Dépendances [Addiction]

This year review emphasizes four aspects coming from addiction psychiatry: 1. Initiation and maintenance of cannabis use. 2. Methadone and heart toxicity. 3. Suicidal behaviour in gambling. 4. Treatment of addictive disorders via internet: present and future perspectives.

Prevalence of hepatitis B and C virus markers among malaria-exposed gold miners in Brazilian Amazon

Hepatitis B and C virus markers were assessed during a survey on malaria in gold mine camps in southern Brazilian Amazon in order to identify risk factors associated to these viral diseases. The study comprised 520 subjects, most of them were gold miners. Missing subjects totaled 49 (8.6%). Among these 520, 82.9% had HBV markers and 7.1% were HBsAg positive. Previous hospitalization, surgery, sexually transmitted diseases and incarceration were quite common among surveyed people, but there is no association between total HBV markers and these factors. On other hand, HBsAg was independently associated to history of sexually transmitted diseases and history of surgery after adjustment. The most frequent HBsAg subtypes identified, adw2 (59%), predominates in populations of Northeast Brazil. The most surveyed people were immigrants coming from that area suggesting that immigrants carried HBV themselves to the study area. Immunoblot (RIBA) confirmed-anti-HCV were found in 2.1%. The only variable associated to anti-HCV in multivariate analysis was illicit intravenous drug. Lack of HCV infection in subjects with such a high HBV markers prevalence reinforces the opinion that HCV is transmitted by restricted routes when compared to HBV. Furthermore, gold miners in Amazon may be considered as a risk group for HBV infection, but not for HCV.

Effect of irrigation water and processing on the microbial quality of lettuces produced and sold on markets in Dakar (Senegal)

The aim of this survey is to assess the microbiological impact of irrigation water on lettuces produced on two urban agricultural sites and sold on markets; 6 and 7%, respectively, of lettuces coming from the sites of Pikine and Patte d'Oie were Salmonella spp. positive. Lettuces irrigated with shallow groundwater (''Ceanes'' water) were more contaminated (8% at both Pikine and Patte d'Oie sites) compared to those irrigated with wastewater (4% at Pikine) or well water (5% at Patte d'Oie). As for the lettuces in marketplaces, their contamination seems to depend on the type of treatment occurring before sale. Lettuces previously washed in the ``Ceanes'' were more contaminated than those rinsed with tap water at the marketplace. Salmonella spp. have been isolated from all marketplaces. However, the rates of contamination in markets surrounding Patte d'Oie are higher (9 and 11% at Grand Yoff and Dalifort) than those surrounding Pikine (4 and 2% at Zinc and Sham) or Rufisque, the control (2%). Our results confirm that the reuse of wastewater in irrigation is an alternative to animal manure. Its risk of microbial contamination can be significantly reduced by washing the vegetables with tap water before they are sold. Copyright (C) 2010 John Wiley & Sons, Ltd.

Drogues d’abús en detinguts al jutjat de guàrdia: repercusió a l’àmbit de l’execució penal i l’Administració de justícia

L’estudi de la saliva com a matriu d’anàlisis de drogues d’abús en conductors es fa des dels anys 80. Els investigadors trobaven dificultats però el major inconvenient va ser l’existència de tècniques analítiques no prou sensibles per a la detecció de les drogues. A finals de les anys 90 la saliva es va considerar un fluid molt adequat i es van anar publicant treballs que investigaven aquesta temàtica. No obstant això encara no n ’hi ha molts treballs, especialment al nostre país. A Catalunya no s’han fet estudis encara que s’ha contribuït en alguns projectes realitats fora de la nostra comunitat. Objectius: Obtenir dades del consum de drogues d’abús en una mostra de conductors de vehicles a motor. Obtenir dades dels tòxics més freqüents trobats en les mostres analitzades. Relacionar el consum de tòxics amb alteracions en la conducta o conduccions temeràries en la població que es sotmet a l’estudi. Metodologia: Estudi d’una mostra de subjectes que són aturats per la Guàrdia Urbana de Barcelona, Girona ,Tarragona i policia local de el Prat de Llobregat conduint vehicles a motor. Obtenció d’una mostra de saliva als subjectes que es consideren que poden trobar-se sota la influència de les drogues. Anàlisis de les mostres per immunoassaig mitjançant el kit Cozart DDS com a test de camp i confirmació dels resultats per cromatografia de gasos i espectrometria de masses. Resultats: Es descriuen en els resultats obtinguts, les freqüències de consum, les principals drogues d’abús trobades i es valoren els símptomes clínics que presentaven els subjectes. Conclusions: Les drogues d’abús estan presents en conductors de vehicles a motor. El kit utilitzat per la determinació de drogues a peu de carretera és una bona eina atès que es confirmen els resultats especialment per a la cocaïna i opiacis.

