Increasing awareness of health related issues

To enhance the health and well-being of members in the Craigavon and Cullyhanna communities. To identify and forge links between both community groups, Trust bodies etc, To offer members of both communities the opportunity to receive information and attend sessions on relevant health related issues. Outcomes - Pharmacists have introduced channels of communication between themselves, community groups and other statutory agencies. - Health benefits through information sessions have been delivered and tailored to meet the needs of local population groups. - The pharmacist has developed group working skills and how to link with others working outside the dispensary environment. - There has also been the opportunity to meet the needs of ethnic minorities in the Craigavon area

2004 National report to the EMCDDA by the Reitox National Focal Point: Norway: New developments, trends and in-depth information on selected issues.

This is the fourth annual report to the EMCDDA from the Norwegian Institute for Alcohol and Drug Research (SIRUS) on the drugs situation in Norway. The report has been drawn up in accordance with the new reporting guidelines introduced by the EMCDDA this year. We have endeavoured to follow these as consistently as possible, with the main focus on “new developments” and substantial changes in epidemiology, legislation and organisation. To allow readers to obtain more background information the report contains a number of references to the national report for 2003, and occasional references to the report for 2002.This resource was contributed by The National Documentation Centre on Drug Use.

2006 National report (2005 data) to the EMCDDA by the Reitox National Focal Point: Norway: New developments, trends and in-depth information on selected issues.

This is a 2006 national report to the EMCDDA, using 2005 data. It is compiled by the Reitox national focal point and covers epidemiology, policing, strategy, drugs markets, drug-related infectious diseases, drug-related death and problem drug use in Norway.This resource was contributed by The National Documentation Centre on Drug Use.

Nutritional Standards for School Lunches and Other School Food

In September 2005 the Government received recommendations fromthe School Meals Review Panel (SMRP) on school lunches and on a number of wider issues concerning food in schools. In response to that report Turning the Tables the newly-established School Food Trust (SFT) was commissioned to advise Ministers on standards for food in school other than lunch.The DfES consulted widely on the recommendations of the SMRP andon a more limited basis on the advice of the SFT. Reports on the responses to each of those consultations are available at: www.dfes.gov.uk/consultations/conresults.cfm?consultationId=1319Having considered responses to those consultations and taken intoaccount the many representations the Department has received on theseissues from a range of stakeholders, the Secretary of State for Education and Skills has arrived at final decisions on the standards. These standards will apply to school lunches and other food provided in all local authority maintained schools in England.

Effects of sarcoptic mange on the behaviour of the red fox and influence on other fox-born zoonoses in Geneva, Switzerland

