Convention-cadre pour la lutte antitabac: un instrument puissant de santé publique. [The Framework Convention for Tobacco Control (FCTC): a powerful public health instrument].

The Framework Convention on Tobacco Control (FCTC) isa global and comprehensive legal framework for reducing demand for tobacco (e.g. price measures; ban on smoking in enclosed places; contents of tobacco products; packaging and labeling; advertising, promotion and sponsorship; liability, tobacco cessation, etc.) and supply (e.g. illicit trade; sales to/by minors, etc.). Adopted in 2003, the FCTC has been ratified by 174 countries so far. Switzerland has signed the treaty in 2004 but ratification will necessitate the implementation of stronger tobacco control measures at the national level. The FCTC is a priority of any strategy to reduce noncommunicable diseases in populations. Broad implementation of the FCTC has the potential to prevent a substantial proportion of the billion of tobacco-related deaths expected in the 21st

Ten-year trends in overweight and obesity in the adult Portuguese population, 1995 to 2005.

ABSTRACT: BACKGROUND: There is little information regarding the trends in body mass index (BMI) and obesity in the overall Portuguese population, namely if these trends are similar according to educational level. In this study, we assessed the trends in the prevalence of overweight and obesity in the Portuguese population, overall and by educational level. METHODS: Cross-sectional national health interview surveys conducted in 1995-6 (n=38,504), 1998-9 (n=38,688) and 2005-6 (n=25,348). Data were derived from the population and housing census of 1991 and two geographically-based strata were defined. The sampling unit was the house, and all subjects living in the sampling unit were surveyed. Height and weight were self-reported; the effects of gender, age group and educational level were also assessed by self-reported structured questionnaires. Bivariate comparisons were performed using Chi-square or analysis of variance (ANOVA). Trends in BMI levels were assessed by linear regression analysis, while trends in the prevalence of obesity were assessed by logistic regression. RESULTS: Mean (+/-standard deviation) BMI increased from 25.2+/-4.0 in 1995-6 to 25.7+/-4.5 kg/m2 in 2005-6. Prevalence of overweight remained stable (36.1% in 1995-6 and 36.4% in 2005) while prevalence of obesity increased (11.5% in 1995-6 and 15.1% in 2005-6). Similar findings were observed according to age group. Mean age-adjusted BMI increase (expressed in kg/m2/year and 95% confidence interval) was 0.073 (0.062, 0.084), 0.016 (0.000, 0.031) and 0.073 (0.049, 0.098) in men with primary, secondary and university levels, respectively; the corresponding values in women were 0.085 (0.073, 0.097), 0.052 (0.035, 0.069) and 0.062 (0.038, 0.084). Relative to 1995-6, obesity rates increased by 48%, 41% and 59% in men and by 40%, 75% and 177% in women with primary, secondary and university levels, respectively. The corresponding values for overweight were 6%, 1% and 23% in men and 5%, 7% and 65% in women. CONCLUSION: Between 1995 and 2005, obesity increased while overweight remained stable in the adult Portuguese population. Although higher rates were found among lesser educated subjects, the strong increase in BMI and obesity levels in highly educated subjects is of concern.

Association between weight perception and socioeconomic status among adults in the Seychelles.

BACKGROUND: Few studies have examined the association between weight perception and socioeconomic status (SES) in sub-Saharan Africa, and none made this association based on education, occupation and income simultaneously. METHODS: Based on a population-based survey (n = 1255) in the Seychelles, weight and height were measured and self-perception of one's own body weight, education, occupation, and income were assessed by a questionnaire. Individuals were considered to have appropriate weight perception when their self-perceived weight matched their actual body weight. RESULTS: The prevalence of overweight and obesity was 35% and 28%, respectively. Multivariate analysis among overweight/obese persons showed that appropriate weight perception was directly associated with actual weight, education, occupation and income, and that it was more frequent among women than among men. In a model using all three SES indicators together, only education (OR = 2.5; 95% CI: 1.3-4.8) and occupation (OR = 2.3; 95% CI: 1.2-4.5) were independently associated with appropriate perception of being overweight. The OR reached 6.9 [95% CI: 3.4-14.1] when comparing the highest vs. lowest categories of SES based on a score including all SES indicators and 6.1 [95% CI: 3.0-12.1] for a score based on education and occupation. CONCLUSIONS: Appropriately perceiving one's weight as too high was associated with different SES indicators, female sex and being actually overweight. These findings suggest means and targets for clinical and population-based interventions for weight control. Further studies should examine whether these differences in weight perception underlie differences in cognitive skills, healthy weight norms, or body size ideals.

