Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: results from a nationwide study in Spain.

OBJECTIVE: To estimate the prevalence of fibromyalgia (FM) and to compare some descriptive epidemiological and quality of life data between persons with and without FM criteria in a representative sample of the general Spanish population. METHODS: Cross sectional study of 2,192 Spaniards aged 20 or above, selected by cluster sampling. Subjects were invited to a structured interview carried out by trained rheumatologists to ascertain various musculoskeletal disorders. The visit included screening and examination, validated instruments for measuring function (HAQ) and quality of life (SF-12) and questions about socio-demographic characteristics and musculoskeletal, mental, and other general symptoms. FM was suspected in subjects with widespread pain for more than three months. FM was defined by theAmerican College of Rheumatology classification criteria. All estimates are adjusted to sampling scheme. RESULTS: The prevalence of FM in Spain is 2.4% (95% CI: 1.5-3.2). FM is significantly more frequent in women (4.2%) than in men (0.2%), with an OR for women of 22.5 (95%CI: 7.2- 69.9), mainly in the 40-49 years age interval. It is more frequent in rural (4.1%) than in urban settings (1.7%), with an OR for rural settings of 2.5 (95%CI: 1.03-5.9). FM is associated with a low educational level, to a low social class, and to self-reported depression. The scores in the HAQ and in the SF-12 were significantly lower in FM subjects, despite adjustment by covariates. CONCLUSION: FM has a high prevalence in the general population. FM is associated to female gender, comorbidities, age between 40 and 59 years, and a rural setting. Persons fulfilling FM criteria show impaired functioning and quality of life.

Beneficial effects of dietary copper supplementation on serum lipids and antioxidant defenses in rats.

BACKGROUND: A nutrition experiment was utilized to investigate the effects of two levels of dietary copper (Cu) supplementation on lipid profile and antioxidant defenses in serum of rats. METHODS: Male Wistar rats (180-200 g; n = 10) were divided into three groups: control group (A), fed a basal diet with 6 microg Cu/g, and rats fed a basal diet with Cu (CuSO4) supplementation from aqueous solutions, for 4 weeks at the final concentrations of 2 mg Cu/rat (B) and 3 mg Cu/rat (C). RESULTS: No significant changes were observed in final body weight, body weight gain, food consumption, total serum protein and high-density lipoprotein. Cu supplementation reduced the triacylglycerol (TG), total cholesterol and low-density lipoprotein (LDL-C). The LDL-C/TG ratio and total antioxidant substances (TAS) were higher in (B) and (C) groups than in (A) group. There was a positive correlation between Cu supplementation and ceruloplasmin levels. The markers of oxidative stress, lipid hydroperoxide and lipoperoxide were decreased with Cu supplementation. No alterations were observed in superoxide dismutase, indicating saturation of Cu enzyme site. The glutathione peroxidase activities (GSH-Px) were increased in both Cu-supplemented groups. Considering that a copper-selenium interaction can affect mineral availability of both elements, the effects of Cu on TAS and GSH-Px activities were associated with increased selenium disposal. CONCLUSIONS: Dietary Cu supplementation had beneficial effects on lipid profile by improving endogenous antioxidant defenses and decreasing the oxidative stress in vivo.

Antioxidant effect of saponin: potential action of a soybean flavonoid on glucose tolerance and risk factors for atherosclerosis.

At the present time, much attention is being paid to antioxidant substances because many pathological conditions are associated with oxidative stress. The purpose of the present study was to discover the potency of saponin (2-phenyl-benzopyrane), a soybean flavonoid, with respect to its hypoglycaemic and hypolipidaemic action, and the association of these effects with oxidative stress. Male Wistar rats were divided into two groups (n = 6): control group and saponin-treated group (60 mg/kg) during 30 days. Saponin had no effects on glucose tolerance. Although no changes had been observed in low-density lipoprotein-cholesterol, saponin-treated animals had increased low-density lipoprotein-cholesterol/triacylglycerol ratio and decreased triacylglycerol, very low-density lipoprotein-cholesterol and total/high-density lipoprotein-cholesterol ratio than the control group. Saponin-treated rats showed lower lipid hydroperoxide than control rats, indicating decreased potential to atherosclerosis. No alterations were observed in antioxidant enzymes, superoxide dismutase and glutathione peroxidase, while lipid hydroperoxide were decreased in saponin-treated rats. In conclusion, the beneficial effects of saponin on serum lipids were related to a direct saponin antioxidant activity.

