The gap between scientific evidence and clinical practice : 5-aminosalicylates are frequently used for the treatment of Crohn's disease

BACKGROUND: There is uncertain evidence of effectiveness of 5-aminosalicylates (5-ASA) to induce and maintain response and remission of active Crohn's disease (CD), and weak evidence to support their use in post-operative CD. AIM: To assess the frequency and determinants of 5-ASA use in CD patients and to evaluate the physicians' perception of clinical response and side effects to 5-ASA. METHODS: Data from the Swiss Inflammatory Bowel Disease Cohort, which collects data since 2006 on a large sample of IBD patients, were analysed. Information from questionnaires regarding utilisation of treatments and perception of response to 5-ASA were evaluated. Logistic regression modelling was performed to identify factors associated with 5-ASA use. RESULTS: Of 1420 CD patients, 835 (59%) were ever treated with 5-ASA from diagnosis to latest follow-up. Disease duration >10 years and colonic location were both significantly associated with 5-ASA use. 5-ASA treatment was judged to be successful in 46% (378/825) of treatment episodes (physician global assessment). Side effects prompting stop of therapy were found in 12% (98/825) episodes in which 5-ASA had been stopped. CONCLUSIONS: 5-Aminosalicylates were frequently prescribed in patients with Crohn's disease in the Swiss IBD cohort. This observation stands in contrast to the scientific evidence demonstrating a very limited role of 5-ASA compounds in the treatment of Crohn's disease.

Regulation of membrane trafficking and organ separation by the NEVERSHED ARF-GAP protein.

Cell separation, or abscission, is a highly specialized process in plants that facilitates remodeling of their architecture and reproductive success. Because few genes are known to be essential for organ abscission, we conducted a screen for mutations that alter floral organ shedding in Arabidopsis. Nine recessive mutations that block shedding were found to disrupt the function of an ADP-ribosylation factor-GTPase-activating protein (ARF-GAP) we have named NEVERSHED (NEV). As predicted by its homology to the yeast Age2 ARF-GAP and transcriptional profile, NEV influences other aspects of plant development, including fruit growth. Co-localization experiments carried out with NEV-specific antiserum and a set of plant endomembrane markers revealed that NEV localizes to the trans-Golgi network and endosomes in Arabidopsis root epidermal cells. Interestingly, transmission electron micrographs of abscission zone regions from wild-type and nev flowers reveal defects in the structure of the Golgi apparatus and extensive accumulation of vesicles adjacent to the cell walls. Our results suggest that NEV ARF-GAP activity at the trans-Golgi network and distinct endosomal compartments is required for the proper trafficking of cargo molecules required for cell separation.

Exposure to tobacco smoke before and after a partial smoking ban in prison: indoors air quality measures

Although exposure to secondhand smoke (SHS) is reportedly high in prison, few studies have measured this in the prison environment, and none have done so in Europe. We measured two indicators of SHS exposure (particulate matter PM10 and nicotine) in fixed locations before (2009) and after (2010) introduction of a partial smoking ban in a Swiss prison. Access to smoking cessation support was available to detainees throughout the study. Objectives To measure SHS before and after the introduction of a partial smoking ban. Methods Assessment of particulate matter PM10 (suspended microparticles of 10 μm) and nicotine in ambient air, collected by real-time aerosol monitor and nicotine monitoring devices. Results The authors observed a significant improvement of nicotine concentrations in the air after the introduction of the smoking ban (before: 7.0 μg/m(3), after: 2.1 μg/m(3), difference 4.9 μg/m(3), 95% CI for difference: 0.52 to 9.8, p=0.03) but not in particulate matter PM10 (before: 0.11 mg/m(3), after: 0.06 mg/m(3), difference 0.06 mg/m(3), 95% CI for difference of means: -0.07 to 0.19, p=0.30). Conclusions The partial smoking ban was followed by a decrease in nicotine concentrations in ambient air. These improvements can be attributed to the introduction of the smoking ban since no other policy change occurred during this period. Although this shows that concentrations of SHS decreased significantly, protection was still incomplete and further action is necessary to improve indoor air quality.

Qualité microbiologique de l'air des écuries et conséquences pour la santé des travailleurs du secteur équestre

Les sports équestres sont en plein développement en France où l'on compte plus d'un million de chevaux. Le nombre de cavaliers pratiquant en club ou chez eux est estimé à 600 000 et l'on dénombre plus de 68 000 emplois en France dans tous les domaines : agriculture, environnement, courses, loisirs, sports (www.haras-nationaux.fr). On trouve également dans les métiers du cheval les vétérinaires spécialisés ainsi que les maréchaux-ferrants. De plus, la France est un pays reconnu pour son activité d'élevage avec une production de chevaux de concours de très grande qualité.Récemment, plusieurs études relatant les expositions professionnelles à la poussière des écuries ont paru dans les journaux scientifiques. Les résultats montrent que la poussière issue des écuries contient, entre autres, des concentrations relativement élevées d'endotoxines (1) et de ?(1-3)-glucan (2) pouvant avoir des conséquences sur la santé respiratoire des travailleurs. En effet, des études précédentes ont montré que le fait de travailler ou de côtoyer des chevaux était associé avec une augmentation des risques de problèmes des voies respiratoires supérieures tels que des irritations du nez, de la toux (sèche et productive), de l'asthme, des bronchites chroniques et des épisodes d'" organic dust toxic syndrome (3) " (Gallagher et al., 2007 ; Mazan et al., 2009). [Auteure]