Résumé : Une épidémie de gale sarcoptique (Sarcoptes scabiei) touche le canton de Genève depuis 1996. Nous avons étudié l'impact de cette maladie sur différents caractères comportementaux du renard roux (Vulpes vulpes) : l'écologie alimentaire, les comportements spatiaux et l'activité, ainsi que les contacts sociaux. Nous avons également évalué si la gale pouvait influencer la composition et la transmission de la communauté helminthique intestinale du renard. En effet, cette espèce est l'hôte de parasites qui sont liés à des zoonoses importantes, en particulier le ténia échinocoque du renard (Echinococcus multilocularis) pour lequel Genève est considérée comme une zone de haute endémie. Durant 5 années, des carcasses de renards ont été récoltées sur l'ensemble du canton. Nous les avons disséquées et avons conservé différents échantillons pour des analyses ultérieures. Des données sur le poids, l'âge et le statut reproductif des femelles ont ainsi pu être obtenues. Les contenus stomacaux ont été analysés pour déterminer le régime alimentaire, les intestins pour collecter des helminthes, des échantillons de sang pour faire des sérologies et des échantillons de peau pour récupérer les sarcoptes. Des renards sauvages ont également été capturés et équipés de colliers émetteurs afin de déterminer leur activité et leur utilisation de l'espace. Finalement, nous avons réalisé des affûts sur des terriers et des observations nocturnes à l'aide d'un détecteur thermique afin d'étudier les contacts sociaux. Nous avons ensuite considéré tous ces aspects pour comparer les renards galeux aux individus sains. Trois catégories de gale ont été prises en compte selon l'importance de l'infection. L'épidémie a traversé le canton en 8 ans environ et elle a provoqué une forte diminution des populations de renard. Les animaux malades étaient caractérisés par un poids réduit, ils utilisaient des domaines vitaux réduits et présentaient un rythme d'activité irrégulier. En ce qui concerne le régime alimentaire, les renards galeux avaient souvent des estomacs vides ou contenant peu d'aliments d'origine animale. Cette réduction de l'alimentation ne semble pas seulement être liée à des capacités de prédation réduite, mais également à un désintérêt face à la nourriture. Tous les changements de comportement cités étaient plus marqués chez les animaux soumis à une forte infestation. Dix taxons d'helminthes ont été identifiés dans les intestins des renards analysés. Deux d'entre eux représentent un risque de santé publique: Echinococcus multilocularis et Toxocara carvis. Pour ces helminthes, nous n'avons pas identifié de différences de prévalence entre les renards galeux et les animaux sains, mais la charge parasitaire était significativement supérieure chez les individus galeux, en particulier ceux souffrant d'une infestation importante. Ceci est probablement lié à une susceptibilité accrue des individus qui présentent une condition physique amoindrie et des défenses immunitaire affaiblies. Selon nos résultats, nous pouvons conclure que la gale induit des changements comportementaux importants et que ces changements ont une influence potentielle sur la transmission de la gale elle-même, mais également sur la transmission du reste de la communauté parasitaire de l'hôte. Les individus qui souffrent d'une infestation importante sont susceptibles de provoquer une contamination de l'environnement accrue en ce qui concerne des helminthes pouvant provoquer des zoonoses. La gale apparaît être un facteur à ne pas négliger dans le cadre de la gestion de la faune sauvage, mais également en ce qui concerne des problématiques de santé publique. Summary An epidemic outbreak of sarcoptic mange (Sarcoptes scabiei) has struck the canton of Geneva since 1996. The impact of the disease on various behavioural traits of the main host, the red fox (Vulpes vulpes), was investigated: feeding ecology, spatial behaviour and activity, and social contacts. We also evaluated if mange might have an influence on the composition and transmission of the intestinal helminth community of foxes. Indeed, this species is host of parasites with potential zoonotic importance, particularly the fox tapeworm (Echinococcus multilocularis) for which Geneva is reported as endemic area. During 5 years, red fox carcasses have been collected throughout the canton. They were then dissected and various samples conserved for further analysis. Data on weight, age, and reproductive status of females were obtained. Stomach content were analysed for diet analysis, intestines to recover helminths, blood to proceed to ELISAs and skin samples to check for the presence of Sarcoptes mites. Further, wild foxes were captured and fitted with transmitters in order to determine their activity pattern and space use. Finally, we proceeded to direct observations at dens and using a thermal imaging sensor at night to gain information about social contacts. A comparison between healthy and mangy foxes was made for all these aspects. Three categories of mangy foxes were considered from moderately to severely infected. The epidemic wave crossed the canton in about 8 years and induced a significant reduction in fox densities. Mangy individuals appeared to have reduced body weights, to use more restricted home ranges and exhibited an irregular activity pattern. Regarding food, sick foxes often had empty stomachs and consumed less food items of animal origin. The reduction in food intake appeared to be linked not only to a reduced ability to hunt, but also to a reduced interest in food. The changes observed were particularly pronounced in individuals with severe infestation. Ten helminth taxa were recovered from the intestines on the analysed fox carcasses. Two of them have an importance with regard to human public health: Echinococcus multilocularis and Toxocara cams. The prevalence of these helminths did not differ between healthy and mangy foxes, however the worm burden was significantly higher in mangy foxes, particularly those with severe mange. This is probably linked to an increased susceptibility in individuals with a reduced body condition and weakened immune defences. From our observations, we can conclude that mange induces pronounced behavioural changes in the red fox, and that those changes influence the transmission risks of mange itself, but also of the rest of the parasite community of the host. Individuals with severe mange are for example likely to increase the environment contamination of free living stages of helminths with zoonotic importance. Mange appears thus to represent a factor not to be neglected for the management of wild species and for public health issues.

