Schistosomiasis vaccine development: approaches and prospects

Mounting evidence for acquired immunity to schistosomiasis in humans supports the case for immunological intervention. On the other hand, rapid reinfection poses a threat to younger age groups due to the slow maturation of natural resistance. However, rational approaches, based on advances in immunology and molecular biology, have substantially increased the odds of producing an effective vaccine. Since the parasite cannot replicate in the human host and serious morbidity generally occurs only after a relatively long period of heavy worm burden, complete protection against infection is not essential. The chances of success would increase if more than one of the various host/parasite interphases were targeted, for example reducing morbidity through decreased worm loads as well as through suppression of egg production. Several promising schistosome antigens have now reached an advanced phase of development and are currently undergoing independent confirmatory testing according to a standardized protocol. A few molecules are being contemplated for scaled-up production but, so far, only one has reached the stage of industrial manufacture and safety testing. Since schistosomiasis cannot realistically be controlled by a single approach, vaccination is envisaged to be implemented in conjunction with other means of control, notably chemotherapy.

The carbohydrate-binding specificity and molecular modelling of Canavalia maritima and Dioclea grandiflora lectins

The carbohydrate-binding specificity of lectins from the seeds of Canavalia maritima and Dioclea grandiflora was studied by hapten-inhibition of haemagglutination using various sugars and sugar derivatives as inhibitors, including N-acetylneuraminic acid and N-acetylmuramic acid. Despite some discrepancies, both lectins exhibited a very similar carbohydrate-binding specificity as previously reported for other lectins from Diocleinae (tribe Phaseoleae, sub-tribe Diocleinae). Accordingly, both lectins exhibited almost identical hydropathic profiles and their three-dimensional models built up from the atomic coordinates of ConA looked very similar. However, docking experiments of glucose and mannose in their monosaccharide-binding sites, by comparison with the ConA-mannose complex used as a model, revealed conformational changes in side chains of the amino acid residues involved in the binding of monosaccharides. These results fully agree with crystallographic data showing that binding of specific ligands to ConA requires conformational chances of its monosaccharide-binding site.

