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Summary: Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the ‘EsPnIC Covid paEdiatric NeonaTal REgistry’ (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March–June 2020 to 74% in January–March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March–June 2020 and January–March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children’s Hospital Foundation: Grant ID 2019–1155 (EJP), Victorian Government Operational Infrastructure Support Program.

Conservation translocations often inherently involve a risk of genetic diversity loss, and thus loss of adaptive potential, but this risk is rarely quantified or monitored through time. The reintroduction of beavers to Scotland, via the Scottish Beaver Trial in Knapdale, is an example of a translocation that took place in the absence of genetic data for the founder individuals and resulted in a small and suspected to be genetically depauperate population. In this study we use a high-density SNP panel to assess the genetic impact of that initial translocation and the effect of subsequent reinforcement translocations using animals from a different genetic source to the original founders. We demonstrate that the initial translocation did, indeed, lead to low genetic diversity ( H o  = 0.052) and high mean kinship (KING-robust = 0.159) in the Knapdale population compared to other beaver populations. We also show that the reinforcement translocations have succeeded in increasing genetic diversity ( H o  = 0.196) and reducing kinship (KING robust = 0.028) in Knapdale. As yet, there is no evidence of admixture between the two genetic lineages that are now present in Knapdale and such admixture is necessary to realise the full genetic benefits of the reinforcement and for genetic reinforcement and then rescue to occur; future genetic monitoring will be required to assess whether this has happened. We note that, should admixture occur, the Knapdale population will harbour combinations of genetic diversity not currently seen elsewhere in Eurasian beavers, posing important considerations for the future management of this population. We consider our results in the wider context of beaver conservation throughout Scotland and the rest of Britain, and advocate for more proactive genetic sampling of all founders to allow the full integration of genetic data into translocation planning in general., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Evolutionary Applications published by John Wiley & Sons Ltd.)

Rationale: Inflation is essential for aeration at birth, but current inflating pressure settings are without an evidence base. Objectives: To determine the role of inflating pressure (ΔP), and its relationship with positive end-expiratory pressure (PEEP), in initiating early lung injury pathways in the preterm lamb lung. Methods: Preterm (124 to 127 d) steroid-exposed lambs ( n  = 45) were randomly allocated (8-10 per group) to 15 minutes of respiratory support with placental circulation and 20 or 30 cm H 2 O ΔP, with an initial high PEEP (maximum, 20 cm H 2 O) recruitment maneuver known to facilitate aeration (dynamic PEEP), and compared with dynamic PEEP with no ΔP or 30 cm H 2 O ΔP and low (4 cm H 2 O) PEEP. Lung mechanics and aeration were measured throughout. After an additional 30 minutes of apneic placental support, lung tissue and bronchoalveolar fluid were analyzed for regional lung injury, including proteomics. Measurements and Main Results: The 30 cm H 2 O ΔP and dynamic PEEP strategies resulted in quicker aeration and better compliance but higher tidal volumes (often >8 ml/kg, all P  < 0.0001; mixed effects) and injury. ΔP 20 cm H 2 O with dynamic PEEP resulted in the same lung mechanics and aeration, but less energy transmission (tidal mechanical power), as ΔP 30 cm H 2 O with low PEEP. Dynamic PEEP without any tidal inflations resulted in the least lung injury. Use of any tidal inflating pressures altered metabolic, coagulation and complement protein pathways within the lung. Conclusions: Inflating pressure is essential for the preterm lung at birth, but it is also the primary mediator of lung injury. Greater focus is needed on strategies that identify the safest application of pressure in the delivery room.

Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic., Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines., Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth., Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed., Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program., Competing Interests: AM received an honorarium from Medtronic for one lecture in a symposium related to mechanical ventilation., (© 2023 The Authors.)