Toxicity of dietary restriction of fat enriched diets on cardiac tissue.

The present study examines the effects of caloric restriction in cardiac tissue evaluation markers of oxidative stress. High-fat dietary restrictions can have a long-term impact on cardiac health. Dietary restriction of control diet increased myocardial superoxide dismutase (SOD) and catalase activities. Dietary restriction of fatty acid-enriched diets increased myocardial lipoperoxide concentrations, while SOD activity was decreased in cardiac tissue of rats with dietary restriction of fatty acid-enriched diets. Dietary restriction of unsaturated fatty acid-enriched diet induced the highest lipoperoxide concentration and the lowest myocardial SOD activity. Dietary restriction of unsaturated fatty acid decreased myocardial glycogen, and increased the lactate dehydrogenase/citrate synthase ratio. Dietary restriction of fatty acid-enriched diets were more deleterious to cardiac tissue than normal ad lib.-fed diet. In conclusion, the effects of caloric restriction on myocardial oxidative stress is dependent on which nutrient is restricted. Dietary restriction of fatty acid-enriched diets is deleterious relative to ad lib.-fed chow diet.

The use of the oxidative stress responses as biomarkers in Nile tilapia (Oreochromis niloticus) exposed to in vivo cadmium contamination.

Water contaminants have a high potential risk for the health of populations. Protection from toxic effects of environmental water pollutants primarily involves considering the mechanism of low level toxicity and likely biological effects in organisms who live in these polluted waters. The biomarkers assessment of oxidative stress and metabolic alterations to cadmium exposure were evaluated in Nile tilapia, Oreochromis niloticus. The fish were exposed to 0.35, 0.75, 1.5, and 3.0 mg/l concentrations of Cd2+ (CdCl2) in water for 60 days. Fish that survived cadmium exposure showed a metabolic shift and a compensatory development for maintenance of the body weight gain. We observed a decreased glycogen content and decreased glucose uptake in white muscle. Lactate dehydrogenase (LDH) and creatine phosphokinase (CK) activities were also decreased, indicating that the glycolytic capacity was decreased in this tissue. No alterations were observed in total protein content in white muscle due to cadmium exposure suggesting a metabolic shift of carbohydrate metabolism to maintenance of the muscle protein reserve. There was an increase in glucose uptake, CK increased activity, and a clear increase of LDH activity in red muscle of fish with cadmium exposure. Since no alterations were observed in lipoperoxide concentration, while antioxidant enzymes glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were changed in the liver and the red and white muscle of fish with cadmium exposure, we can conclude that oxygen free radicals are produced as a mediator of cadmium toxicity. Resistance development is related with increased activities of antioxidant enzymes, which were important in the protection against cadmium damage, inhibiting lipoperoxide formation.

Toxicity of ad lib. overfeeding: effects on cardiac tissue.

The aim of the present study was to determine the effects of ad lib. overfeeding and of dietary restriction (DR) on oxidative stress in cardiac tissue. Lipoperoxide concentrations were decreased and antioxidant enzymes were increased in moderate-DR-fed rats. Severe-DR induced increased lipoperoxide concentrations. Overfeeding increased lipoperoxide levels in cardiac tissue. Total superoxide dismutase (SOD) and Cu-Zn superoxide dismutase (Cu-Zn SOD) activities were decreased in cardiac tissue at 35 days of overfeeding. As no changes in glutathione peroxidase (GSH-Px) were observed in overfed rats, while SOD and Cu-Zn SOD activities were decreased in these animals, it is assumed that superoxide anion is an important intermediate in the toxicity of ad lib. overfeeding. Overfeeding induced alterations in markers of oxidative stress in cardiac tissue.