Nocardiose oculaire endogène

IntroductionNous avons diagnostiqué et traité un patient atteint de nocardiose oculaire endogène. Grâce à la chirurgie vitréo-rétinienne, le diagnostique définitif a pu être établi avec un résultat oculaire fonctionnel excellent. La nocardiose oculaire endogène étant une maladie rare, l'image clinique oculaire et la prise en charge n'ont pas encore été décrites systématiquement. Nous avons analysé tous les cas rapportés dans la littérature mondiale (38 cas, publiés jusqu'en 2007) pour trouver des indices sur la physiopathologie, la présentation oculaire, sur la meilleure façon d'établir le diagnostique et sur l'efficacité du traitement antibiotique systémique. Enfin, nous avons établit des directives pour la prise en charge oculaire.La nocardiose (défini comme maladie systémique ou locale) est une maladie touchant surtout des patients immunosupprimés ou immunocompromis comme les patients transplantés, avec maladie auto-immune, atteints du virus HIV sans HAART ou des patients ayant subit un trauma, une opération avec inoculation du germe. Aux Etats-Unis environs 500-1000 nouveaux cas sont diagnostiqués par année avec 20% de dissémination dans des autres organes, le plus fréquemment dans le cerveau. Environs 0.6-1% des patients (3-5 cas/année/US) auront un foyer dans l'oeil, c'est-à-dire la nocardiose oculaire endogène. Nocarida est un Actinomycète, classé comme bactérie, avec une morphologie et un comportement proche aux champignons, avec un cycle de reproduction lente, se trouvant dans la poussière (ubiquitaire) et la matière végétale se décomposant. Elle est sensible aux sulfamides avec émergence de résistances. La mortalité est environs de 25%.RésultatsLa moitié des patients présentait comme premier signe de la maladie systémique des problèmes oculaires, le plus souvent une baisse d'acuité visuelle progressive indolore. Un abcès choroïdien unilatéral unique dans la région maculaire associé ou non à un décollement rétinien séreux et/ou à une vitrite variable était la présentation dans 70% des cas. Nocardia dissémine au niveau des choriocapillaires, rarement, dans l'iris résultant dans un hypopyon isolé. Il y a deux modes de propagation locale: vers l'intérieur, par une nécrose de l'épithélium pigmentaire avec l'envahissement de la rétine et du corps vitré; vers l'extérieure, produisant une sclérite résultant dans une perforation du globe. Avant la séquestration au niveau du corps vitré, la réponse au traitement par antibiose voie générale est favorable: 75% des cas analysés. La rupture de la barrière hémato-oculaire externe (épithélium pigmentaire) peut être mis en évidence par la fluorescence angiographique : les images tardives montrent la diffusion de la fluorescéine dans le corps vitré. Si le corps vitré est atteint, au minimum des injections antibiotiques intravitréen (amikacin), mieux une vitréctomie sont indiqué pour diminuer la charge bactérienne et faciliter la pénétration des antibiotiques donnés par voie systémique. Signes d'une extériorisation d'un abcès choroïdien sont des douleurs intenses, l'exophthalmie et l'hypopyon associé.Soixante-deux pourcents des patients ont souffert d'une dissémination continue par retardement du diagnostique/traitement. La moitié des patients ont eu des abcès cérébraux avant, simultanément ou après présentation. Un quart des patients sont décédés suite de la nocardiose, 32% incluant la maladie de base (tumeur maligne hématologique) ou des autres infections opportunistiques (aspergillose). La morbidité oculaire est importante: un tiers des patients survivants ont retenu une acuité visuelle 0.5 ou mieux, un tiers une acuité visuelle égale ou inférieure à 0.1 et un tiers ont perdu l'oeil par énucléation/éviscération(l). La suspicion clinique et la biopsie de la lésion pour un examen microbiologique direct et des cultures sont cruciales pour la prise en charge. Les risques facteurs sont sexe masculin (4 :1), stéroïdes, immunosuppression pour transplantation ou maladie auto-immune et des tumeurs hématologiques malignes, plus rarement des accidents/ traumas graves. La ponction directe de la lésion assure les meilleures chances pour collectionner un spécimen contenant des bactéries: dans des petits abcès sous-rétiniens maculaires par ponction transvitréenne sous-rétinienne par aiguille fine décrit par le Prof. Augsburger (Référence 7) ou dans des lésions avancées par biopsie sous-rétinienne/rétinienne pendant une vitréctomie selon l'extension et la localisation de l'abcès. Le spécimen doit être préparé pour un examen direct (4 lames) et des cultures utilisant des plaques ordinaires sauf exceptions. La suspicion doit être communiquée au laboratoire et les cultures incubées de façon prolongée (4-6 semaines). Un bilan d'extension avec au minimum un CT scan thoracique et une IRM cérébrale sont indiqués.Le traitement de choix est un antibiotique du groupe des sulfamides à haute dose comme par exemple le co- trimoxazole à double dose. Le choix, le nombre et le dosage du/des médicaments doivent être adapté selon résistance, extension de la maladie, médicaments autres et état de santé général du patient (foie, reins). Les figures 6a et 6b illustrent la prise en charge de patients selon diagnostique établit (Fig. 6b) ou non (Fig 6a).

Cross-country polarisation in CO2 emissions per capita in the European Union: changes and explanatory factors

In this study, we analyse the degree of polarisation-a concept fundamentally different from that of inequality-in the international distribution of CO2 emissions per capita in the European Union. It is analytically relevant to examine the degree of instability inherent to a distribution and, in the analysed case, the likelihood that the distribution and its evolution will increase or decrease the chances of reaching an agreement. Two approaches were used to measure polarisation: the endogenous approach, in which countries are grouped according to their similarity in terms of emissions, and the exogenous approach, in which countries are grouped geographically. Our findings indicate a clear decrease in polarisation since the mid-1990s, which can essentially be explained by the fact that the different groups of countries have converged (i.e. antagonism among the CO2 emitters has decreased) as the contribution of energy intensity to between-group differences has decreased. This lower degree of polarisation in CO2 distribution suggests a situation more conducive to the possibility of reaching EU-wide agreements on the mitigation of CO2 emissions.