Positive end-expiratory pressure (PEEP) is critical to the preterm lung at birth, but the optimal PEEP level remains uncertain. The objective of this study was to determine the effect of maximum PEEP levels at birth on the physiological and injury response in preterm lambs. Steroid-exposed preterm lambs (124-127 days gestation; n = 65) were randomly assigned from birth to either 1 ) positive pressure ventilation (PPV) at 8 cmH 2 O PEEP or 3-min dynamic stepwise PEEP strategy (DynPEEP), with either 2 ) 20 cmH 2 O maximum PEEP (10 PEEP second steps) or 3 ) 14 cmH 2 O maximum PEEP (20-s steps), all followed by standardized PPV for 90 min. Lung mechanics, gas exchange, regional ventilation and aeration (electrical impedance tomography), and histological and molecular measures of lung injury were compared between groups. Dynamic compliance was greatest using a maximum 20 cmH 2 O (DynPEEP). There were no differences in gas exchange, end-expiratory volume, and ventilator requirements. Regional ventilation became more uniform with time following all PEEP strategies. For all groups, gene expression of markers of early lung injury was greater in the gravity nondependent lung, and inversely related to the magnitude of PEEP, being lowest in the 20 cmH 2 O DynPEEP group overall. PEEP levels had no impact on lung injury in the dependent lung. Transient high maximum PEEP levels using dynamic PEEP strategies may confer more lung protection at birth.