The association between drinking motives and alcohol-related consequences - room for biases and measurement issues?

Aims  To investigate whether the predominant finding of generalized positive associations between self-rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by (i) using raw scores of motives that may weight inter-individual response behaviours too strongly, and (ii) predictor-criterion contamination by using consequence items where respondents attribute alcohol use as the cause. Design  Cross-sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD). Setting  School classes. Participants  Students, aged 13-16 (n = 5633). Measurements  Raw, rank and mean-variance standardized scores of the Drinking Motives Questionnaire-Revised (DMQ-R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights and troubles with the police, each itemized with attribution ('because of your alcohol use') and without. Findings  As found previously in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or Z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative and internal reinforcing motives (enhancement, coping) had non-significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non-attributed ones. Conclusion  Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified, whereas use of rank or Z-scores does permit this. Use of attributed consequences overestimates the association with drinking motives.

Getting ready for malaria elimination: a check list of critical issues to consider

In recent years, a renewed interest in malaria elimination and eradication has emerged and seems to be rooting in the minds of the scientific community, public health specialists, funding bodies, policy makers and politicians. Malaria eradication will certainly benefit from improved and innovative tools; notwithstanding novel knowledge in fields ranging from basic science to mathematical modelling and health systems research. However, the elimination of malaria also encompasses a broad range of essential aspects that countries and other actors need to consider when thinking of embarking on such an adventure, including the implementation of innovative strategies, the ability to incorporate the most up-to-date evidence into policy, the integration of malaria into the broader health agenda, the strengthening of surveillance and health systems, capacity building, funding, advocacy and, very importantly, research. While in some cases this enthusiasm is clearly justified, some countries are still a long way from realistically advancing towards elimination. This paper attempts to provide guidance on all the necessary issues that should be considered when initiating a malaria elimination program.

Smart News, Issues 6, Summer 2001

Newsletter for Economic Development

Non-medical prescription drug and illicit street drug use among young Swiss men and associated mental health issues.

Non-medical use of prescription drugs (NMUPD) is increasing among the general population, particularly among teenagers and young adults. Although prescription drugs are considered safer than illicit street drugs, NMUPD can lead to detrimental consequences. The aim of the present study was to investigate the relationship between drug use (NMUPD on the one side, illicit street drugs on the other side) with mental health issues and then compare these associations. A representative sample of 5719 young Swiss men aged around 20 years filled in a questionnaire as part of the ongoing baseline Cohort Study on Substance Use Risk Factors (C-SURF). Drug use (16 illicit street drugs and 5 NMUPDs, including sleeping pills, sedatives, pain killers, antidepressants, stimulants) and mental health issues (depression, SF12) were assessed. Simple and multiple linear regressions were employed. In simple regressions, all illicit and prescription drugs were associated with poorer mental health. In multiple regressions, most of the NMUPDs, except for stimulants, were significantly associated with poorer mental health and with depression. On the contrary, the only associations that remained significant between illicit street drugs and mental health involved cannabis. NMUPD is of growing concern not only because of its increasing occurrence, but also because of its association with depression and mental health problems, which is stronger than the association observed between these problems and illicit street drug use, excepted for cannabis. Therefore, NMUPD must be considered in screening for substance use prevention purposes.

