525 research outputs found
Bodies in transition: Changes in body shape, body composition, and cardiovascular risk factors in transgender adolescents and adults
No full textHeijer, M. den [Promotor]Twisk, J.W.R. [Promotor]Mutsert, R. de [Copromotor
Nutritional status in chronic dialysis patients : associations with development of disease and survival
No full textThe main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where as obesity is an established risk factor for morbidity and mortality in the general population, many survival studies in hemodialysis patients have indicated reverse associations of obesity with mortality. We showed, however, that the association between BMI and mortality in the hemodialysis population was similar, and not reversed compared with the general population of equal baseline age and duration of follow-up. Independent from BMI, weight loss and muscle mass depletion were both associated with an increased mortality risk in hemodialysis patients. Furthermore, we observed an interaction effect between protein-energy wasting, inflammation and cardiovascular disease, resulting in excess mortality in chronic dialysis patients. Finally, compared with a normal nutritional status, the short-term impact of protein-energy wasting on mortality appeared more important than the long-term effect. The results of this thesis emphasize the importance of maintaining a good nutritional status in chronic dialysis patients. The nutritional status of dialysis patients should be assessed regularly, at least every 6 months. In clinical practice, the 7-point Subjective global assessment can be used for this.UBL - phd migration 201
Oxidative stress in chronic diseases: causal inference from observational studies
No full textHet hoofddoel van dit proefschrift is het ontrafelen van de causale rol van oxidatieve stress, gemeten door antioxidanten spiegels in bloed en mitochondriaal DNA-kopieaantal (mtDNA-CN), bij het ontstaan van chronische ziekten. In dit proefschrift is de nadruk gelegd op het onderzoek naar cardiometabole ziekten en verwante risicofactoren door het toepassen van conventionele epidemiologische technieken in combinatie met Mendeliaanse Randomisatie. De studies beschreven in dit proefschrift hebben antwoord gegeven op twee hoofdvragen na toepassing van innovatieve epidemiologische onderzoeksmethoden op populatieniveau, namelijk: 1) of mitochondriale disfunctie een causale risicofactor is in de ontwikkeling van atherosclerotische cardiovasculaire ziekten en verwante risicofactoren, en 2) of antioxidanten in de voeding klinisch relevante voordelen opleveren bij de preventie van atherosclerotische cardiovasculare ziekten. Daarnaast werpt dit proefschrift licht op de rol van ontsteking, welke een bron kan zijn van verhoogde oxidatieve stress , bij neurologische aandoeningen.LUMC / Geneeskund
Força do aperto da mão e ângulo de fase: acurácia diagnóstica para a avaliação da desnutrição em pacientes submetidos à hemodiálise
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2012Introdução: Na ausência de uma técnica ideal para avaliar o estado nutricional em pacientes renais, tem-se buscado identificar parâmetros capazes de diagnosticar a desnutrição. O objetivo deste estudo foi verificar a acurácia diagnóstica da força do aperto da mão (FAM) e do ângulo de fase (AF) na avaliação da desnutrição de pacientes submetidos à hemodiálise (HD). Métodos: Estudo de avaliação da acurácia diagnóstica de parâmetros nutricionais com pacientes em HD. A acurácia e os pontos de corte para desnutrição da FAM e do AF foram investigados por meio das curvas ROC (receiver operating characteristic - características de operação do receptor), utilizando como padrão de referência: avaliação subjetiva global (ASG), escore de desnutrição-inflamação (malnutrition-inflammation score - MIS) e rastreamento de risco nutricional 2002 (nutritional risk screening 2002 - NRS 2002). A associação da FAM e do AF com outros parâmetros nutricionais, como o índice de massa corporal (IMC), porcentagem de massa de gordura (% MG), massa livre de gordura (MLG), circunferência do braço (CB), circunferência muscular do braço (CMB) e AF ou FAM, foi verificada por correlação e regressão linear múltipla, considerando como significância P Abstract : Background: In the absence of an ideal technique for assessing the nutritional status in renal patients, researchers have tried to identify appropriate parameters for the diagnosis of malnutrition. The objective of this study was to verify the diagnostic accuracy of the handgrip strength (HGS) and phase angle (PA) in the assessment of malnutrition in patients undergoing hemodialysis (HD). Methods: Validation study of diagnostic tests for HD patients. The HGS and PA accuracy