Objective: To describe the regional distribution patterns of tidal ventilation within the lung during mechanical ventilation that is synchronous or asynchronous with an infant's own breathing effort., Study Design: Intubated infants receiving synchronized mechanical ventilation at The Royal Children's Hospital neonatal intensive care unit were studied. During four 10-minute periods of routine care, regional distribution of tidal volume (V T ; electrical impedance tomography), delivered pressure, and airway flow (Florian Respiratory Monitor) were measured for every inflation. Post hoc, each inflation was then classified as synchronous or asynchronous from video data of the ventilator screen, and the distribution of absolute V T and delivered ventilation characteristics determined., Results: In total, 2749 inflations (2462 synchronous) were analyzed in 19 infants; mean (SD) age 28 (30) days, gestational age 35 (5) weeks. Synchronous inflations were associated with a shorter respiratory cycle (P = .004) and more homogenous V T (center of ventilation) along the right (0%) to left (100%) lung plane; 45.3 (8.6)% vs 48.8 (9.4)% (uniform ventilation 46%). The gravity-dependent center of ventilation was a mean (95% CI) 2.1 (-0.5, 4.6)% toward the dependent lung during synchronous inflations. Tidal ventilation relative to anatomical lung size was more homogenous during synchronized inflations in the dependent lung., Conclusions: Synchronous mechanical ventilator lung inflations generate more gravity-dependent lung ventilation and more uniform right-to-left ventilation than asynchronous inflations., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Objective: Skin-to-skin care (SSC) has proven psychological benefits; however, the physiological effects are less clearly defined. Regional ventilation patterns during SSC have not previously been reported. This study aimed to compare regional ventilation indices and other cardiorespiratory parameters during prone SSC with supine and prone position cot-nursing., Design: Prospective observational study., Setting: Single quaternary neonatal intensive care unit in Australia., Patients: 20 infants spontaneously breathing (n=17) or on non-invasive ventilation (n=3), with mean (SD) gestational age at birth of 33 (5) weeks., Interventions: Thirty-minute episodes of care in each position: supine cot care, prone SSC and prone cot care preceding a 10 min period of continuous electrical impedance tomography measurements of regional ventilation., Main Outcome Measures: In each position, ventral-dorsal and right-left centre of ventilation (CoV), percentage of whole lung ventilation by region and percentage of apparent unventilated lung regions were determined. Heart and respiratory rates, oxygen saturation and axillary temperature were also measured., Results: Heart and respiratory rates, oxygen saturation, temperature and right-left lung ventilation did not differ between the three positions (mixed-effects model). Ventilation generally favoured the dorsal lung, but the mean (95% CI) ventrodorsal CoV was -2.0 (-0.4 to -3.6)% more dorsal during SSC compared with prone. Supine position resulted in 5.0 (1.5 to 5.3)% and 4.5 (3.9 to 5.1)% less apparently unventilated lung regions compared with SSC and prone, respectively., Conclusions: In clinically stable infants, SSC generates a distinct regional ventilation pattern that is independent of prone position and results in greater distribution of ventilation towards the dorsal lung., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The influence of pressure strategies to promote lung aeration at birth on the subsequent physiological response to exogenous surfactant therapy has not been investigated., Objectives: To compare the effect of sustained inflation (SI) and a dynamic positive end-expiratory pressure (PEEP) manoeuvre at birth on the subsequent physiological response to exogenous surfactant therapy in preterm lambs., Methods: Steroid-exposed preterm lambs (124-127 days' gestation; n=71) were randomly assigned from birth to either (1) positive-pressure ventilation (PPV) with no recruitment manoeuvre; (2) SI until stable aeration; or (3) 3 min dynamic stepwise PEEP strategy (maximum 14-20 cmH 2 O; dynamic PEEP (DynPEEP)), followed by PPV for 60 min using a standardised protocol. Surfactant (200 mg/kg poractant alfa) was administered at 10 min. Dynamic compliance, gas exchange and regional ventilation and aeration characteristics (electrical impedance tomography) were measured throughout and compared between groups, and with a historical group (n=38) managed using the same strategies without surfactant., Results: Compliance increased after surfactant only in the DynPEEP group (p<0.0001, repeated measures analysis of variance), being 0.17 (0.10, 0.23) mL/kg/cmH 2 O higher at 60 min than the SI group. An SI resulted in the least uniform aeration, and unlike the no-recruitment and DynPEEP groups, the distribution of aeration and tidal ventilation did not improve with surfactant. All groups had similar improvements in oxygenation post-surfactant compared with the corresponding groups not treated with surfactant., Conclusions: A DynPEEP strategy at birth may improve the response to early surfactant therapy, whereas rapid lung inflation with SI creates non-uniform aeration that appears to inhibit surfactant efficacy., Competing Interests: Competing interests: DGT and RLD have previously received grant funding from Chiesi Farmaceutici unrelated to this study., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To describe the outbreak investigation and control measures for a cluster of measles cases involving 'fly-in fly-out' (FIFO) workers on an off-shore industrial vessel., Methods: Following Australian guidelines, measles cases were interviewed and at-risk contacts on the Australian mainland received measles vaccine, immunoglobulin or health advice. For the industrial vessel: (i) exposed FIFO workers who had already left the vessel received health advice through their employer; (ii) workers remaining on the vessel were offered measles vaccine; and (iii) FIFO workers joining the vessel for 21 days following the prodrome onset of the last case of measles on the vessel were offered measles vaccine. Measles virus isolates were sent for genotype determination., Results: Four measles cases from two Australian jurisdictions were epidemiologically linked to the retrospectively identified index case, a New Zealand FIFO worker. No further cases were detected following the institution of outbreak control measures., Conclusion: FIFO workers congregating on large industrial projects are a discrete risk group with the potential to spread infectious diseases over large distances, both domestically and internationally., Implications: FIFO workers' immunisation history should be reviewed prior to deployment. Catch-up vaccination, where appropriate, would minimise transmission of vaccine-preventable diseases such as measles and help maintain a healthy, productive workforce., (© 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.)

Australian and New Zealand health authorities identified seasonal trivalent inactivated influenza vaccines manufactured by CSL Biotherapies as the probable cause of increased febrile convulsions in children under five within 24 hours of vaccination and recommended against their use in this age group. We quantified the benefit-risk profile of the CSL vaccines using the number needed to vaccinate and suggest they might have caused two to three hospital admissions due to febrile convulsions for every hospital admission due to influenza prevented.

