Background: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives. Aim: The aim of this study is to translate and pre-test the 'Care Of the Dying Evaluation' (CODE TM) questionnaire across seven participating countries prior to conducting an evaluation of current quality of care. Design: The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group technique to establish a common, core international version of CODE. Setting/participants: Hospital settings: for each country, at least five patient and public involvement representatives, selected by purposive sampling, fed back on CODE TM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured consensus meeting held to determine content of international CODE (i-CODE) questionnaire. Results: In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages. No specific question item was recommended for exclusion from CODE TM. Revisions to the demographic section were needed to be culturally appropriate. Conclusion: Patient and public involvement and bereaved relatives' perceptions helped enhance the face and content validity of i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying.
Aim of the studyTo assess the changes in the leukocyte profile and C-reactive protein (CRP) concentration in adolescents with excess fat mass after 6-12 months of dietary intervention.Material and methodsThe retrospective study included 99 overweight and obese adolescents, aged from 10.0 to 17.5 years, 82 of whom were re-hospitalized 6 to 12 months after dietary counseling. The control group consisted of 42 normal weight peers. Anthropometric measurements and laboratory tests were performed, homeostasis model assessment – insulin resistance (HOMA-IR) and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio were calculated.ResultsObese and overweight adolescents had higher white blood cells (WBC), neutrophil, monocyte counts and CRP concentration. In the backward stepwise regression analysis, body mass index standard deviation score (BMI SDS) and fasting insulin concentration were independent predictors of WBC and neutrophil counts at the baseline. At the follow-up visit in 45 (54.8%) children, who had lost weight, decreases in WBC, neutrophil and monocyte counts and CRP, fasting insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) concentrations were observed. Changes in WBC and neutrophil counts were dependent on changes in HOMA-IR and TG/HDL ratio. Changes in HOMA-IR had a significant impact on changes in the monocyte count.ConclusionsAdipose tissue promotes systemic inflammation and its intensity depends on the degree of obesity and insulin resistance. This state is reversible. Changes in HOMA-IR were independent predictors of changes in WBC, neutrophil and monocyte counts after reduction of body weight.
Markery komórek śródbłonka w chorobie niedokrwiennej sercaM Ma ag gd da al le en na a L La am mp pk ka a 1 1 , , Z Zo of fi ia a G Gr rą ąb bc cz ze ew ws sk ka a 2 2 , , M Ma ar ri ia a K Kr ra aj je ew ws sk ka a 1 1 , , I Ig ga a H Ho oł ły yń ńs sk ka a--I Iw wa an n 1 1 , , J Ja ac ce ek k K Ku ub bi ic ca a 2 2 , , T To om ma as sz z T Ty yr ra ak ko ow ws sk ki i We examined 57 patients with coronary artery disease (CAD): 27 patients with acute myocardial infarction (AMI) and 30 patients with stable angina pectoris (SA). The control group comprised 23 patients without symptoms of CAD. The concentration of von Willebrand factor (vWF), thrombomodulin (sTM), endothelin-1 (ET-1), and adhesion molecules (soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1)) was analysed in plasma or serum.R Re es su ul lt ts s: : A significant increase in vWF, sICAM-1, sVCAM-1 and ET-1 concentrations was found in AMI compared to the control group. Increased vWF and sICAM-1 concentrations were found in SA compared to the control group. The AMI group was characterized by significantly higher vWF concentration than the SA group. Thrombomodulin concentration did not differ significantly between any patient groups and the control group. There was a positive correlation between vWF concentration and sVCAM-1 and sTM concentrations, and an inverse correlation between ET-1 and sICAM-1 concentrations in AMI. A sICAM-1 correlated positively with sVCAM-1 concentration in SA.C Co on nc cl lu us si io on ns s: : von Willebrand factor is more useful than sTM, endothelin-1, and cell adhesion molecules