Stringless Portland Cement Concrete Paving, February 2004

This report describes results from a study evaluating the use of stringless paving using a combination of global positioning and laser technologies. CMI and Geologic Computer Systems developed this technology and successfully implemented it on construction earthmoving and grading projects. Concrete paving is a new area for considering this technology. Fred Carlson Co. agreed to test the stringless paving technology on two challenging concrete paving projects located in Washington County, Iowa. The evaluation was conducted on two paving projects in Washington County, Iowa, during the summer of 2003. The research team from Iowa State University monitored the guidance and elevation conformance to the original design. They employed a combination of physical depth checks, surface location and elevation surveys, concrete yield checks, and physical survey of the control stakes and string line elevations. A final check on profile of the pavement surface was accomplished by the use of the Iowa Department of Transportation Light Weight Surface Analyzer (LISA). Due to the speed of paving and the rapid changes in terrain, the laser technology was abandoned for this project. Total control of the guidance and elevation controls on the slip-form paver were moved from string line to global positioning systems (GPS). The evaluation was a success, and the results indicate that GPS control is feasible and approaching the desired goals of guidance and profile control with the use of three dimensional design models. Further enhancements are needed in the physical features of the slipform paver oil system controls and in the computer program for controlling elevation.

Smoking trends in Switzerland, 1992-2007: a time for optimism?

Objective To assess trends in smoking status according to gender, age and educational level in the adult Swiss population. Methods Four national health interview surveys conducted between 1992 and 2007 in representative samples of the Swiss population. Results The prevalence of current smokers increased between 1992 and 1997, decreasing thereafter. In 2007, the prevalence of current smokers (32.0% of men and 23.8% of women) was lower than in 1992 (38.4% and 26.7%, respectively). Whereas the prevalence of current + former smoking decreased from 64.5% in 1992 to 59.3% in 2007 among men, it was similar among women during the same period (44.0% in 1992 and 43.9% in 2007). The prevalence of current + former smokers decreased from 47.2% in 1992 to 46.3% in 2007 in the lower education group (no education + primary), from 54.8% to 52.9% in subjects with secondary level education, and from 55.4% to 48.7% in subjects with university level education. The prevalence of current smokers decreased in all age groups. Finally, the amount of cigarette equivalents smoked per day decreased, but the amount of non-cigarette tobacco (alone or in combination with cigarettes) increased for both sexes. Conclusion The prevalence of smoking has been decreasing in the Swiss population, for both sexes and for most age groups and educational levels between 1992 and 2007. The health effects of the change in type of tobacco products consumed await further investigation.

Varicella Zoster Virus CNS disease in hematopoietic cell transplantation: A single center experience

Background: Varciella Zoster Virus (VZV) can lead to serious complications in Hematopoietic Cell Transplant (HCT) recipients. Central nervous system (CNS) VZV can be one of the most devastating infections in transplant recipients, yet little is known about this rare disease. Objectives: To describe CNS VZV in the post-transplant period and to define potential risk factors in the HCT population. Methods: We reviewed the course of all patients who received a first HCT at the Fred Hutchinson Cancer Center (FHCRC) in Seattle, WA from 1/1996 through 12/2007. Data were collected retrospectively using the Long-Term Follow-Up database, which includes on-site examinations, outside records, laboratory tests, and yearly questionnaires. Patients were classified as CNS VZV if they had laboratory confirmation of VZV in the cerebrospinal fluid (CSF), or had zoster with associated clinical and laboratory findings consistent with CNS disease. Results: A total of six patients developed VZV CNS disease during the evaluation period (table 1). Diagnosis was confirmed in 3/6 by detection of VZV in CSF by PCR. All other patients had a clinical diagnosis based on the presence of CNS symptoms, zoster, lymphocytic pleiocytosis, and response to IV acyclovir. Patients who developed CNS disease had a mean age of 42 years (range 34-51) at time of transplant. CNS disease developed at a mean of 9 months posttransplantation (range 0.5-24 months), and severity varied, ranging from meningitis (3/6) to encephalitis/myelitis (3/6). All had active graft-versus host disease (GHVD) and all were being treated with immunosuppressive therapy at time of diagnosis. Fever and headache were the most common symptoms, but patients who developed focal CNS findings or seizures (3/6) had a more complicated clinical course. While most patients presented with classic VZV/zoster skin lesions, 2/6 patients had no dermatologic findings associated with their presentation. Four (66%) of patients who developed VZV CNS disease died, two related to VZV complications despite aggressive antiviral therapy. Conclusions: In this cohort of HCT patients, VZV CNS disease was a rare complication. Mortality due to CNS VZV is high, particularly in patients who develop focal neurologic findings or seizures. Even in the absence of skin lesions, VZV CNS disease should be considered in patients who develop fevers and neurologic symptoms.