Pseudomarkets with priorities in large random assignment economies

I study large random assignment economies with a continuum of agents and a finite number of object types. I consider the existence of weak priorities discriminating among agents with respect to their rights concerning the final assignment. The respect for priorities ex ante (ex-ante stability) usually precludes ex-ante envy-freeness. Therefore I define a new concept of fairness, called no unjustified lower chances: priorities with respect to one object type cannot justify different achievable chances regarding another object type. This concept, which applies to the assignment mechanism rather than to the assignment itself, implies ex-ante envy-freeness among agents of the same priority type. I propose a variation of Hylland and Zeckhauser' (1979) pseudomarket that meets ex-ante stability, no unjustified lower chances and ex-ante efficiency among agents of the same priority type. Assuming enough richness in preferences and priorities, the converse is also true: any random assignment with these properties could be achieved through an equilibrium in a pseudomarket with priorities. If priorities are acyclical (the ordering of agents is the same for each object type), this pseudomarket achieves ex-ante efficient random assignments.

Urologie [Trends in urology]

The systemic treatment of kidney cancers is promising regarding the first results of the inhibiting molecules of the angiogenesis. Projections in research are encouraging for more specific and sensitive markers of the prostate cancer. For this last the intermittent hormonotherapy improves the quality of life of the patients. The overweight control in infertility allows greater chances of giving birth. The morbidity of the kidney percutaneous surgery is decreased by the use of smaller tools. Reduction rate of reobstruction thanks to new manufactoring stents. The botulinic toxin for the hyperactive bladder refunded by the health insurances.

Prise en charge de l'hémorragie du post-partum [Management of postpartum haemorrhage].

Today, postpartum hemorrhage remains a leading cause of maternal morbidity and mortality. Medical treatment, various surgical procedures and/or uterine artery embolisation have considerably reduced the risk of hysterectomy. It is important to identify the different risk factors of hemorrhage after delivery and to take the precautions to avoid it. A clear strategy defined by the obstetrical team is essential to decrease the delay in the management of this complication in order to increase the chances of a successful treatment.

Briefing Paper on Health Inequalities for Elected Members of Local Government (ROI)

The social and economic circumstances in which people live strongly influence their chances to be healthy.  Factors such as housing, transport, environment, education and employment are just some of the functions of local government that influence health. IPH, in partnership with CAN and Nexus developed a briefing paper to support elected members of local government to ensure that the decision in which they are involved have a positive impact on health, especially the health of vulnerable groups.  It provides councillors with information to assist in contributing to a better quality of life for constituents with healthier decision making in areas such as safer environments, increased education opportunities, better housing stock and improved public transport availability.

IPH response to 'Towards a Childcare Strategy' (Northern Ireland)

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. Giving every child the best start in life is recognised by governments worldwide as the most effective way to improve life chances and health outcomes.  This is one of IPH’s key strategic action areas in our Business Plan and we endorse the need for early intervention, particularly in tackling health inequalities and improving the health and wellbeing of children in the most disadvantaged communities.  International evidence is increasingly pointing towards investment in the early years as a critical component of any sensible approach to improving population health and tackling health inequalities across the life course (WHO, 2008 and Marmot, 2010).  It is also apparent that Northern Ireland public policy is now reorienting towards achieving better and fairer outcomes in the early years, as demonstrated through the recent draft public health strategy (DHSSPS, 2012a) and the draft early years strategy (Department of Education, 2012).

Altruism across disciplines: one word, multiple meanings

Altruism is a deep and complex phenomenon that is analysed by scholars of various disciplines, including psychology, philosophy, biology, evolutionary anthropology and experimental economics. Much confusion arises in current literature because the term altruism covers variable concepts and processes across disciplines. Here we investigate the sense given to altruism when used in different fields and argumentative contexts. We argue that four distinct but related concepts need to be distinguished: (a) psychological altruism, the genuine motivation to improve others' interests and welfare; (b) reproductive altruism, which involves increasing others' chances of survival and reproduction at the actor's expense; (c) behavioural altruism, which involves bearing some cost in the interest of others; and (d) preference altruism, which is a preference for others' interests. We show how this conceptual clarification permits the identification of overstated claims that stem from an imprecise use of terminology. Distinguishing these four types of altruism will help to solve rhetorical conflicts that currently undermine the interdisciplinary debate about human altruism.