Determinación de la permitividad y conductividad eléctricas a la frecuencia de microondas de varios tejidos de rata tratadas con cadmio / Determination of permittivity and conductivity in several rat tissues treated with cadmium

Los campos electromagnéticos ambientales cada vez más presentes en el entorno, pueden afectar a los propios seres humanos y, según su intensidad (magnetoterapia), activar o modular procesos fisiológicos o inducir a posibles patologías. En este trabajo se pretende determinar las características fisicoquímicas (los parámetros permitividad, (e) y conductividad eléctrica (s)) de varios tejidos de rata, mediante la aplicación de microondas de radiofrecuencia, ante variaciones en la concentración de cadmio (Cd) y comprobar si se pueden utilizar como indicadores del efecto específico de la presencia de cadmio, evaluar su efecto por la contaminación del entorno y cuantificar su acúmulo. Por consiguiente, se pretende aportar nuevos datos sobre los efectos de la toxicidad del cadmio en diversos órganos sistémicos y comprobar si existe sinergismo entre el efecto tóxico del cadmio (contaminante ambiental) y el de los campos electromagnéticos. Se utilizan dos grupos de ratas macho Wistar, uno control y otro tratado con Cd (CdCl2 ), con doce dosis (una por día) por vía intraperitoneal desde 0,1 a 1 mg Cd/Kg rata/día. Se extrae la sangre bajo anestesia con éter por punción cardíaca hasta su muerte, y se diseccionan los órganos. Se analizan diversos parámetros sanguíneos, y se congelan los órganos siguientes: hígado, riñones, pulmones, corteza cerebral, testículos, páncreas y músculo, en los que se determina la permitividad y conductividad. Se determinan los coeicientes de reflexión y transmisión de estas muestras a la frecuencia industrial de 2,45 GHz. Esta frecuencia está comprendida dentro del rango de las frecuencias de microondas. Los coeficientes de reflexión y transmisión se miden mediante un analizador de redes, se usa un estimulador HFSS de HP que determina la permitividad de un tejido que produjera los mismos valores de los coeficientes de reflexión y transmisión medidos experimentalmente. Los resultados muestran que en el caso del riñón e hígado los valores de e (permitividad) y s (conductividad) son menores que en el control, lo que se puede explicar porque ambos órganos son los principales tejidos diana de la toxicidad del cadmio. Este elemento provoca disfunción en los túbulos proximales del riñón, y en el caso del hígado, el cadmio también se acumula en este órgano provocando daño hepático, un descenso de la integridad estructural de los hepatocitos y liberación de las transaminasas en el suero. Del análisis de sangre se observa que el cadmio provoca un estado anémico, de forma que se produce una disminución de los valores de hematocrito y hemoglobina con respecto a los controles (AU)

Los grupos de atención ambulatoria como sistema de clasificación de pacientes para la atención primaria

Los Ambulatory Care Groups (ACG) son un sistema de clasificación de pacientes en el ámbito de la atención ambulatoria, basado en la premisa que indica que midiendo la carga de morbilidad de la población es posible explicar las variaciones en el consumo de recursos sanitarios. Este sistema tiene una buena adaptación a las características de la atención primaria (AP), ya que se basa en la unidad paciente, agrupa a toda la población (tanto la atendida como la no atendida) y utiliza un reducido número de variables para su construcción (edad, sexo y problemas de salud atendidos). El comportamiento que tiene para agrupar pacientes en isorrecursos es satisfactorio: la mayoría de los coeficientes de variación de los ACG son menores que los de la población sin agrupar, evidenciando un aumento de la homogeneidad al agrupar; la variabilidad explicada de las variables dependientes utilizadas por los ACG, mediante modelos de regresión multivariante, es bastante alta. La aplicación de los ACG también evidencia unas potencialidades muy interesantes: en el área de la financiación, en el ajuste de distintas fórmulas de pago capitativo y en el área de la gestión de recursos sanitarios, en la gestión mediante el cálculo de los índices de riesgo y de eficiencia. En conclusión, la buena adaptación a las características de la AP, su comportamiento satisfactorio y el potencial de sus aplicaciones hacen de los ACG el sistema de clasificación de pacientes más idóneo para la AP (AU)

[The development of ambulatory care groups in primary care]. / Desarrollo de los Ambulatory Care Groups en Atención Primaria.