and cutoff values for malnutrition were evaluated by the ROC (receiver operating characteristic) curves, using as reference standards the subjective global assessment (SGA), malnutrition-inflammation score (MIS) and nutritional risk screening 2002 (NRS 2002). The association of HGS and PA with other nutritional parameters, such as the body mass index (BMI), the fat mass percentage (% FM), fat-free mass (FFM), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) and PA or HGS, was verified by correlation and multiple linear regression, considering P<0.05 as significant. Results: A total of 138 patients on hemodialysis (85 men/53 women), aged between 24 and 84 years (average 55.4 ± 15.2 years) were evaluated. The area under the curve for the HGS and PA showed moderate accuracy in the case of women (HGS: SGA = 0.818; MIS = 0.834; NRS 2002 = 0.882 and PA: SGA = 0.718; MIS = 0.780; NRS 2002 = 0.778) and low accuracy in the case of men (HGS: SGA = 0.646; MIS = 0.606; NRS 2002 = 0.620 and PA: SGA = 0.570; MIS = 0.662 NRS 2002 = 0.668). The cutoff values in the diagnosis of malnutrition according to the reference standard (MIS) were: < 18 kg and < 28.5 kg for HGS; < 6.1° and < 6.5° for PA, for women and men, respectively. The positive and negative predictive values were also higher for women. There was a positive correlation of the PA with HGS (r = 0.396; P <0.001) and with FFM (women: r = 0.340; P < 0,001; men: r = 0.535; P = < 0,001) for both genders and only in the case of men with, MAC (r = 0.384, P < 0.001) and MAMC (r = 0.386, P < 0.001). For men, the AF was positively correlated with the BMI (r = 0.270, P < 0.019), % FM (r = 0.237, P < 0.041), MAC (r = 0.464, P < 0.001) and MAMC (r = 0.335; P < 0.001). Among women, patients diagnosed as malnourished by the HGS had lower values for PA (ß=-1.00), FFM (ß = -3.15) and MAC (ß = -2.80), while in the case of men, the malnourished patients, had lower values for FFM (ß = -4,53), MAC (ß = -1.71) and MAMC (ß = -1.28). The women diagnosed as malnourished by the PA had lower values for %FM (ß = -5.4) and HGS (ß = -5.4), while for the malnourished men lower values were obtained for MAC (ß = -2.57), MAMC (ß = -2.07) and BMI (ß = -2.44). Conclusions: HGS and PA presented accuracy in the diagnosis of malnutrition in women, and there was association with some of the nutritional parameters for both genders, suggesting that these two nutritional parameters may be useful when used as a complement in the assessment of malnutrition in HD patients
MVA-based H5N1 vaccine affords cross-clade protection in mice against influenza A/H5N1 viruses at low doses and after single immunization.
No full textHuman infections with highly pathogenic avian influenza viruses of the H5N1 subtype, frequently reported since 2003, result in high morbidity and mortality. It is feared that these viruses become pandemic, therefore the development of safe and effective vaccines is desirable. MVA-based H5N1 vaccines already proved to be effective when two immunizations with high doses were used. Dose-sparing strategies would increase the number of people that can be vaccinated when the amount of vaccine preparations that can be produced is limited. Furthermore, protective immunity is induced ideally after a single immunization. Therefore the minimal requirements for induction of protective immunity with a MVA-based H5N1 vaccine were assessed in mice. To this end, mice were vaccinated once or twice with descending doses of a recombinant MVA expressing the HA gene of influenza virus A/Vietnam/1194/04. The protective efficacy was determined after challenge infection with the homologous clade 1 virus and a heterologous virus derived from clade 2.1, A/Indonesia/5/05 by assessing weight loss, virus replication and histopathological changes. It was concluded that MVA-based vaccines allowed significant dose-sparing and afford cross-clade protection, also after a single immunization, which are favorable properties for an H5N1 vaccine candidate
The Aquatic Monitoring Program for the Hunting Creek Area of the Tidal Freshwater Potomac River 2015
