensitivity (32-55%) in contrast-enhanced CT can be obtained by reducing the slice thickness and increasing the contrast medium dose. This optimised technique should be the method of choice in patients with known primary malignancy and suspected brain metastases.

Psychopharmacoepidemiology in Iceland: effects of regulations and new medications.

The sale of psychotropic medications in Iceland has waxed and waned during the past 20 years with approximately 5 years between peak and bottom quantities sold. Apparently, it has decreased following restrictions imposed by the public health authorities and increased again following the introduction of new drug. In order to study this further, all prescriptions for psychotropic medications to non-hospitalized inhabitants of the capital city (Reykjavík) and dispensed by pharmacists there during 1 month in 1984, 1989 and 1993 were analysed in order to estimate the 1-month prevalence of psychopharmacological use. The results support the hypothesis partly as prescriptions for tranquillizers decreased in 1989 as well as the amount of tranquillizers and hypnotics prescribed following new restrictions, whereas the prevalence odds ratio of obtaining prescriptions for hypnotics remained unchanged. The proportion of patients receiving excessive amounts of tranquillizers and/or hypnotics decreased. The prevalence of excessive use of these drugs (i.e. > 90 DDD/month) was 0.5% in 1993. In 1993 the prevalence of the use of antidepressants as well as the amount prescribed had increased substantially following the introduction of the new selective serotonin reuptake inhibitor medications. Thus, the prevalence of patients obtaining any psychotropic medication remained unchanged from 1984 to 1993.

Oral contraceptives and risk of breast cancer. A historical prospective case-control study.

BACKGROUND: The goal of this study is to quantify the risk of breast cancer related to use of oral contraceptives while adjusting for known risk factors, e.g. age at first delivery, number of children, and family history, as well as minimising memory bias. METHODS: A historical prospective study design was used. Data collected over a period of 25 years in the screening program of a cancer detection clinic for women aged 25-69 years were utilised. Information on breast cancer among those attending the screening program was searched for in the national cancer registry. Women with breast cancer were matched on date of birth with on average 5.3 control women who were still alive when the diagnosis was made. Mothers and sisters of cases and controls were identified through a national genealogy registry. RESULTS: The odds ratio of developing breast cancer among women with a first degree relative with breast cancer was about 2, but for those ever using oral contraceptives it was 0.92 and even lower (0.50-0.75) if the cancer was diagnosed before the age of 45 years. CONCLUSIONS: Use of oral contraceptives (OC) does not seem to increase the risk of developing breast cancer among women in Iceland.

Risk scores from logistic regression: unbiased estimates of relative and attributable risk.

In epidemiology, the risk of disease in terms of a set of covariates is often modelled by logistic regression. The resulting linear predictor can be used to define the extent of risk between extremes, and to calculate an attributable risk for the covariates taken together. As is well known, straightforward use of the linear predictor, on the sample from which it was derived, to obtain estimates the relative and attributable risk will be biased, often seriously. Use of the jack-knife technique is extended to produce asymptotically unbiased estimates of relative and attributable risks. The asymptotic variances associated with these estimates are derived by using the formulae of conditional variances. They are applied to the results of a case-control study of stomach cancer.

[Blood haemoglobin concentration in elderly people seeking doctors clinics: opposite changes in men and women].

Anaemia of uncertain origin is common in elderly people and is reported to be more common in men than women. We have investigated retrospectively a database of haematological and biochemical data on 16.332 people referred to an outpatient laboratory and compared the blood haemoglobin (Hb) concentration of the sexes. In men the mean adult Hb values of 151 g/1 started to decline at the age of 60 to reach the level of 138 g/1 by the age of 80 and older. In women, by contrast, the mean adult Hb concentration of 134 g/1 started to increase at the age of 50 to 137 g/1 then declining after the age of 70. A multiple regression analysis of variables likely to influence measured Hb values indicated that 6,7 g/1 of the observed 13 g/1 decrease in elderly men could not be explained by chance or selection bias and that an increase of Hb values in women was sustained until after 80 years of age. Results would suggest that sex or sex hormone related factors influence haemoglobin concentrations in elderly people.

The Copenhagen case-control study of renal pelvis and ureter cancer: role of analgesics.

Analgesic intake was investigated for 96 patients with cancer of the renal pelvis and ureter (including papillomas) and 294 hospital controls. In comparison with persons who never used analgesics, increased relative risks (RR) were seen for users of phenacetin-containing drugs after adjustment for smoking and high-risk occupational exposure (men: RR = 2.4; women: RR = 4.2). A significant relative risk for aspirin use among women was also observed. There was an indication of a dose-effect relationship for both types of analgesics. The influence of phenacetin and aspirin on the development of renal pelvis and ureter tumours could not be separated since in this study the two compounds occurred so frequently in the same formulation. Experimental studies and phenacetin metabolism makes it biologically most relevant to attribute the observed association in the present study to the phenacetin component of the drugs.

Tuberculosis and nonsteroidal anti-inflammatory drugs.

In 1980 and 1982 two case reports documented reactivation of pulmonary tuberculosis in patients who had used nonsteroidal anti-inflammatory drugs (NSAIDs). A case-control study was designed to test the hypothesis that such an association does exist. Data for 38 patients were obtained from the patients' family physicians, and each patient was matched with a control from the same practice for age, sex, race and length of time in that practice. A statistically significant relation was found between the reactivation of tuberculosis and the use of NSAIDs. However, further research is imperative to determine whether the association is direct, indirect or secondary to an unknown factor. Physicians should keep in mind that NSAIDs are potent anti-inflammatory agents and may thus activate, spread and mask infections.

Rubella in Iceland.

Rubella has been a notifiable disease in Iceland since 1888. In this century rubella epidemics of increasing size have occurred at intervals of 5-10 years. The disease has spread throughout the country. About 75% of the patients were below 15 years of age at the time of the last two epidemics. Females account for 51-61 per cent of the reported cases. In this first study of the sero-epidemiology of rubella in Iceland, epidemiological data and blood samples were collected from 1464 women from 13 locations. The group of 1464 women was further divided into 12 age-groups (range 5-49 years), so as to make correlations with the last six epidemics. The immunity status was determined by measuring HI-antibodies in serum. 67.8 percent of the sera were positive (HI-titre greater than 20). 81.1 per cent of women of child-bearing age (16-42 ys.) were seropositive. Two of the age-groups have gone through only one epidemic '63-'64. Children who were then 1-3 ys. old have an immunity ratio of 46.1 per cent, this ratio being 73.3 per cent in the case of children who had attained school age. The immunity ratio is slightly lower among subjects from rural districts than among those from urban districts. Most of the women have caught the disease at the time of the first or second epidemic to occur in their lifetime. 11.6 per cent of persons giving a positive history were seronegative, 52.1 per cent of seropositive subjects gave a positive history. According to population statistics and the serological results it is estimated that appr. 1 out of 7 cases was reported in the epidemic '63-'64.