What other sciences look like

In order to have references for discussing mathematical menus in political science, Ireview the most common types of mathematical formulae used in physics andchemistry, as well as some mathematical advances in economics. Several issues appearrelevant: variables should be well defined and measurable; the relationships betweenvariables may be non-linear; the direction of causality should be clearly identified andnot assumed on a priori grounds. On these bases, theoretically-driven equations onpolitical matters can be validated by empirical tests and can predict observablephenomena.

Position statement--altitude training for improving team-sport players' performance: current knowledge and unresolved issues.

Despite the limited research on the effects of altitude (or hypoxic) training interventions on team-sport performance, players from all around the world engaged in these sports are now using altitude training more than ever before. In March 2013, an Altitude Training and Team Sports conference was held in Doha, Qatar, to establish a forum of research and practical insights into this rapidly growing field. A round-table meeting in which the panellists engaged in focused discussions concluded this conference. This has resulted in the present position statement, designed to highlight some key issues raised during the debates and to integrate the ideas into a shared conceptual framework. The present signposting document has been developed for use by support teams (coaches, performance scientists, physicians, strength and conditioning staff) and other professionals who have an interest in the practical application of altitude training for team sports. After more than four decades of research, there is still no consensus on the optimal strategies to elicit the best results from altitude training in a team-sport population. However, there are some recommended strategies discussed in this position statement to adopt for improving the acclimatisation process when training/competing at altitude and for potentially enhancing sea-level performance. It is our hope that this information will be intriguing, balanced and, more importantly, stimulating to the point that it promotes constructive discussion and serves as a guide for future research aimed at advancing the bourgeoning body of knowledge in the area of altitude training for team sports.

One hundred issues of Revista Española de Financiación y Contabilidad (REFC)-insights into trends in the Spanish academic community

From the year of its foundation, until the foundation of Revista deContabilidad in 1997, REFC has been the only referred accounting journalin Spain. Published by the Spanish Association for Accounting and BusinessAdministration (AECA), this journal is at the heart of the emergence ofa distinctly Spanish academic accounting community.Our study is based on:1. An analysis of 100 issues of REFC covering the period from 1985 to 1999.2. A questionnaire to Spanish accounting academics on their perceptionsand experience of the journal.Key points emerging from this study include:a) A move away from interest in accounting concepts and rules, as wellas accounting history, and towards positive accounting theory, the impactof accounting information on capital markets, and financial analysis.b) The emergence of a small number of universities as the driving forcein Spanish accounting research.c) Spanish academics rate REFC highly compared to other Spanish journalsfor publication status, as a support for research, and as a support forteaching. A number of English language journals are rated more highly forboth publication status and as a support for teaching.

Novel anesthetics and other treatment strategies for refractory status epilepticus