INTRODUCTION: Ambulatory care groups (ACG) are a system of classification for patients in an ambulatory setting and in Primary Care (PC), based on the premise that by measuring the morbidity load of the population, it is possible to explain variations in the consumption of healthcare resources. PATIENTS AND METHODS: In order to study the behaviour of the ACG in our PC, we made a prospective study of a sample of the patients of 13 doctors and nurses working in new PC centres in Barcelona province. Analysis of the behaviour of the ACG was based on four variables of use of resources: number of episodes per patient, number of visits per patient, cost per patient including diagnostic procedures, prescriptions made and the time taken by health workers, and the total cost of PC per patient which also included the cost of PC, emergencies, hospital admissions and consultations with specialists in Outpatient Departments or Health Centres. RESULTS: It was confirmed that the coefficients of variation of the measurements were within acceptable limits, the worst performing ACG were identified and it was seen that the variability explained by dependent variables--apart from the total cost per patient--by the ACG, by multiple regression models, was fairly high. CONCLUSION: The ACG may be a useful classification system for our PC.

Risk assessment of cadmium toxicity on hepatic and renal tissues of rats.

Pollution and industrial practices result in concentrations of metals and other environmental agents that are related to environmental toxicity. A rat bioassay was utilized for the identification of toxic effects of cadmium intake. This demonstrated increased total urinary proteins and increased kidney weights in rats exposed to CdCl2 for 7 days, in drinking water (100 mg/L). Serum creatinine, total and direct bilirubin concentrations and alanine transaminase activity were increased in Cd-exposed rats, indicating renal and hepatic toxicity. It was also observed that lipoperoxide concentrations were increased, while Cu-Zn superoxide dismutase activity was decreased in rats treated with cadmium. This indicated that the renal and hepatic toxicity induced by cadmium involved superoxide radicals.

Toxicity of chronic ethanol ingestion and superoxide radical formation on seminal vesicle of rats.

The toxic effects of chronic ethanol ingestion were evaluated in male adult rats for 300 days. The animals were divided into three groups: the controls received only tap water as liquid diet; the chronic ethanol ingestion group received only ethanol solution (30%) in semivoluntary research; and the withdrawal group received the same treatment as chronic ethanol-treated rats until 240 days, after which they reverted to drinking water. Chronic ethanol ingestion induced increased lipoperoxide levels and acid phosphatase activities in seminal vesicles. Cu-Zn superoxide dismutase (SOD) decreased from its basal level 70.8 +/- 3.5 to 50.4 +/- 1.6 U/mg protein at 60 days of chronic ethanol ingestion. As changes in GSH-PX activity were observed in rats after chronic ethanol ingestion, while SOD activities were decreased in these animals, it is assumed that superoxide anion elicits lipoperoxide formation and induces cell damage before being converted to hydrogen peroxide by SOD. Ethanol withdrawal induced increased SOD activity and reduced seminal vesicle damage, indicating that the toxic effects were reversible, since increased SOD activity was adequate to scavenge superoxide radical formation. Superoxide radical is an important intermediate in the toxicity of chronic ethanol ingestion.

Pulmonary toxicity of cadmium in rats: a histologic and ultrasound study.

Several studies have shown a carcinogenic effect of inhaled or injected cadmium in rats. This carcinogenity has not yet been confirmed in humans. We have performed a study with 48 Wistar male rats, to which we have administered either cadmium sulphide (0.2 mg/Kg/day) or the same doses of placebo for four or eight days. 24 hours after the last administration, the rats were euthanised and an autopsy was performed. The histologic changes in the lung of the cadmium-exposed group were diffuse areas of alveolar collapse due to narrowing of the bronchioles secondary to the alteration of the surrounding connective tissue, with compensating alveolar emphysema near these foci and also at the periphery of the lung. There was also an increased number of intra-alveolar macrophages. We also noticed small foci of dysplasia in the alveolar epithelium. Ultrastructural changes were inspecific but suggested a toxic effect of cadmium on the epithelium. These findings, absent in the control group, confirm that intrathoracic injection of cadmium is associated with an increased tendency to the development of pulmonary emphysema and with dysplastic changes in the alveolar epithelium (peribronchiolar alveolar dysplasia).