Melioidosis, caused by the gram negative bacterium Burkholderia pseudomallei, is endemic in northern Australia. Using data collated from centres in Western Australia, the Northern Territory and Queensland, this report describes the epidemiology of this disease between 1 November, 2001 and 31 October, 2002. There were 47 cases seen during this period with an average annual incidence of 5.8 cases per 100,000 population. In Indigenous Australians, an incidence of 25.5 cases per 100,000 population was seen. The timing and location of cases was generally correlated with rainfall across northern Australia. A case-cluster in a Queensland community was associated with post-cyclonic flooding. Risk factors included diabetes, alcohol-related problems and renal disease. Pneumonia (51%) was the most common clinical diagnosis. The mortality rate attributable to melioidosis was 21 per cent, although a number of other patients died of underlying disease. Despite improvements in recognition and treatment, melioidosis is still associated with a high morbidity and mortality, particularly in Indigenous Australians.

In April 2000, we investigated an outbreak of gastroenteritis amongst attendees of a local community dinner in a Perth suburb. Of the 98 people interviewed (response rate 98%), 53 reported gastrointestinal symptoms (attack rate 54%). Faecal cultures from 11 cases, 2 food preparers, 1 waitress and leftover mock ice-cream dessert grew Salmonella Typhimurium PT135. Of the 3 food handlers, one was asymptomatic, another gave an unclear history of onset of illness and the waitress claimed illness onset 9 days after the dinner. A cohort study implicated fruit salad (RR 1.64 [95% CI: 1.05-2.58], p=0.017) and/or mock ice-cream dessert (RR 1.78 [95% CI: 0.91-3.52], p=0.045). Eggs used to make the mock ice-cream dessert were supplied directly from the producer who used inappropriate shell cleaning methods. The method of preparation of the dessert encouraged contamination. Salmonella species were not isolated in poultry faecal samples collected from the implicated egg farm. The cause of this outbreak was almost certainly the ice-cream dessert with contamination most likely resulting either from the eggs used to make the dessert or one or both of the food preparers, coupled with inadequate cooking of the dessert. Eggs used in preparing food for mass consumption should be sourced from distributors with approved cleaning procedures. Furthermore, pasteurised egg products or egg pulp should be used in the preparation of uncooked or minimally cooked dishes.

Mean values and reference ranges are presented for serum creatinine and serum urea in Melanesian men and women aged over 50 years from coastal Papua. The values are presented separately for three age groups, 51-60, 61-70 and 71-85 years, but there was no significant difference between them. The values for women were lower than for men in all age groups.

Objective: To evaluate anthropometric, haemodynamic and biochemical risk markers for coronary heart disease (CHD) in the Polynesian population of Western Samoa in a case-control study of 43 cases of CHD compared with 90 age- (mean 53 years) and sex-matched controls., Methods: Cases were identified on the basis of a 12-lead electrocardiogram and clinical history., Results: More than 60% of the participants had a body mass index > or =30 kg/m2 and nearly 80% had central obesity. Both diabetes mellitus (17%) and impaired glucose tolerance (9%) were also common in this population. Nineteen per cent of the population were hypertensive and both antihypertensive therapy (21 versus 1%, P<0.001, risk 23.6) and hypertension (35 versus 11%, P<0.01, risk 4.3) were significantly more common among cases than they were among controls. In addition, the plasma high-density lipoprotein cholesterol level was lower (1.00+/-0.09 versus 1.24+/-0.05 mmol/l, P<0.05) and the plasma urate level was higher (0.42+/-0.02 versus 0.37+/-0.01 mmol/l, P<0.05) in the female cases than they were in their respective controls. Low-density lipoprotein (LDL) particle sizing did not reveal an excess of small LDL particles to be a feature of CHD cases, but more than 70% both of cases and of controls had multiple LDL species. The response of the triglyceride level to a fat-rich meal was the same for CHD cases and controls., Conclusion: The population studied had a high prevalence of several risk factors for CHD, including obesity and non-insulin-dependent diabetes mellitus; however, the most prominent factor relating to CHD within the community was the presence of hypertension.