Refractory status epilepticus (RSE)-that is, seizures resistant to at least two antiepileptic drugs (AEDs)-is generally managed with barbiturates, propofol, or midazolam, despite a low level of evidence (Rossetti, 2007). When this approach fails, the need for alternative pharmacologic and nonpharmacologic strategies emerges. These have been investigated even less systematically than the aforementioned compounds, and are often used, sometimes in succession, in cases of extreme refractoriness (Robakis & Hirsch, 2006). Several possibilities are reviewed here. In view of the marked heterogeneity of reported information, etiologies, ages, and comedications, it is extremely difficult to evaluate a given method, not to say to compare different strategies among them. Pharmacologic Approaches Isoflurane and desflurane may complete the armamentarium of anesthetics,' and should be employed in a ''close'' environment, in order to prevent intoxication of treating personnel. c-Aminobutyric acid (GABA)A receptor potentiation represents the putative mechanism of action. In an earlier report, isoflurane was used for up to 55 h in nine patients, controlling seizures in all; mortality was, however, 67% (Kofke et al., 1989). More recently, the use of these inhalational anesthetics was described in seven subjects with RSE, for up to 26 days, with an endtidal concentration of 1.2-5%. All patients required vasopressors, and paralytic ileus occurred in three; outcome was fatal in three patients (43%) (Mirsattari et al., 2004). Ketamine, known as an emergency anesthetic because of its favorable hemodynamic profile, is an N-methyl-daspartate (NMDA) antagonist; the interest for its use in RSE derives from animal works showing loss of GABAA efficacy and maintained NMDA sensitivity in prolonged status epilepticus (Mazarati & Wasterlain, 1999). However, to avoid possible neurotoxicity, it appears safer to combine ketamine with GABAergic compounds (Jevtovic-Todorovic et al., 2001; Ubogu et al., 2003), also because of a likely synergistic effect (Martin & Kapur, 2008). There are few reported cases in humans, describing progressive dosages up to 7.5 mg/kg/h for several days (Sheth & Gidal, 1998; Quigg et al., 2002; Pruss & Holtkamp, 2008), with moderate outcomes. Paraldehyde acts through a yet-unidentified mechanism, and appears to be relatively safe in terms of cardiovascular tolerability (Ramsay, 1989; Thulasimani & Ramaswamy, 2002), but because of the risk of crystal formation and its reactivity with plastic, it should be used only as fresh prepared solution in glass devices (Beyenburg et al., 2000). There are virtually no recent reports regarding its use in adults RSE, whereas rectal paraldehyde in children with status epilepticus resistant to benzodiazepines seems less efficacious than intravenous phenytoin (Chin et al., 2008). Etomidate is another anesthetic agent for which the exact mechanism of action is also unknown, which is also relatively favorable regarding cardiovascular side effects, and may be used for rapid sedation. Its use in RSE was reported in eight subjects (Yeoman et al., 1989). After a bolus of 0.3 mg/kg, a drip of up to 7.2 mg/kg/h for up to 12 days was administered, with hypotension occurring in five patients; two patients died. A reversible inhibition of cortisol synthesis represents an important concern, limiting its widespread use and implying a careful hormonal substitution during treatment (Beyenburg et al., 2000). Several nonsedating approaches have been reported. The use of lidocaine in RSE, a class Ib antiarrhythmic agent modulating sodium channels, was reviewed in 1997 (Walker & Slovis, 1997). Initial boluses up to 5 mg/kg and perfusions of up to 6 mg/kg/h have been mentioned; somewhat surprisingly, at times lidocaine seemed to be successful in controlling seizures in patients who were refractory to phenytoin. The aforementioned dosages should not be overshot, in order to keep lidocaine levels under 5 mg/L and avoid seizure induction (Hamano et al., 2006). A recent pediatric retrospective survey on 57 RSE episodes (37 patients) described a response in 36%, and no major adverse events; mortality was not given (Hamano et al., 2006 Verapamil, a calcium-channel blocker, also inhibits P-glycoprotein, a multidrug transporter that may diminish AED availability in the brain (Potschka et al., 2002). Few case reports on its use in humans are available; this medication nevertheless appears relatively safe (under cardiac monitoring) up to dosages of 360 mg/day (Iannetti et al., 2005). Magnesium, a widely used agent for seizures elicited by eclampsia, has also been anecdotally reported in RSE (Fisher et al., 1988; Robakis & Hirsch, 2006), but with scarce results even at serum levels of 14 mm. The rationale may be found in the physiologic blockage of NMDA channels by magnesium ions (Hope & Blumenfeld, 2005). Ketogenic diet has been prescribed for decades, mostly in children, to control refractory