PHE-CRCE-010: Estimating Local Mortality Burdens associated with Particulate Air Pollution

The increase in mortality risk associated with long-term exposure to particulate air pollution is one of the most important, and best-characterised, effects of air pollution on health. This report presents estimates of the size of this effect on mortality in local authority areas in the UK, building upon the attributable fractions reported as an indicator in the public health outcomes framework for England. It discusses the concepts and assumptions underlying these calculations and gives information on how such estimates can be made. The estimates are expected to be useful to health and wellbeing boards when assessing local public health priorities, as well as to others working in the field of air quality and public health. The estimates of mortality burden are based on modelled annual average concentrations of fine particulate matter (PM2.5) in each local authority area originating from human activities. Local data on the adult population and adult mortality rates is also used. Central estimates of the fraction of mortality attributable to long-term exposure to current levels of anthropogenic (human-made) particulate air pollution range from around 2.5% in some local authorities in rural areas of Scotland and Northern Ireland and between 3 and 5% in Wales, to over 8% in some London boroughs. Because of uncertainty in the increase in mortality risk associated with ambient PM2.5, the actual burdens associated with these modelled concentrations could range from approximately one-sixth to about double these figures. Thus, current levels of particulate air pollution have a considerable impact on public health. Measures to reduce levels of particulate air pollution, or to reduce exposure of the population to such pollution, are regarded as an important public health initiative.

Changes in the NI life expectancy gap 1999/01 to 2004/06

In Northern Ireland between 1999-01 and 2004-06 male life expectancy at birth increased from 74.8 to 76.2 years (an increase of 1.4 years) and female life expectancy increased from 79.8 to 81.0 years (an increase of 1.3 years). Declining mortality rates due to Coronary Heart Disease, strokes and other circulatory causes, as well as cancer and respiratory disease caused life expectancy to increase.However, these increases were partially offset by increasing mortality rates over time due to accidental deaths, suicides and chronic liver disease and other causes of death (not separately identified).

Indoor air microbiological evaluation of offices, hospitals, industries, and shopping centers

In this study it was compared the MAS-100 and the Andersen air samplers' performances and a similar trend in both instruments was observed. It was also evaluated the microbial contamination levels in 3060 samples of offices, hospitals, industries, and shopping centers, in the period of 1998 to 2002, in Rio de Janeiro city. Considering each environment, 94.3 to 99.4% of the samples were the allowed limit in Brazil (750 CFU/m³). The industries' results showed more important similarity among fungi and total heterotrophs distributions, with the majority of the results between zero and 100 CFU/m³. The offices' results showed dispersion around 300 CFU/m³. The hospitals' results presented the same trend, with an average of 200 CFU/m³. Shopping centers' environments showed an average of 300 CFU/m³ for fungi, but presented a larger dispersion pattern for the total heterotrophs, with the highest average (1000 CFU/m³). It was also investigated the correlation of the sampling period with the number of airborne microorganisms and with the environmental parameters (temperature and air humidity) through the principal components analysis. All indoor air samples distributions were very similar. The temperature and air humidity had no significant influence on the samples dispersion patterns.

Closing the gap (Care Quality Commission national study)

Closing the gap: Tackling cardiovascular disease and health inequalities by prescribing statins and stop smoking services

World class healthcare for London. Mind the gap! A briefing on equity of health and healthcare in the capital

This briefing provides an overview of equity of access to some of the essential elements of healthcare in the capital

Closing the gap: Setting local targets to reduce health inequalities

This briefing paper provides a summary of the policies, theory and practice of setting targets to reduce health inequalities. It offers some guidance for those responsible for setting local targets and sets this in the context of local experience drawn from documentary evidence from health improvement programmes (HImPs), community strategies and health action zones (HAZs).

Quantifying the gap between policy and practice in cardiovascular risk reduction: a review of evidence from recent cardiovascular and diabetes audits in the UK

As part of CHD NSF implementation, a pilot project is being undertaken under the auspices of the National Screening Committee to test the practical implications and outcomes of implementing a systematic programme of cardiovascular risk reduction in primary care, initially identifying those at high risk due to pre-existing cardiovascular disease or diabetes. To assist in assessing the magnitude of the challenge faced by the pilot programmes, the UK National Screening Committee (NSC) commissioned a review of current practice based on recent cardiovascular and diabetes audits in the UK. This report details the findings of the review, providing 6 key recommendations for future cardiovascular audits.