Leptin's association with fasting insulin raises the possibility that hyperleptinaemia is an additional component of the Metabolic Syndrome, or perhaps underlies the syndrome. This population-based study of Western Samoans examined the relationship of serum leptin with insulin sensitivity assessed by Homeostatic Model Assessment (HOMA) and components of the Metabolic Syndrome. Two hundred and forty subjects (114 men, 126 women), aged 28-74 years, were drawn from a study conducted in 1991. An oral glucose tolerance test indicated that 59 subjects had diabetes. Diabetic men had higher leptin levels than non-diabetic (6.0 vs 3.2 ng ml-1) but this difference was no longer significant after adjustment for BMI. Leptin levels in diabetic women (24.7 ng ml-1) non-diabetic women (22.6 ng ml-1) were not different. Leptin was strongly, positively correlated with BMI, fasting insulin and mean blood pressure after adjusting for age and sex (r > 0.43, p < 0.001), irrespective of glucose tolerance status. Linear regression models indicated that leptin was associated with insulin sensitivity independent of age, BMI, waist/hip ratio, triglycerides, HDL-cholesterol, and hypertension. Similar models were computed with mean blood pressure or triglycerides as the dependent variable, and including insulin sensitivity with the independent variables. Leptin was independently associated with mean blood pressure in men, but was not independently associated with triglycerides. Mean levels of 2-h insulin, triglycerides, LDL-cholesterol, and systolic blood pressure varied across tertiles of leptin in men after adjusting for age, BMI, and insulin sensitivity, and mean levels in the top tertile tended to be higher than in the lowest tertile. These results indicate an independent relationship between leptin and insulin sensitivity, but the equivocal results concerning associations of leptin with components of the Metabolic Syndrome make it unlikely that leptin affects these directly.

We recently identified a mutation in the human beta 3-adrenergic receptor (beta 3AR) gene (codon 64 TGGTrp -> CGGArg; TRP64ARG) that associates with features of the insulin resistance syndrome and an earlier onset of noninsulin-dependent diabetes mellitus (NIDDM). We scanned the beta 3AR gene for mutations by single stranded conformational polymorphism analysis in 20 Nauruans with obesity and NIDDM. No mutations were identified. Sixty-five Nauruan subjects were genotyped for the TRP64ARG beta 3AR. All subjects were homozygous for the normal allele. We genotyped Samoans and Asians for the TRP64ARG beta 3AR. Seven of 52 Samoans were heterozygous for the mutant arginine allele (allele frequency, 0.07). Of these, 5 were diabetic and 2 were nondiabetic (by Fisher's exact test, P = 0.4). There were trends toward increased body mass indices, waist to hip ratios, and 2-h insulin levels during oral glucose tolerance tests in Samoans with the mutation; however, the limited number of subjects available for study precluded rigorous statistical analysis. The TRP64ARG beta 3AR was also detected in Chinese, Chinese Americans, and subjects from the Indian subcontinent. In conclusion, the TRP64ARG beta 3AR mutation or any other mutation in the beta 3AR gene is not a major contributor to genetic susceptibility to NIDDM and obesity likely in Nauruans.

Objective: To determine the extent to which reducing the saturated fatty acid composition of a ubiquitously used cooking oil influenced changes in cholesterol concentration in the population during a five year intervention programme in Mauritius., Design: Cross sectional surveys in 1987 and 1992 determined mean total cholesterol concentrations in the population. A random sample of respondents in the 1992 survey completed a nutrition questionnaire that included questions on diet in the previous 24 hours., Setting: Mauritius., Intervention: In 1987 the government of Mauritius changed the composition of the commonly used cooking oil from being mostly palm oil (high in saturated fatty acids) to being wholly soya bean oil (high in unsaturated fatty acids)., Subjects: 5080 and 5162 subjects in 1987 and 1992 cross sectional surveys. 2059 subjects aged 30-64 years were randomly selected from the respondents of the 1992 survey to take part in the nutrition survey., Main Outcome Measures: Fatty acid composition of phospholipids in pooled serum samples from men and women from the two surveys; measured and predicted change in serum cholesterol concentration., Results: From 1987 to 1992 total cholesterol concentrations fell significantly by 0.79 mmol/l (P < 0.001) in men and 0.82 mmol/l (P < 0.001) in women. The estimated intake of saturated fatty acids decreased by 3.5% of energy intake in men and by 3.6% in women, and the intake of polyunsaturated fatty acids increased by 5.5% and 5.6% of energy intake, respectively. These changes were reflected in changes in the fatty acid composition of serum phospholipids, and according to Keys' formula these changes explained much of the decrease in serum cholesterol concentrations (predicted decrease of 0.38 mmol/l in men and by 0.40 mmol/l in women)., Conclusion: Dietary changes that entailed a reduction in the saturated fat content of a ubiquitous cooking oil explained most of the observed decrease in serum cholesterol concentration over five years in the population of Mauritius.