Superoxide radical and toxicity of environmental nickel exposure.

Three nickel compounds were tested for pancreatic, hepatic and osteogenic damage in rats by a single i.m. injection Ni++ (7 mg kg-1). The nickel induced biochemical alterations included significantly increased levels of serum alkaline phosphatase in rats with NiS (75%) and NiO (50%). Amylase and aspartate transaminase were also increased, and lipoperoxide was increased in rats with NiO (5.6-fold) and NiS (3.4-fold). No serum changes were observed with NiCl2. Daily injection of Cu-Zn superoxide dismutase (SOD) conjugated with polyethylene glycol prevented the serum level changes, indicating that superoxide radical is an important intermediate in toxicity of nickel insoluble compounds.

Increased oxygen radical and high-dietary-carbohydrate pancreatic damage.

These data suggest that an improved understanding of the relationship between high dietary carbohydrate and the rate of lipid peroxidation may give some insight into possible treatment modalities for pancreatic damages and may shed light on molecular mechanisms underlying certain pathological processes. High dietary carbohydrate lesions are age related and induced alterations on ceruloplasmin, phospholipids, total proteins, copper and zinc serum levels. Significantly increased serum and pancreatic amylase, and lipoperoxide determinations were observed in 20 month old rats. Cu-Zn superoxide dismutase was decreased in these animals. Daily injection of Cu-Zn superoxide dismutase conjugated with polyethylene glycol (SOD-PEG) prevented the serum and pancreatic changes, indicating that superoxide radical is an important intermediate to high dietary carbohydrate lesion.

Protective effect of nickel chloride on superoxide damage: enhancement of CuZn superoxide dismutase affinity to the oxygen free radical.

The effect of nickel from soluble NiCl2 on Cu-Zn superoxide dismutase (SOD) activity, as well as on rate of nitro blue tetrazolium reduction, was studied in vitro since lipid peroxidation has been implicated in cell damage by nickel insoluble compounds, whose toxicity and carcinogenicity are well established. The physical and chemical nature of nickel compounds is one of the key determinations of its toxicity. Soluble nickel freely enter cells, but is just as readily excreted reducing the opportunity for production of lipid damage. Nickel from NiCl2 strongly activated SOD activity. In vitro addition of nickel chloride to a crude lung preparation altered the KM for SOD without changing the Vmax. Nickel chloride produced increased enzyme affinity to the substrate, because decreased (O2-) concentration that yields half-maximal velocity. The combination of nickel and SOD may contribute to stabilization of the particular conformation of SOD responsible for maximal catalytically activity.

High dietary carbohydrate and pancreatic lesion.

The ability of high dietary carbohydrate to induce acute pancreatitis was investigated in groups of 16, 21-day and 15-month old rats fed different carbohydrate diets for 30 days. Significantly increased levels of serum amylase (2-fold), phospholipids (50%), phosphorus (2-fold), and lipoperoxides (8-fold) were observed in 15-month old rats fed a high-carbohydrate diet, compared to rats fed a diet with normal carbohydrate levels, indicating peroxidation of membrane lipids which caused final cell death and pancreatic lesion. Serum Cu-Zn superoxide dismutase activity was not altered. Daily administration of bovine Cu-Zn superoxide dismutase conjugated with polyethylene glycol prevented the serum level alterations and pancreatic lesions, indicating that the superoxide radical has a role in dietary carbohydrate-induced acute pancreatitis. No biochemical changes were observed in rats in which treatment was initiated on the 21st day of life indicating that this is an age-related lesion.