Interpretation of partial fingermarks using an automated fingerprint identification system

Abstract : In the subject of fingerprints, the rise of computers tools made it possible to create powerful automated search algorithms. These algorithms allow, inter alia, to compare a fingermark to a fingerprint database and therefore to establish a link between the mark and a known source. With the growth of the capacities of these systems and of data storage, as well as increasing collaboration between police services on the international level, the size of these databases increases. The current challenge for the field of fingerprint identification consists of the growth of these databases, which makes it possible to find impressions that are very similar but coming from distinct fingers. However and simultaneously, this data and these systems allow a description of the variability between different impressions from a same finger and between impressions from different fingers. This statistical description of the withinand between-finger variabilities computed on the basis of minutiae and their relative positions can then be utilized in a statistical approach to interpretation. The computation of a likelihood ratio, employing simultaneously the comparison between the mark and the print of the case, the within-variability of the suspects' finger and the between-variability of the mark with respect to a database, can then be based on representative data. Thus, these data allow an evaluation which may be more detailed than that obtained by the application of rules established long before the advent of these large databases or by the specialists experience. The goal of the present thesis is to evaluate likelihood ratios, computed based on the scores of an automated fingerprint identification system when the source of the tested and compared marks is known. These ratios must support the hypothesis which it is known to be true. Moreover, they should support this hypothesis more and more strongly with the addition of information in the form of additional minutiae. For the modeling of within- and between-variability, the necessary data were defined, and acquired for one finger of a first donor, and two fingers of a second donor. The database used for between-variability includes approximately 600000 inked prints. The minimal number of observations necessary for a robust estimation was determined for the two distributions used. Factors which influence these distributions were also analyzed: the number of minutiae included in the configuration and the configuration as such for both distributions, as well as the finger number and the general pattern for between-variability, and the orientation of the minutiae for within-variability. In the present study, the only factor for which no influence has been shown is the orientation of minutiae The results show that the likelihood ratios resulting from the use of the scores of an AFIS can be used for evaluation. Relatively low rates of likelihood ratios supporting the hypothesis known to be false have been obtained. The maximum rate of likelihood ratios supporting the hypothesis that the two impressions were left by the same finger when the impressions came from different fingers obtained is of 5.2 %, for a configuration of 6 minutiae. When a 7th then an 8th minutia are added, this rate lowers to 3.2 %, then to 0.8 %. In parallel, for these same configurations, the likelihood ratios obtained are on average of the order of 100,1000, and 10000 for 6,7 and 8 minutiae when the two impressions come from the same finger. These likelihood ratios can therefore be an important aid for decision making. Both positive evolutions linked to the addition of minutiae (a drop in the rates of likelihood ratios which can lead to an erroneous decision and an increase in the value of the likelihood ratio) were observed in a systematic way within the framework of the study. Approximations based on 3 scores for within-variability and on 10 scores for between-variability were found, and showed satisfactory results. Résumé : Dans le domaine des empreintes digitales, l'essor des outils informatisés a permis de créer de puissants algorithmes de recherche automatique. Ces algorithmes permettent, entre autres, de comparer une trace à une banque de données d'empreintes digitales de source connue. Ainsi, le lien entre la trace et l'une de ces sources peut être établi. Avec la croissance des capacités de ces systèmes, des potentiels de stockage de données, ainsi qu'avec une collaboration accrue au niveau international entre les services de police, la taille des banques de données augmente. Le défi actuel pour le domaine de l'identification par empreintes digitales consiste en la croissance de ces banques de données, qui peut permettre de trouver des impressions très similaires mais provenant de doigts distincts. Toutefois et simultanément, ces données et ces systèmes permettent une description des variabilités entre différentes appositions d'un même doigt, et entre les appositions de différents doigts, basées sur des larges quantités de données. Cette description statistique de l'intra- et de l'intervariabilité calculée à partir des minuties et de leurs positions relatives va s'insérer dans une approche d'interprétation probabiliste. Le calcul d'un rapport de vraisemblance, qui fait intervenir simultanément la comparaison entre la trace et l'empreinte du cas, ainsi que l'intravariabilité du doigt du suspect et l'intervariabilité de la trace par rapport à une banque de données, peut alors se baser sur des jeux de données représentatifs. Ainsi, ces données permettent d'aboutir à une évaluation beaucoup plus fine que celle obtenue par l'application de règles établies bien avant l'avènement de ces grandes banques ou par la seule expérience du spécialiste. L'objectif de la présente thèse est d'évaluer des rapports de vraisemblance calcul és à partir des scores d'un système automatique lorsqu'on connaît la source des traces testées et comparées. Ces rapports doivent soutenir l'hypothèse dont il est connu qu'elle est vraie. De plus, ils devraient soutenir de plus en plus fortement cette hypothèse avec l'ajout d'information sous la forme de minuties additionnelles. Pour la modélisation de l'intra- et l'intervariabilité, les données nécessaires ont été définies, et acquises pour un doigt d'un premier donneur, et deux doigts d'un second donneur. La banque de données utilisée pour l'intervariabilité inclut environ 600000 empreintes encrées. Le nombre minimal d'observations nécessaire pour une estimation robuste a été déterminé pour les deux distributions utilisées. Des facteurs qui influencent ces distributions ont, par la suite, été analysés: le nombre de minuties inclus dans la configuration et la configuration en tant que telle pour les deux distributions, ainsi que le numéro du doigt et le dessin général pour l'intervariabilité, et la orientation des minuties pour l'intravariabilité. Parmi tous ces facteurs, l'orientation des minuties est le seul dont une influence n'a pas été démontrée dans la présente étude. Les résultats montrent que les rapports de vraisemblance issus de l'utilisation des scores de l'AFIS peuvent être utilisés à des fins évaluatifs. Des taux de rapports de vraisemblance relativement bas soutiennent l'hypothèse que l'on sait fausse. Le taux maximal de rapports de vraisemblance soutenant l'hypothèse que les deux impressions aient été laissées par le même doigt alors qu'en réalité les impressions viennent de doigts différents obtenu est de 5.2%, pour une configuration de 6 minuties. Lorsqu'une 7ème puis une 8ème minutie sont ajoutées, ce taux baisse d'abord à 3.2%, puis à 0.8%. Parallèlement, pour ces mêmes configurations, les rapports de vraisemblance sont en moyenne de l'ordre de 100, 1000, et 10000 pour 6, 7 et 8 minuties lorsque les deux impressions proviennent du même doigt. Ces rapports de vraisemblance peuvent donc apporter un soutien important à la prise de décision. Les deux évolutions positives liées à l'ajout de minuties (baisse des taux qui peuvent amener à une décision erronée et augmentation de la valeur du rapport de vraisemblance) ont été observées de façon systématique dans le cadre de l'étude. Des approximations basées sur 3 scores pour l'intravariabilité et sur 10 scores pour l'intervariabilité ont été trouvées, et ont montré des résultats satisfaisants.