Objective: To measure serum leptin concentrations in the Polynesian population of Western Samoa and to examine epidemiological associations of leptin with anthropometric, demographic, behavioural, and metabolic factors in this population with a high prevalence of obesity and non-insulin dependent diabetes mellitus., Design: Cross sectional study, leptin concentration being measured in a subgroup of a population based sample., Subjects: 240 Polynesian men and women aged 28-74 years were selected to cover the full range of age, body mass index, and glucose tolerance., Main Outcome Measurements: Serum leptin, insulin, and glucose concentrations; anthropometric measures; physical activity; and area of residence., Results: Leptin concentrations were correlated with body mass index (r = 0.80 in men, 0.79 in women) and waist circumference (r = 0.82 in men, 0.78 in women) but less so with waist to hip ratio. At any body mass index, leptin concentration was higher in women than men (geometric mean adjusted for body mass index 15.3 v 3.6 pg/l, P < 0.001). Leptin concentration also correlated with fasting insulin concentration (r = 0.63 in men, 0.64 in women) and insulin concentration 2 hours after a glucose load (r = 0.58 in men, 0.52 in women). These associations remained significant after controlling for body mass index; effects of physical activity and of rural or urban living on leptin concentration were eliminated after adjusting for obesity, except values remained high in urban men. 78% of variance in leptin was explained by a model including fasting insulin concentration, sex, body mass index, and a body mass index by sex interaction term. Similar results were obtained if waist circumference replaced body mass index., Conclusions: The strong relation of leptin with obesity is consistent with leptin production being proportional of mass to adipose tissue. The relation with insulin independent of body mass index suggests a possible role for leptin in insulin resistance or hyperinsulinaemia.

A cross-sectional population survey was carried out in 15 population groups (ethnicity includes Melanesian, Polynesian, Micronesian, Asian Indian and Chinese) in 9 developing countries: Fiji, Nauru, Kiribati, Cook Island, Niue, Western Samoa, New Caledonia, Mauritius and China (Beijing) in 1978-1987. The total sample included 4594 men and 4988 women aged 35-59 years. The aim of study is to report the prevalence of coronary heart disease (CHD) as indicated by ECG Minnesota coding, and risk factor levels and to describe the individual and ecological relationship between CHD prevalence and CHD risk factors among different ethnic groups in developing countries. Mauritians had the highest prevalence of CHD of these countries. Total serum cholesterol concentration and the prevalence of CHD were higher in Mauritius Chinese than in Beijing Chinese. Mean total cholesterol was lower than or equal to 5.2 mmol/l (200 mg/dl) in all population groups, except in Mauritians. Hypertensive subjects in most populations had a low cholesterol concentration. The prevalence of hypertension varied from 7 to 35% and mean body mass index (BMI) from 22.9 to 37.0 kg/m2. Smoking was more common in men (36-82%) than women (0.8-65%). Multiple logistic regression analysis using individuals as a unit of analysis showed that cholesterol and systolic blood pressure were significant independent predictors of CHD prevalence. When fasting or 2 hr post-load blood glucose was included in the model total cholesterol was no longer significant in men but remained significant in women. Ecological analysis using populations as units of analysis showed that the combination of several CHD risk factors could explain about 90% of the interpopulations variance of the CHD prevalence in women. The best models were those where 2 hr post-load glucose was included. Our study has demonstrated that the total cholesterol concentration of the population was consistent with the prevalence of CHD in the population. A considerable proportion of the variation in CHD prevalence across populations in developing countries can be explained by well-known risk factors. These data support the concept that retaining traditional balanced dietary habits and limiting salt intake together with avoiding smoking use are important activities for the prevention of cardiovascular disease (CVD) in developing countries.