High dietary carbohydrate and pancreatic lesion

The ability of high dietary carbohydrate to induce acute pancreatitis was investigated in groups of 16, 21-day and 15-month old rats fed different carbohydrate diets for 30 days. Significantly increased levels of serum amylase (2-fold), phospholipids (50 per cent ), phosphorus (2-fold), and lipoperoxides (8-fold) were observed in 15-month old rats fed a high-carbohydrate diet, compared to rats fed a diet with normal carbohydrate levels, indicating peroxidation of membrane lipids which caused final cell death and pancreatic lesion. Serum Cu-Zn superoxide dismutase activity was not altered. Daily administration of bovine Cu-Zn superoxide dismutase conjugated with polyethylene glycol prevented the serum level alterations and pancreatic lesions, indicating that the superoxide radical has a role in dietary carbohydrate-induced acute pancreatitis. No biochemical changes were observed in rats in which treatment was initiated on the 21st day of life indicating that this is an age-related lesion

[The validation of the process and the results of an information system in primary care]. / Validación del proceso y resultados de un sistema de información en atención primaria.

BACKGROUND: The needs of information for the primary health care centers planning and management, and the poor situation we started from, have generated a large amount of information systems, which, as a general rule, have not been sufficiently evaluated. Since 1986, in the Area de Gestión, 7, Centro, of the ICS here exists an information system of the general medicine services with a sampling method (ANAC-2). The validation of some aspects of the process and content is shown in order to evaluate the quality of information. METHODS: The problems arisen during the process of collecting data from nine centers are analyzed during six months and its information content is compared with the one of each system with a standard respect their value. To evaluate the concordance, we have used a graphic representation of the differences of each system with a standard respect their mean value, and the "limits of agreement". RESULTS: On relation with the problems of collecting data, two centers show a nonfulfillment of the observation calendar higher than 20% and the logical divergences are not important. The kind of visits distribution is quite correct, even if the estimate of the whole number of visits is higher than 20% in two centers. In the activity indicators, the system of reference has a tendency to give average values lower than the ANAC-2, with the exception of prescription/visit. In referrals and prescriptions, the use of different sources of information between systems produces an average difference of 3.3 interconsults/100 visits and 0.8 prescriptions/visit respectively. Generally, the limits of agreement are wide and become unacceptable in laboratory. CONCLUSIONS: The study carried out is evaluated positively, for it detects the problematical areas which can be modified or require further studies. The importance of validating the information systems is emphasized, in spite of difficulties.

Intratracheal injection of nickel chloride and copper-zinc superoxide dismutase activity in lung of rats.

Superoxide radical (O2-) is a free radical that may be involved in various toxic processes. Cu--Zn superoxide dismutase catalyses the dismutation of the superoxide free radical and protects cells from oxidative damage, and it has been used clinically. The concentration of Ni2+ and Cu--Zn superoxide dismutase activity were measured in lungs of rats at time intervals of 5, 12, 19, 26, 33, and 40 days following an intratracheal injection of 127 nmol of NiCl2. Nickel chloride increased nickel content and resulted in a significant increase of Cu--Zn superoxide dismutase activity in lungs. This elevation of Cu--Zn superoxide dismutase activity was highest on the 12th day (approximately threefold) and is at levels comparable to controls rats on day 40 onwards. Since Cu--Zn superoxide dismutase activity was increased in lung throughout our experimental period without corresponding increases of Cu2+ and Zn2+, we speculate that the elevation of Cu--Zn superoxide dismutase activity might be due to an increased half-life of the enzyme, induced by nickel.

Isolation of 203mercury-induced metallothionein in rat kidney by direct connection of HPLC to a beta radioactivity detector.

Rat kidney 203Hg-induced metallothionein (HgMT) was separated on a high performance liquid chromatograph equipped with a gel permeation column and an on-line beta radioactivity detector, in order to obtain the simultaneous measurements of renal MT by UV detection and MT-associated 203Hg by a beta radioactivity detector. Metallothionein was separated in three major species by both UV detection at 254 nm and 203Hg detection, probably due to the presence of mercury and copper. A standard curve was prepared which demonstrated excellent linear correlation between the integrated HgMT peaks area and the quantity of HgMT injected into the column. In contrast to the results with the gel permeation column above mentioned, rat kidney HgMT was separated in four peaks by reversed-phase height performance liquid chromatography.