Genetic epidemiology of fecal egg excretion during Schistosoma mansoni infection in an endemic area in Minas Gerais, Brazil

There is considerable variation in the level of fecal egg excretion during Schistosoma mansoni infections. Within a single endemic area, the distribution of egg counts is typically overdispersed, with the majority of eggs excreted coming from a minority of residents. The purpose of this study was to quantify the influence of genetic factors on patterns of fecal egg excretion in a rural study sample in Brazil. Individual fecal egg excretions, expressed in eggs per gram of feces, were determined by the Kato-Katz method on stool samples collected on three different days. Detailed genealogic information was gathered at the time of sampling, which allowed assignment of 461 individuals to 14 pedigrees containing between 3 and 422 individuals. Using a maximum likelihood variance decomposition approach, we performed quantitative genetic analyses to determine if genetic factors could partially account for the observed pattern of fecal egg excretion. The quantitative genetic analysis indicated that between 21-37% of the variation in S. mansoni egg counts was attributable to additive genetic factors and that shared environment, as assessed by common household, accounted for a further 12-21% of the observed variation. A maximum likelihood heritability (h²) estimate of 0.44 ± 0.14 (mean ± SE) was found for the 9,604 second- and higher-degree pairwise relationships in the study sample, which is consistent with the upper limit (37%) of the genetic factor determined in the variance decomposition analysis. These analyses point to the significant influence of additive host genes on the pattern of S. mansoni fecal egg excretion in this endemic area.