The prevalence of coronary heart disease (CHD) was determined in a population survey in Mauritius where the prevalence of non-insulin dependent diabetes and mortality from CHD are amongst the highest in the world. Men and women aged 35-74 years of all major ethnic groups were included: Asian Indians (Hindus and Muslims), Creoles and Chinese. ECG abnormalities suggesting either 'probable CHD' or 'possible CHD' were defined using standard criteria. The overall prevalence of probable CHD was 2.7% in men and 0.9% in women, and that of probable or possible CHD together 17.8% in men and 33.3% in women. The prevalence of CHD did not vary significantly between the four ethnic groups. In the multivariate analyses, age and high blood pressure were the most important independent predictors of ECG abnormalities. Neither diabetes nor serum insulin seemed to contribute independently to the prevalence of CHD. This survey confirmed the high ranking of Mauritius in international mortality statistics. The high rates of CHD seen in Asian Indians, African-origin Creoles and Chinese in the rapidly developing country of Mauritius may be a pointer to future problems in their regions of origin.

Objective: To compare the prevalence of electrocardiographic abnormalities and to evaluate the association between these abnormalities and the levels of coronary heart disease among Chinese living in different environments., Design: Cross sectional surveys., Setting: Beijing, China, and the island of Mauritius., Subjects: Random samples of people aged 35-64 years in Beijing (621 men, 642 women) in 1984 and in Mauritius among Chinese (137 men, 130 women) and non-Chinese (1265 men, 1432 women) in 1987., Main Outcome Measures: Prevalence of electrocardiographic abnormalities suggesting coronary heart disease and of associated risk factors., Results: Prevalence of electrocardiographic abnormalities suggesting coronary heart disease was significantly lower in Beijing (4.0%) than in Mauritian Chinese (24.3%) and Mauritian non-Chinese (24.5%). Mean serum concentrations of total and non-high density lipoprotein cholesterol were lower in Beijing Chinese than in Mauritian Chinese, but smoking and hypertension were slightly more prevalent. Overall, men with electrocardiographic abnormalities had higher risk factor levels than those with a normal electrocardiogram regardless of ethnic origin., Conclusions: The prevalence of coronary heart disease and associated risk factors was different among Chinese living in two different environments: in Beijing in the People's Republic of China and in Mauritius. Chinese, who traditionally have a very low frequency of coronary heart disease, are by no means protected against coronary heart disease and other non-communicable diseases. Therefore, primary prevention of coronary heart disease is a major challenge for preventive medicine in China, as well as in many other developing countries.