No full textThis section reports the results of the third year of an aquatic monitoring program for Alexandria Renew Enterprises conducted by the Potomac Environmental Research and Education Center (PEREC) in the College of Science at George Mason University. Three other sections of the report include an anadromous fish study of Cameron Run, a study of the incidence of PCB’s and endocrine disrupting chemicals in Hunting Creek, and a survey of Escherichia coli levels in the Hunting Creek area of the tidal Potomac River. This work was in response to a request from Karen Pallansch, Chief Executive Officer of Alexandria Renew Enterprises (Alex Renew), operator of the wastewater reclamation and reuse facility (WRRF) which serves about 350,000 people in the City of Alexandria and the County of Fairfax in northern Virginia. The study is patterned on the long-running Gunston Cove Study which PEREC has been conducting in partnership with the County of Fairfax Department of Public Works and Environmental Services since 1984. The goal of these projects is to provide baseline and on-going trend analysis of the ecosystems receiving reclaimed water from wastewater treatment facilities with the objective of adaptive management of these valuable freshwater resources. This will facilitate the formulation of well-grounded management strategies for maintenance and improvement of water quality and biotic resources in the tidal Potomac. A secondary but important educational goal is to provide training for Mason graduate and undergraduate students in water quality and biological monitoring and assessment.Alexandria Renew Enterprise
The Ongoing Aquatic Monitoring Program for the Gunston Cove Area of the Tidal Freshwater Potomac River 2012
No full text
Indicadores nutricionais compostos e sobrevida de pacientes submetidos à hemodiálise
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2013.Introdução: Diversos parâmetros podem indicar a depleção energéticoproteicaem pacientes submetidos à hemodiálise (HD); sendo que taldepleção tem sido associada à sobrevida nestes pacientes. Nossoobjetivo foi identificar quais parâmetros seriam associados ao maiorrisco de óbito em HD. Métodos: Estudo prospectivo com pelo menos 13meses de acompanhamento de 138 pacientes submetidos à HD 3 vezespor semana, 61,6% homens; 29,7% portadores de diabetes mellitus e81,9% de hipertensão arterial sistêmica. Foi verificada a associação dosindicadores nutricionais: albumina, linfócitos, % de massa de gordura(%MG), circunferência muscular do braço (CMB), avaliação subjetivaglobal (ASG), escore de desnutrição-inflamação (malnutritioninflammation score ? MIS) e rastreamento de risco nutricional 2002(nutritional risk screenning 2002 ? NRS 2002) com a sobrevida atravésda Análise de Kaplan-Meier. Como análise ajustada foi realizada aRegressão de Cox e obtido o risco de óbito dos pacientes (razão dedensidade de incidência de óbito - RDI). Resultados: A desnutriçãopelos indicadores nutricionais isolados: linfócitos e %MG não foiassociada com o óbito nos pacientes. Pacientes classificados comodesnutridos pela CMB tiveram risco maior de óbito do que osconsiderados nutridos, porém não foi estatisticamente significativo. Osindicadores: albumina sérica, ASG, MIS e NRS 2002 por sua vez,apresentaram associação com o óbito dos pacientes (RDI=2,77 P=0,042;RDI 1,88 P=0,202; RDI 4,47 P=0,011; RDI 3,13 P=0,022,respectivamente), sendo que pelos dois últimos e pela albumina sérica,observam-se altos valores de risco para desnutridos com significânciaestatística. Conclusão: Os indicadores nutricionais compostos MIS eNRS 2002 apresentaram associação com os maiores valores de risco deóbito, portando em condições semelhantes ao nosso estudo sugere-se apreferência pela utilização destes parâmetros. Abstract : Background: Several parameters may indicate the protein-energy wasting in patients undergoing hemodialysis (HD), and such depletion has been associated with survival in these patients. Our aim was toidentify which parameters would be associated with increased risk ofdeath in HD. Methods: Prospective study with at least 13 monthsfollow-up of 138 patients undergoing HD three times a week, 61.6%men, 28.9% diabetes mellitus and 81.9% of hypertension. Verified theassociation of nutritional indicators: albumin, lymphocytes, % fat mass(% FM), mid-arm muscle circumference (MAMC), subjective globalassessment (SGA), malnutrition-inflammation score (MIS) andnutritional risk screening 2002 (NRS 2002) with survival by Kaplan-Meier analysis. Cox proportional hazard analysis was used to identifythe risk of death of patients (hazard proportional ratio - HR). Results:Nutritional parameters: lymphocytes and % FM was not associated withdeath in patients. Patients classified as malnourished by the CMB had agreater risk of death than those considered nourished, but notstatistically significant. Indicators: serum albumin, SGA, MIS, and NRS2002 were associated with patient death (HR=2.77 P =0.042, HR=1.88P=0.202, HR=4.47 P=0.011, HR=3.13 P=0.022, respectively), and thelast two, there are high values of risk for malnutrition with statisticalsignificance. Conclusion: Nutritional indicators compounds MIS andNRS 2002 were associated with the highest values of mortality risk,bearing in conditions similar to our study suggest a preference for theuse of these parameters
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