Report of the National Advisory Committee on Palliative Care

Report of the National Advisory Committee on Palliative Care It is anticipated that the need for palliative care services will increase in coming years. Population projections indicate that between 1996 and 2031 the population aged 65 years and over is expected to more than double. Currently, over 95% of all patients availing of palliative care services suffer from cancer. The number of people dying from cancer is expected to rise in future years, due to the ageing population. Click here to download the document (PDF, 1mb)

Decomposing the Tourist’s Satisfaction Gap: The Role of Expectations and Cognitions

In this paper we present an empirical methodology that allows the tourist’s satisfaction gap between two destinations to be decomposed into two components. One explains the role of differences in observed characteristics of the tourists and the stay (endowments). The other captures the share of the gap due to differences in the utility that tourists derive from those characteristics (cognitive). To illustrate the use of this method, we employ data coming from a sample of tourists visiting two touristic enclaves in Tarragona (Spain). Our results indicate that the cognitive component explains most of the satisfaction gap. Keywords: Satisfaction, expectations, cognition, touristic destination

Cadmium distribution in soils covering Jurassic oolitic limestone with high Cd contents in the Swiss Jura

Oolitic carbonates belonging to the Hauptrogenstein Formation of Bajocian (Middle Jurassic) age have been shown to be anomalously enriched in cadmium (Cd) throughout the Jura Mountains. Soils associated with this type of rock substratum may be naturally polluted with regards to Cd. At Schleifenberg (Canton Basel Land, Switzerland) the Hauptrogenstein Formation is almost entirely exposed along a trail on its SW flank. Cadmium concentrations were systematically measured throughout this formation and Cd enrichments in rocks are shown to occur to a maximum content of 4.9 mg kg(-1). We investigated associated soils, which cover the entire outcrop, and show that they have been formed through the weathering of the underlying bedrock and through the uptake of colluvial limestone fragments from the same and older formations. Cadmium contents in the soils reach a maximum value of 2.0 mg kg(-1), thereby exceeding the official Swiss indicative guideline value for soils fixed at 0.8 mg.kg(-1). Mineralogical analyses on the soils and associated bedrock suggest that no allochthonous component related to aeolian transport is present. Sequential extractions applied to selected soil samples show that about half of the Cd resides in the carbonate fraction coming from the fractured parent-rock, while the Cd released from the weathered carbonates is associated either with organic matter (over 10%) or with Fe and Mn-oxihydroxides (approximately 30%). No exchangeable Cd phase was found and this, together with the buffer capacity of this calcareous soil, suggests that the amount of mobile Cd is quite negligible in this soil, which also greatly reduces the amount of bioavailable

Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

The Swiss Systemic lupus erythematosus Cohort Study (SSCS) - cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland.

OBJECTIVES: To describe disease characteristics and treatment modalities in a multidisciplinary cohort of systemic lupus erythematosus (SLE) patients in Switzerland. METHODS: Cross-sectional analysis of 255 patients included in the Swiss SLE Cohort and coming from centres specialised in Clinical Immunology, Internal Medicine, Nephrology and Rheumatology. Clinical data were collected with a standardised form. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), an integer physician's global assessment score (PGA) ranging from 0 (inactive) to 3 (very active disease) and the erythrocyte sedimentation rate (ESR). The relationship between SLE treatment and activity was assessed by propensity score methods using a mixed-effect logistic regression with a random effect on the contributing centre. RESULTS: Of the 255 patients, 82% were women and 82% were of European ancestry. The mean age at enrolment was 44.8 years and the median SLE duration was 5.2 years. Patients from Rheumatology had a significantly later disease onset. Renal disease was reported in 44% of patients. PGA showed active disease in 49% of patients, median SLEDAI was 4 and median ESR was 14 millimetre/first hour. Prescription rates of anti-malarial drugs ranged from 3% by nephrologists to 76% by rheumatologists. Patients regularly using anti-malarial drugs had significantly lower SELENA-SLEDAI scores and ESR values. CONCLUSION: In our cohort, patients in Rheumatology had a significantly later SLE onset than those in Nephrology. Anti-malarial drugs were mostly prescribed by rheumatologists and internists and less frequently by nephrologists, and appeared to be associated with less active SLE.