Prevalence of normal weight obesity in Switzerland: effects of various definitions

Background: normal weight obesity (NWO) is defined as an excessive body fat associated with a normal body mass index (BMI<25 kg/m2), but its prevalence in the general population is unknown. Objective: to assess the prevalence of NWO in Switzerland according to different cut points used to define excess body fat. Design: cross-sectional study including 3,213 women and 2,912 men aged 35-75 years. Body fat was assessed by bioimpedance and prevalence of NWO was assessed using four previously published definitions for excess body fat. Results: % body fat increased with age: in men, the values (mean SD) were 20.2 5.4, 23.0 5.4, 26.3 5.2 and 28.2 4.6 for age groups [35 - 44], [45 - 54], [55 - 64] and [65 - 75] years, respectively; the corresponding values for women were 29.9 7.8, 33.1 7.4, 36.7 7.5 and 39.6 6.9. In men, prevalence of NWO was <1% irrespective of the definition used. Conversely, in women, a one to twenty fold difference (from 1.4% to 27.8%) in NWO prevalence was found. The prevalence of NWO increased with age when age-independent cut points were used in women, but not in men. Conclusions: prevalence of NWO is low in the general population and higher in women than in men. The prevalence is highly dependent on the criteria used to define excess body fat, namely in women. The use of gender- and age-specific cut points to define excess body fat is better than fixed or gender-specific only cut points.

Adiponectin and C-reactive protein are positively associated with microalbuminuria in an adult Caucasian population

Objective: Microalbuminuria (MAU) is a marker of early kidney injury and cardiovascular risk. We assessed the association of MAU with plasma adiponectin, leptin, and hsCRP as inflammatory marker, accounting for hypertension, diabetes and obesity. Design and Methods: Population based, cross-sectional study in Caucasian subjects aged 35 to 75 years in Lausanne, Switzerland. MAU, measured by quantitative immunonephelometry on spot morning urine, was used either as a continuous (MAU) or dichotomized variable (MA defined as MAU > 2.5 and >3.5 mg/mmol creatinine in men and women, respectively). Results: The 2955 women (age 53.3_10.7, mean_SD years) had mean body mass index (BMI) 24.9_4.5 kg/m. The 2479 men (age 53.1_10.8 years) hadmean BMI 27.0_3.9 kg/m2.Median hsCRP was 1.3 and 1.3 mg/L, median adiponectin 6.2 and 10.6mg/mL in men and women, respectively. MA prevalence was 4.9% in women and 9.8% in men. In multivariate regression analysis adjusting for potential confounders (age, sex, hypertension, diabetes, eGFR, BMI, percent fat mass, insulin and smoking), logtransformed MAU was positively associated with hsCRP (P<0.001) and adiponectin (P¼0.002), but not with leptin. The association of adiponectin with MAU was stronger in subjects with low hsCRP, and vice versa (P interaction&lt;0.001). Conclusion: Adiponectin and hsCRP are significant positive determinants of MAU, independently of diabetes, hypertension and fat mass. A negative interaction between hsCRP and adiponectin was found for their effect on MAU. Whether hyperadiponectinemia represents an adequate protective response to vascular stress or has negative causal impact on the development of MAU should be assessed in further studies.

Laboratory-based versus non-laboratory-based CVD risk analysis.

Commentaire de: Gaziano TA, Young CR, Fitzmaurice G, Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. Lancet. 2008;371(9616):923-31. PMID: 18342687