Indoor air quality in a public building following smoking bans

Introduction: Exposure to environmental tobacco smoke (ETS) is a major environmental risk factor. Indoor contaminants come from a variety of sources, which can include inadequate ventilation, volatile organic compounds (VOCs), biological agents, combustion products, and ETS. Because ETS is one of the most frequent causes of IAQ complaints as well as the high mortality of passive smoking, in June 2004 the University of Geneva made the decision to ban smoking inside the so called "Uni-Mail" building, the biggest Swiss University human science building of recent construction, and the ordinance was applied beginning in October 2004. This report presents the finding related to the IAQ of the "Uni-Mail" building before and after smoking bans using nicotine, suspended dust, condensate and PAHs level in air as tracers to perform an assessment of passive tobacco exposure for non-smokers inside the building. Methods: Respirable particles (RSP) A real time aerosol monitor (model DataRAM)was place at sampling post 1, level ground floor. Condensate It consists in extracting any organic matter taken on the glass fibre filters by MeOH, and then measuring the total absorbent of the MeOH extract to the UV wavelength of 447 nm. Nicotine Nicotine was taken by means of cartridges containing of XAD-4 to the fixed flow of 0.5 L/min. The analytical method used for the determination of nicotine is based on gas chromatography with Nitrogen selective detector GC-NPD. Results: Figure 1 shows the box plot density display of 3 parameters before and after smoking bans for all 7 sampling posts: dust, condensate and nicotine in air in μg/m3. Conclusion: Before the smoking ban, the level of the concentrations of respirable particles (RSP) is raised more, average of the day 320 μg/m3, with peaks of more than 1000 μg/m3, compared with the values of the surrounding air between 22 and 30 μg/m3. The nicotine level is definitely more important (average 5.53 μg/m3, field 1.5 to 17.9 μg/m3). Once the smoking bans inside the building were applied, one notes a clear improvement in terms of concentrations of pollutants. For dust, the concentration fell by 3 times (average: 130 μg/m3, range: 40 to 160 μg/m3) and that of nicotine by 10 times (average: 0.53 μg/m3, range: 0 to 1.69 μg/m3) compared to that found before smoking bans. The outdoor air RSP concentration was 22 μg/m3 or 10 times lower. Nicotine seems to be the best tracer for ETS free of interference, independent of location or season.

Mise en oeuvre des politiques de la mobilité urbaine : analyse comparée de processus de régulation des usages des voies publiques et de l'air dans quatre villes suisses

Résumé Ce travail s'intéresse à la mise en oeuvre des politiques publiques visant à résoudre les problèmes engendrés par le développement de la mobilité urbaine. Nous adoptons sur cette dernière un point de vue nouveau, à savoir que l'enjeu de la régulation du trafic est d'abord celui de la maîtrise des usages nombreux et conflictuels sur deux ressources collectives, l'air et les voies publiques. Pour comprendre comment ces usages sont régulés, nous mobilisons les deux apports théoriques de l'économie institutionnelle (Bromley 1991, Devlin et Grafton 1990, Ostrom 1990, 2000) et de l'analyse des politiques publiques (Knoepfel et al. 2001) au sein du cadre d'analyse des régimes institutionnels de ressources collectives. La première problématise la difficulté de définir des règles communes d'usage pour éviter la surexploitation des ressources alors que la seconde met en jeu notamment le problème de la coordination des politiques publiques d'exploitation et de protection de l'environnement. Sur ce socle, nous choisissons de retenir une approche « institutionnaliste centrée sur les acteurs » (Scharpf 1997), aussi thématisée par les approches néo-institutionnalistes (Hall/Taylor 1996, March/Olsen 1989) visant à expliquer le changement politique par deux types de variables explicatives, à savoir les changements dans la régulation publique (variable institutionnelle) et les changements de la configuration des acteurs en présence, à partir desquels nous bâtissons nos hypothèses de recherche. En l'espèce, l'étude mobilise la variable explicative des régimes institutionnels de l'air et du sol mobilisés par les acteurs de la mobilité pour comprendre l'évolution de la répartition des usages sur les routes urbaines. Ce processus passe par le recours à des ressources de politiques publiques comme le droit, l'argent, l'information, le consensus, le soutien politique, l'infrastructure ou le temps que les acteurs peuvent activer en fonction des règles institutionnelles en présence. On peut classer ces dernières d'abord selon leur niveau de généralité (niveaux opérationnel, des choix collectifs et constitutionnel - Ostrom 1990). L'étude établit que la régulation des usages connaît une importante gradation que rend compte le concept de résistance normative. En fonction de cette dernière, les acteurs essaient de s'imposer au moyen de deux dimensions des règles, que ce travail met en exergue, à savoir selon qu'elles régulent tantôt le mode de décision tantôt le mode d'appropriation. Ces règles décisionnelles et possessionnelles déterminent les possibilités d'accès, ainsi que la procédure d'intervention et la place qui sont réservées aux acteurs, aussi bien pour les ressources collectives physiques que de politique publique. L'étude permet ainsi à la fois d'apporter des éléments nouveaux à la théorie des changements de régimes institutionnels de ressources collectives, d'éclairer un peu plus les processus de mise en couvre de l'action publique et de contribuer au débat sur les principales propositions permettant de maîtriser les impacts négatifs du développement de la mobilité.