sICAM-1 and sVCAM-1 to assess endothelium state in patients with CAD. The increase in plasma vWF concentration confirms endothelial injury and/or activation in CAD and indicates a greater severity of these disorders in AMI than in SA.K Ke ey y w wo or rd ds s: : coronary artery disease, endothelial markers S t r e s z c z e n i e W Ws st tę ęp p: : Uszkodzenie, aktywacja lub zaburzenie funkcji śródbłonka naczyniowego odgrywają ważną rolę w progresji zmian miaż-dżycowych i rozwoju chorób układu krążenia.C Ce el l: : Ocena wskaźników biochemicznych określających stan śródbłonka naczyń krwionośnych u osób z chorobą niedokrwienną serca.M Ma at te er ri ia ał ł i i m me et to od dy y: : Badaniami objęto 57 osób z chorobą niedokrwienną serca (coronary artery disease -CAD): 27 pacjentów z ostrym zawałem serca (acute myocardial infarction -AMI) oraz 30 pacjentów ze stabilną chorobą wieńcową (stable angina -SA). Grupę kontrolną stanowiły 23 osoby bez objawów choroby wieńcowej. Stężenia czynnika von Willebranda (von Willebrand factorvWF), trombomoduliny (thrombomodulin -sTM), endoteliny-1 (endothelin-1 -ET-1), cząsteczek adhezyjnych [międzykomórkowej (soluble intercellular adhesion molecule-1 -sICAM-1) i naczyniowej (soluble vascular cell adhesion molecule-1 -sVCAM-1)] oznaczano w osoczu lub surowicy.W Wy yn ni ik ki i: : U pacjentów z AMI obserwowano istotnie zwiększone w stosunku do grupy kontrolnej...
BackgroundObesity is related to changes in adipokine secretion, activity of adipose tissue macrophages, helper T cells, and regulatory T cells. It has been confirmed that vitamin D has potent anti-inflammatory properties. It contributes to reduction in pro-inflammatory mediators and an increase in anti-inflammatory cytokines. There is also evidence that vitamin D could decrease C-reactive protein (CRP) and affect selected haematological indices.Aim of the StudyWe aimed to evaluate the effect of vitamin D on interleukin (IL)-10, IL-17, CRP, blood leukocyte profile, and platelet (PLT) count in overweight and obese children before and after six months of vitamin D supplementation.Material and MethodsThe study group consisted of 67 overweight and obese children aged 9.08-17.5 years. The control group included 31 normal weight peers age- and sex-matched. None of the studied children had received vitamin D supplementation before the study. Data were analyzed at baseline and after vitamin D supplementation.ResultsThe study group had lower baseline 25(OH)D (p<0.001) and higher white blood cell (WBC) (p=0.014), granulocyte (p=0.015), monocyte (p=0.009) and CRP (p=0.002) compared to the control group. In the study group, vitamin D levels were related negatively to nutritional status. Leukocyte profile parameters, PLT, CRP, IL-10 or IL-17 were not related to baseline 25(OH)D. Baseline IL-17 levels correlated with monocytes (R= 0.36, p=0.003) independently on 25(OH)D deficit. In children with vitamin D <15ng/ml, the baseline 25(OH)D was related to CRP (R=-0.42, p=0.017). After six months of vitamin D supplementation, we noticed a decrease in CRP levels (p=0.0003). Serum 25(OH)D correlated with IL-10 in that period (R=0.27, p=0.028). Moreover, we noticed that IL-10 correlated with monocyte (R=-0.28, p=0.023). We did not find any significant associations between 25(OH)D and leukocyte profile parameters, PLT, or IL-17. The multivariable stepwise regression analysis identified IL-10 as the parameter positively associated with 25(OH)D.ConclusionsOur study confirmed beneficial effects of vitamin D supplementation in overweight and obese paediatric populations. Vitamin D intake seems to exert its anti-inflammatory effect mainly via decreasing the CRP level and protecting stabile values of IL-10, rather than its impact on pro-inflammatory factors such as lL-17 and leukocyte profile parameters.
Numerous studies highlighted the link between vitamin D deficiency and cardiovascular, autoimmune, metabolic diseases, and obesity. However, a clear role of vitamin D in these disorders is still unknown. Vitamin D deficiency in children can be a potential risk factor for developing diseases at a later age. Early prevention and vitamin D supplementation should become a public health priority. This review highlights the clinical implications of vitamin D deficiency in adults and children with obesity.
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