Susceptibility of Biomphalaria straminea (Dunker, 1848) from Serra da Mesa Dam, Goiás, Brazil to infection with three strains of Schistosoma mansoni Sambon, 1907

Ecological changes from water resources development projects often affect the epidemiology of water-associated diseases. In order to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area of influence of the Serra da Mesa Hydroelectric a survey has been performed since 1997 and revealed the occurrence of well-established populations of Biomphalaria straminea (Dunker, 1848) in the 8 municipalities surrounding the lake. Areas of epidemiologic risk for schistosomiasis were selected and studies of parasite-mollusc compatibility were undertaken using specimens from 19 populations of B. straminea and 3 strains (CM, EC and PB) originally isolated from B. straminea. Among 1,135 specimens used 15 became infected (infection index of 1.3%) and 8 populations were susceptible to the schistosome strains: B. straminea from Campinorte (Castelão, susceptible to CM and EC strains, and Planeta Água, EC strain), Colinas (Tocantinzinho river, CM and EC strains), Minaçu (Canabrava river, EC strain), Niquelândia (Codemin, CM and PB strains, and Almas river, CM strain), Uruaçu (touristic area, PB strain) and Santa Rita do Novo Destino (Maranhão river, CM and EC strains). These results, associated with marked social and ecological changes occurred, strongly suggest the possibility of B. straminea coming to act as a vector of schistosomiasis in the studied area.

Building a Culture of Patient Safety - Report of the Commission on Patient Safety and Quality Assurance

The Commission on Patient Safety and Quality Assurance was established in January 2007 and reported to the Minister in July 2008. The report was considered by government in January 2009 which agreed the implementation process. The overall objective of the Commission was to develop clear and practical recommendations to ensure that safety and quality of care for patients is paramount within the healthcare system. The Commission’s report set out a wide range of policy measures that will drive the safety and quality agenda in Irish healthcare in the coming years. The establishment of the Commission was prompted by an increasing awareness of patient safety issues in general and high profile health service system failures at home and abroad and in particular by the Lourdes Hospital Inquiry. These have underlined the need for an increased focus on patient safety and quality. Download document here Download summary document on the Report

Phenotypic divergence but not genetic distance predicts assortative mating among species of a cichlid fish radiation.

The hypothesis of ecological divergence giving rise to premating isolation in the face of gene flow is controversial. However, this may be an important mechanism to explain the rapid multiplication of species during adaptive radiation following the colonization of a new environment when geographical barriers to gene flow are largely absent but underutilized niche space is abundant. Using cichlid fish, we tested the prediction of ecological speciation that the strength of premating isolation among species is predicted by phenotypic rather than genetic distance. We conducted mate choice experiments between three closely related, sympatric species of a recent radiation in Lake Mweru (Zambia/DRC) that differ in habitat use and phenotype, and a distantly related population from Lake Bangweulu that resembles one of the species in Lake Mweru. We found significant assortative mating among all closely related, sympatric species that differed phenotypically, but none between the distantly related allopatric populations of more similar phenotype. Phenotypic distance between species was a good predictor of the strength of premating isolation, suggesting that assortative mating can evolve rapidly in association with ecological divergence during adaptive radiation. Our data also reveals that distantly related allopatric populations that have not diverged phenotypically, may hybridize when coming into secondary contact, e.g. upon river capture because of diversion of drainage systems.

Department of Health Statement of Strategy 2011-2014

The Programme for Government sets out an agenda of fundamental change for our health services. The Department of Health must lead the implementation of Government policy and, in the course of the coming years, must also remodel itself to meet the challenges inherent in these radical changes. This Statement of Strategy outlines the high-level aims and objectives of the overall health system for the period 2011 to 2014. Click here to download PDF 191kb