Antimalarial Drug Resistance: Surveillance and Molecular Methods for National Malaria Control Programmes

National malaria control programmes have the responsibility to develop a policy for malaria disease management based on a set of defined criteria as efficacy, side effects, costs and compliance. These will fluctuate over time and national guidelines will require periodic re-assessment and revision. Changing a drug policy is a major undertaking that can take several years before being fully operational. The standard methods on which a decision can be taken are the in vivo and the in vitro tests. The latter allow a quantitative measurement of the drug response and the assessment of several drugs at once. However, in terms of drug policy change its results might be difficult to interpret although they may be used as an early warning system for 2nd or 3rd line drugs. The new WHO 14-days in vivo test addresses mainly the problem of treatment failure and of haematological parameters changes in sick children. It gives valuable information on whether a drug still `works'. None of these methods are well suited for large-scale studies. Molecular methods based on detection of mutations in parasite molecules targeted by antimalarial drugs could be attractive tools for surveillance. However, their relationship with in vivo test results needs to be established

Physical activity in 22 African countries: results from the World Health Organization STEPwise approach to chronic disease risk factor surveillance.

BACKGROUND: Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking. PURPOSE: To describe and compare levels and patterns of physical activity among adults across 22 African countries. METHODS: Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003-2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week. RESULTS: Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries. CONCLUSIONS: Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

Epidemiology and Anthropology: an integrated approach dealing with bio-socio-cultural aspects as strategy for the control of endemic diseases

The control of endemic diseases has not attained the desired level of effectiveness in spite of the use of modern efficient thecnologies. The classic interventionist approach for the control of schistosomiasis is centered on systemic control of the snail hosts combined to large scale medical treatment and is usually carried out without social preocupation due to the assisted communities. It is easy to understand the interest and the ethical compromise of public health research while producing studies in which the biological and social determinants as well as the cultural components should be considered and also encompass the historical dimensions and symbolic representations. In face of the recent political decision in favor of decentralizations of health administration to municipal level, we suggest, in the present paper, an integrated approach for the epidemiological diagnosis of an endemic situation at local level. Theoretical and methodological aspects from both, epidemiology and anthropology are discussed. Epidemiological methods can be used to detect the dependent variables (those related to the human infection) and the independent variables (demographic, economic, sanitary and social). Another methodological approach of anthropological /etnographic nature can be conducted in order to make an articulation of the knowledge on the various dimensions or determinant levels of the disease. Mutual comprehension, between researchers and the people under investigation, on the dynamic transmission process would be relevant for a joint construction, at local level, of programmed actions for the control of endemic diseases. This would extend reflections on the health/disease process as a whole.

Appropriateness of colonoscopy in Europe (EPAGE II). Surveillance after polypectomy and after resection of colorectal cancer.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [< 1 cm], tubular, no high-grade dysplasia) vs. high-risk adenomas (large [> or = 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection. CONCLUSIONS: Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.

European Home and Leisure Accident Surveillance System report for Ireland 2001

EHLASS provides a harmonised approach throughout the EU to facilitate the analyses of intercountry differences in modes and distributions of home and leisure accidents. EHLASS contributes to the formulation of EU policies and initiatives on accidents and product safety. EHLASS is the only source of detailed information on home and leisure accidents in Ireland. Some general information is available through the Hospital In-Patient Enquiry (HIPE) system but this concentrates on medical diagnoses rather than on specific causes of accidents.This report is the eleventh national EHLASS report for Ireland. Download document here

European Home and Leisure Accident Surveillance System Report for Ireland 1998

The EHLASS survey was set up in April 1986 as a five-year demonstration project. The objective was to monitor home and leisure accidents in a harmonised manner, throughout the EU, to determine their causes, the circumstances of their occurrence, their consequences and, most importantly, to provide information on consumer products involved. Armed with accurate information, it was felt that consumer policy could be directed at the most serious problems andthe best use could be made of available resources.   Data collection systems were set up for the collection of EHLASS data in the casualty departments of selected hospitals in each of the member states. The information was subsequently gathered together by the European Commission in Brussels. Extensive analysis was undertaken on 778,838 accidents reported throughout the EU. Centralised analysis of EHLASS data proved problematic due to lack of  co-ordination in data quality. In 1989 it was decided that each member state should  produce its own annual EHLASS report in a harmonised format specified by the European Commission. This report is the ninth such report for Ireland. Download the Report here

European Home and Leisure Accident Surveillance System report for Ireland 1999

The EHLASS survey was set up in April 1986 as a five-year demonstration project.  The objective was to monitor home and leisure accidents in a harmonised manner, throughout the EU, to determine their causes, the circumstances of their occurrence, their consequences and, most importantly, to provide information on consumer products involved. Armed with accurate information, it was felt that consumer policy could be directed at the most serious problems and the best use could be made of available resources Download the Report here

European Home and Leisure Accident Surveillance System report for Ireland 2000

The EHLASS survey was set up in April 1986 as a five-year demonstration project. The objective was to monitor home and leisure accidents in a harmonised manner, throughout the EU, to determine their causes, the circumstances of their occurrence, their consequences and, most importantly, to provide information on consumer products involved. Armed with accurate information, it was felt that consumer policy could be directed at the most serious problems andthe best use could be made of available resources Download the Report here

European Home and Leisure Accident Surveillance System report for Ireland 2002

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A Review of the Bio-medical Evidence on Breast, Ovarian and Cervical Cancer

This review aims to provide good quality, up-to-date biomedical evidence of the therapies available to women in Ireland to treat breast, cervical and ovarian cancer. This review summarises evidence from guidelines and high quality studies. It should be noted however that scientific evidence is not infallible, and knowledge in this field is constantly evolving. The evidence summarised in this review presents the current consensus. Download document here   Download summary of report

Infertility Treatments for Women: A Review of the Bio-medical Evidence

Infertility Treatments for Women: A Review of the Bio-medical Evidence Click here to download PDF 1.5mb Summary of Report PDF 971kb