Prevent type 2 diabetes by preventing obesity

In 2011 nearly 73,000 adults in Northern Ireland are registered as having diabetes. Many cases of diabetes are preventable and are the result of obesity. With this in mind, on World Diabetes Day, 14 November 2011, the Public Health Agency is encouraging everyone across Northern Ireland to be aware of how Type 2 diabetes can be prevented, the dangers it can cause to your health and what the signs and symptoms of diabetes are to ensure early diagnosis.The links between type 2 diabetes and obesity are firmly established. Without the intervention of a healthy diet and appropriate exercise, obesity may develop into diabetes over a relatively short period of time. According to the International Diabetes Federation (IDF), worldwide 80 per cent of people with Type 2 diabetes are overweight or obese at the time of diagnosis.If you are overweight, or obese the key step to preventing or delaying the onset of Type 2 diabetes is to lose a small amount of weight by making healthy food choices and being physically active 30 minutes a day, 5 days a week.Diabetes, if left untreated can cause serious long term health complications such as heart disease, kidney damage, eye problems, which can affect vision, and foot problems leading to amputation.Dr Brid Farrell, Consultant in Public Health Medicine, PHA, said: "The increase of diabetes occurring in the population can be explained by rising levels of obesity, people living longer and improved detection and diagnosis of diabetes in primary care."Having a family history of Type 2 diabetes increases your chances of developing diabetes. Take the first step today toward lowering your risk for Type 2 diabetes and improving your health and the health of future generations." The symptoms of diabetes can include increased thirst, passing urine more, frequently (bedwetting in children), extreme tiredness, slow healing infections, blurred vision and significant or unexplained weight loss. Symptoms of diabetes can develop quickly over days or weeks, and sometimes with Type 2 diabetes, a person may have no symptoms. Early diagnosis is important. If you think you have diabetes speak to your GP or pharmacist.Dr Farrell continued: "Diabetes is a lifelong condition, but complications can be prevented or delayed by controlling your blood sugar, and treating high blood pressure and high cholesterol. If you have diabetes, a healthy diet and regular exercise is very important."Health Minister Edwin Poots said:"Diabetes is a serious condition, which affects many thousands of people across Northern Ireland. While not all diabetes is preventable, we all have a responsibility to look after our own health. "By making healthier lifestyle choices such as eating a healthy, well-balanced diet and taking regular exercise, we can reduce our risk of developing potentially life threatening conditions such as type 2 diabetes. I would urge everyone to take every possible step to improve their health and avoid developing preventable illnesses

Simple steps to a healthy heart

The number of deaths from coronary heart disease in Northern Ireland has dropped significantly, according to recent figures. However, the Public Health Agency is urging everyone to take steps to protect their heart and reduce their chances of developing the disease during National Heart Month (February).Despite the number of deaths dropping significantly in recent years, coronary heart disease is still the number one killer across the country. Over 2,200 people died in Northern Ireland from coronary heart disease in 2010 compared to just over 2,300 people in 2009 - an overall reduction of 100 province-wide. The latest figure reveals the positive downward trend is continuing - in 2008, there were 2,410 deaths, 2,493 in 2007 and 2,554 in 2006, while in 1979 there were nearly 5,000 deaths. Throughout National Heart Month in February, the PHA is calling for people to follow a number of steps in a bid to reduce their chances of developing the disease.Smoking is a major risk factor and, the more cigarettes you smoke, the higher the risk, according to Dr Christine McMaster, Consultant in Public Health Medicine, with responsibility for cardiovascular disease in the PHA."The reduction in smoking over the past number of years through public education, stop smoking programmes and smoke free legislation has had a major impact on reducing deaths from heart disease. However, 24% of the population in Northern Ireland still smoke, putting them at risk of developing the disease."People who suffer from high blood pressure also run an increased risk of developing coronary heart disease. High blood pressure is a silent, but treatable condition. In order to minimise the risk, I would urge everyone over the age of 45 to have their blood pressure measured every five years by their GP," said Dr McMaster.Simple lifestyle changes will also reduce the risk of heart disease, including eating at least five servings of fruit and vegetables a day, avoiding saturated fats, limiting alcohol intake and taking at least 30 minutes of exercise a day, five days a week.Dr McMaster described the reduction in deaths from coronary heart disease over the past few years as "a big success story". "It shows that people can take very positive steps to reduce their risk of heart disease by getting their blood pressure checked and adopting a healthier lifestyle; in particular by not smoking," he added. "The message is clear during National Heart Month - you only have one heart and you can take steps to keep it healthy."