To test the hypothesis that alterations in regulatory regions of the insulin gene occur in a subset of patients with non-insulin-dependent diabetes mellitus (NIDDM), the promoter region was studied by polymerase chain reaction (PCR) amplification directly from genomic DNA, followed by high-resolution polyacrylamide gel electrophoresis under nondenaturing conditions. By using this method a previously identified HincII polymorphism (GTTGAC to GTTGAG at position-56) in American Blacks was readily detected, indicating that single base changes could be observed. In the course of screening the insulin promoter from 40 American Black subjects with NIDDM, an apparent larger allele was found in two individuals. Both patients were shown to have in addition to a normal allele, a larger allele containing an 8-bp repeat, TGGTCTAA from positions -322 to -315 of the insulin promoter. To facilitate rapid screening for the 8-bp repeat, a high-resolution agarose gel electrophoretic analysis was adopted. DNA from American Black NIDDM subjects (n = 100) and nondiabetic subjects (n = 100) was PCR amplified and analyzed. The 8-bp repeat was present in five NIDDM subjects, and one nondiabetic subject. DNA from Mauritius Creoles, also of African ancestry, was analyzed, and the 8-bp repeat was present in 3 of 41 NIDDM subjects, and 0 of 41 nondiabetic subjects. Analysis of glucose metabolism in three presumed normal sibs of an NIDDM patient with an 8-bp repeat revealed that one sib had overt diabetes, and two sibs were glucose intolerant, but there was no consistent segregation of the insulin promoter variant with the diabetes phenotype. The variant promoter was not present in 35 Caucasian NIDDM patients or in 40 Pima Indians. To test the biological consequences of the 8-bp repeat sequence in the insulin promoter, a normal and variant promoter were subcloned into a luciferase plasmid, and reporter gene activity assessed by transient transfection into mouse insulinoma (beta TC1) and hamster insulinoma (HIT) cells. The promoter activity of the variant allele was found to be reduced to 37.9 +/- 10.3% of the activity of the normal promoter in HIT cells (P less than 0.01, n = 4), and 49.1 +/- 6.4% in beta TC1 cells (P less than 0.01, n = 6). These data thus suggest that a naturally occurring variant of the insulin promoter may contribute to the diabetes phenotype in 5-6% of Black NIDDM patients.

Prevalence of hypertension was investigated in Mauritius in 2362 men and 2712 women among Hindu and Muslim Indian, Creole and Chinese ethnic groups aged 25-74 years. The age-standardized prevalence of hypertension varied from 9.4% to 17.3% in men and from 9.5% to 16.9% in women among the four ethnic groups and increased with age. The population mean values of systolic/diastolic blood pressure were 126/79 mmHg in men and 124/75 mmHg in women. The proportion of hypertensive persons aware of their condition was 50.5% in men and 66.6% in women. The proportion of treated and adequately controlled hypertensive patients was only 21.7% in men and 29.3% in women. Creoles had the highest mean value of systolic and diastolic blood pressure and the highest prevalence of hypertension whilst Muslim Asian Indians had the lowest values both in men and women. Further studies are needed to define the determinants of hypertension in the multi-ethnic Mauritian population. Diagnosis and treatment of hypertension need to be improved, especially in men and the Creole ethnic group.

Most incidence studies indicate that baseline plasma glucose, either fasting or post-glucose load, is the best predictor of progression to non-insulin-dependent diabetes mellitus (NIDDM)--the higher the level, the higher the risk. Elevated serum insulin concentrations in the presence of normal fasting plasma glucose levels reflect the presence of insulin resistance and they have also been shown to predict deterioration to NIDDM in a number of populations. Hyperinsulinaemia is a notable characteristic of populations with a high prevalence of NIDDM such as Micronesian Nauruans, American Pima Indians, Mexican-Americans and Asian Indians. In Nauruans and Pima subjects with normal glucose tolerance, those with higher post-load (2-hour) serum insulin at baseline were more likely to progress to either impaired glucose tolerance (IGT) or NIDDM. Conversely, amongst subjects with IGT, progression to NIDDM was predicted by lower (but still high relative to normal) baseline insulin responsiveness. Similar results for subjects with IGT have been described in Japanese. It appears from longitudinal studies that baseline insulin and glucose levels explain much of the association of obesity with risk of NIDDM. It remains to be resolved whether obesity itself may be a manifestation of an underlying defect (such as primary hyperinsulinaemia) which leads to both obesity and NIDDM. The possible sequence of events for the development of NIDDM includes a genetic defect resulting in hyperinsulinaemia and/or insulin resistance and leading ultimately to secondary pancreatic exhaustion with an insulin secretory defect which may also be genetically determined or the result of glucotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

House dust mites were sought in indigenous houses of parts of the western and eastern highlands of Papua New Guinea during four field visits over a period of five years. A detailed search was made of various materials from different parts of the houses, including blankets. Findings showed that Dermatophagoides species reach very high concentrations in blankets but are relatively scarce in other places in the houses. A possible role for mite contaminated blankets in the reported increased prevalence of asthma in the Eastern Highlands Province is discussed.