seizures. Its use in RSE as ''ultima ratio'' has been occasionally described: three of six children (Francois et al., 2003) and one adult (Bodenant et al., 2008) were responders. This approach displays its effect subacutely over several days to a few weeks. Because ''malignant RSE'' seems at times to be the consequence of immunologic processes (Holtkamp et al., 2005), a course of immunomodulatory treatment is often advocated in this setting, even in the absence of definite autoimmune etiologies (Robakis & Hirsch, 2006); steroids, adrenocorticotropic hormone (ACTH), plasma exchanges, or intravenous immunoglobulins may be used alone or in sequential combination. Nonpharmacologic Approaches These strategies are described somewhat less frequently than pharmacologic approaches. Acute implantation of vagus nerve stimulation (VNS) has been reported in RSE (Winston et al., 2001; Patwardhan et al., 2005; De Herdt et al., 2009). Stimulation was usually initiated in the operation room, and intensity progressively adapted over a few days up to 1.25 mA (with various regimens regarding the other parameters), allowing a subacute seizure control; one transitory episode of bradycardia/asystole has been described (De Herdt et al., 2009). Of course, pending identification of a definite seizure focus, resective surgery may also be considered in selected cases (Lhatoo & Alexopoulos, 2007). Low-frequency (0.5 Hz) transcranial magnetic stimulation (TMS) at 90% of the resting motor threshold has been reported to be successful for about 2 months in a patient with epilepsia partialis continua, but with a weaning effect afterward, implying the need for a repetitive use (Misawa et al., 2005). More recently, TMS was applied in a combination of a short ''priming'' high frequency (up to 100 Hz) and longer runs of low-frequency stimulations (1 Hz) at 90-100% of the motor threshold in seven other patients with simple-partial status, with mixed results (Rotenberg et al., 2009). Paradoxically at first glance, electroconvulsive treatment may be found in cases of extremely resistant RSE. A recent case report illustrates its use in an adult patient with convulsive status, with three sessions (three convulsions each) carried out over 3 days, resulting in a moderate recovery; the mechanism is believed to be related to modification of the synaptic release of neurotransmitters (Cline & Roos, 2007). Therapeutic hypothermia, which is increasingly used in postanoxic patients (Oddo et al., 2008), has been the object of a recent case series in RSE (Corry et al., 2008). Reduction of energy demand, excitatory neurotransmission, and neuroprotective effects may account for the putative mechanism of action. Four adult patients in RSE were cooled to 31_-34_C with an endovascular system for up to 90 h, and then passively rewarmed over 2-50 h. Seizures were controlled in two patients, one of whom died; also one of the other two patients in whom seizures continued subsequently deceased. Possible side effects are related to acid-base and electrolyte disturbances, and coagulation dysfunction including thrombosis, infectious risks, cardiac arrhythmia, and paralytic ileus (Corry et al., 2008; Cereda et al., 2009). Finally, anecdotic evidence suggests that cerebrospinal fluid (CSF)-air exchange may induce some transitory benefit in RSE (Kohrmann et al., 2006); although this approach was already in use in the middle of the twentieth century, the mechanism is unknown. Acknowledgment A wide spectrum of pharmacologic (sedating and nonsedating) and nonpharmacologic (surgical, or involving electrical stimulation) regimens might be applied to attempt RSE control. Their use should be considered only after refractoriness to AED or anesthetics displaying a higher level of evidence. Although it seems unlikely that these uncommon and scarcely studied strategies will influence the RSE outcome in a decisive way, some may be interesting in particular settings. However, because the main prognostic determinant in status epilepticus appears to be related to the underlying etiology rather than to the treatment approach (Rossetti et al., 2005, 2008), the safety issue should always represent a paramount concern for the prescribing physician. Conclusion The author confirms that he has read the Journal's position on issues involved in ethical publication and affirms that this paper is consistent with those guidelines.

Study of the Regulatory Issues Affecting Truck Freight Movement in the Midwest, RB29-013, 2014

This project investigated regulatory issues that may affect or limit freight movement in Iowa and other Midwest states: Illinois, Kansas, Minnesota, Missouri, Nebraska, South Dakota, and Wisconsin. Current state regulations for the following are reviewed and summarized: - Vehicle dimensions - Vehicle weights - Speed limits - Weight compliance enforcement - Fees and taxes - Driver qualifications - Medical certification - Hours of service - Oversize-overweight permits