Etat de santé des migrants précarisés : l'exemple de l'aide d'urgence dans le Canton de Vaud

En 2008, la PMU et le CHUV ont mis en place une commission chargée d'évaluer, pour le canton de Vaud, les demandes fondées sur des arguments médicaux d'aménagement des conditions d'hébergement de personnes soumises au régime de l'aide d'urgence, introduit à la suite de l'acceptation en votation populaire, le 24 septembre 2006, de la nouvelle loi sur l'asile (LAsi). Nous présentons le contexte historique, politique, institutionnel et médical dans lequel ce groupe de travail intervient, ainsi que ses modalités de fonctionnement, puis abordons les résultats d'une analyse récente de nos données sur les caractéristiques démographiques et l'état de santé des personnes dont les dossiers nous ont été soumis. Cette analyse révèle leur mauvaise santé générale, notamment psychique, avec en particulier une prévalence très élevée d'états de stress post-traumatiques. De façon surprenante, les événements traumatiques surviennent assez fréquemment après l'arrivée en Suisse. Nous évoquons pour conclure une série de préoccupations éthiques en rapport avec cette activité.

Reducing the number of young people not in employment, education or training (NEET)

Evidence Review 3 - Reducing the number of young people not in employment, education or training (NEET) Briefing 3 - Reducing the number of young people not in employment, education or training (NEET) This pair of documents, commissioned by Public Health England, and written by the UCL Institute of Health Equity, examine how to help young people into employment, education or training. They describe the relationship between being NEET and health; inequalities in prevalence of being NEET; and the scale of the problem. The papers show that being NEET, particularly for prolonged periods, is associated with negative effects on health and a range of other outcomes. Furthermore, the chances of becoming NEET are not equally or randomly distributed throughout society – those who are relatively disadvantaged, from poor backgrounds, or who have had negative experiences at school are more likely to spend some time being NEET. The papers also propose actions that can be taken at a local level in order to reduce the proportion of young people who are NEET. There is good evidence on what works in order to enable and support young people to enter employment, education and training. Taking action to reduce NEET levels is both possible and necessary – both to ensure young people have opportunities, and also as an important way to improve public health and reduce inequalities. The full evidence review and a shorter summary briefing are available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

4th annual conference on Clinical Trials in Alzheimer's Disease: Highlights

��In a sign that researchers are grappling with therapy development, the 4th annual conference on Clinical Trials in Alzheimer's Disease was filled beyond its venue's capacity, drawing 522 researchers from around the globe. Held 3-5 November 2011 in San Diego, CTAD is the brainchild of Paul Aisen, Jacques Touchon, Bruno Vellas, and Michael Weiner. The conference posted no ringing trial successes. Instead, scientists worked on methodological aspects they hope will improve future trials' chances. They discussed Bayesian models, simulated placebos, and biomarker data standards. They presented alternative outcome measures to the ADAS-cog, ranging widely from composite scales that are sensitive early on to continuous measures that encompass a patients' day-to-day variability. They focused on EEG, and on a collective effort to develop patient-reported outcomes. Highlights include:Whence and Where To: History and Future of AD Therapy Trials��Webinar: Evolution of AD Trials��Nutrient Formulation Appears to Grease Memory Function��Door Slams on RAGE��Clinical Trials: Making "Protocols From Hell" Less Burdensome��EEG: Coming in From the Margins of Alzheimer's Research?��EEG: Old Method to Lend New Help in AD Drug Development?������