IPH response to Department of the Environment (NI) Planning Policy Statement 21 (PPS21)

In responding, IPH identify a number of potential health impacts including providing employment opportunities through farm diversification.  Other issues include access to open space and housing located close to traditional focal points.   The Institute of Public Health in Ireland (IPH) is an all-island body which aims to improve health in Ireland, by working to combat health inequalities and influence public policies in favour of health. IPH promotes co-operation in research, training, information and policy in order to contribute to policies which tackle inequalities in health. IPH is particularly interested in the Draft Planning Policy Statement 21 due to the impact on the countryside and potential implications on health for the population of Northern Ireland. IPH conducted a Health Impact Assessment on the proposed West Tyrone Area Plan 2019 and through this work has developed extensive knowledge when looking at health and rural issues.

Triatoma sordida Stål 1859 (Hemiptera, Reduviidae: Triatominae) in palms of northeastern Argentina

Several palms species provide an important habitat for triatomines and associate vertebrates in tropical America. The objective of this work is to identify the triatomine species living in the palms of rural areas in the Province of Corrientes, and to estimate the potential epidemiological risk they represent for the residents of nearby houses. The survey was carried out in a palm community in Colonia Laurel, Department San Roque, Province of Corrientes, Argentina. Samplings were performed in October, November and December 1998; January, February and March 1999; May and June 1999. Thirty palms: 27 (90%) Butia yatay (Mart.) Becc. and 3 Acrocomia aculeata (Jacq.) Lodd ex Mart. were dissected. Triatoma sordida Stål 1859 was found in 96.2% of B. yatay and in all the A. aculeata palms. A total of 272 live T. sordida was collected; 36 of them (13.2%) were found in bird nests in the frond and the remainder in other locations of the tree. The mean number of triatomines per palm was 9.6 (range 1-60, mode 2). T. sordida was collected during all the sampling months and all stages were present at all seasons. The highest population density was reached in spring and the lowest in autumn. Trypanosoma cruzi was detected in 38.5% in feces of 174 examined insects and identified as such, both by microscopical examination and PCR. This is the first finding of T. sordida populations in B. yatay, an endemic palm of South America distributed in southern Brazil, Uruguay and northeastern Argentina. The high infection prevalence found in this work suggests that T. sordida plays an essential role in the maintenance of the wild T. cruzi transmission cycle in northeastern Argentina.

Comparison of indices proposed as criteria for assigning skin notation

OBJECTIVES: Skin notations are used as a hazard identification tool to flag chemicals associated with a potential risk related to transdermal penetration. The transparency and rigorousness of the skin notation assignment process have recently been questioned. We compared different approaches proposed as criteria for these notations as a starting point for improving and systematizing current practice. METHODS: In this study, skin notations, dermal acute lethal dose 50 in mammals (LD(50)s) and two dermal risk indices derived from previously published work were compared using the lists of Swiss maximum allowable concentrations (MACs) and threshold limit values (TLVs) from the American Conference of Governmental Industrial Hygienists (ACGIH). The indices were both based on quantitative structure-activity relationship (QSAR) estimation of transdermal fluxes. One index compared the cumulative dose received through skin given specific exposure surface and duration to that received through lungs following inhalation 8 h at the MAC or TLV. The other index estimated the blood level increase caused by adding skin exposure to the inhalation route at kinetic steady state. Dermal-to-other route ratios of LD(50) were calculated as secondary indices of dermal penetrability. RESULTS: The working data set included 364 substances. Depending on the subdataset, agreement between the Swiss and ACGIH skin notations varied between 82 and 87%. Chemicals with a skin notation were more likely to have higher dermal risk indices and lower dermal LD(50) than chemicals without a notation (probabilities between 60 and 70%). The risk indices, based on cumulative dose and kinetic steady state, respectively, appeared proportional up to a constant independent of chemical-specific properties. They agreed well with dermal LD(50)s (Spearman correlation coefficients -0.42 to -0.43). Dermal-to-other routes LD(50) ratios were moderately associated with QSAR-based transdermal fluxes (Spearman correlation coefficients -0.2 to -0.3). CONCLUSIONS: The plausible but variable relationship between current skin notations and the different approaches tested confirm the need to improve current skin notations. QSAR-based risk indices and dermal toxicity data might be successfully integrated in a systematic alternative to current skin notations for detecting chemicals associated with potential dermal risk in the workplace. [Authors]

Is your waistline creeping up on you? poster (female)

This poster was produced to support the choose to live better campaign aimed at raising awareness of the health risks associated with overweight and obesity in women Northern Ireland.�

La mort subite: de l' épidémiologie à la prévention [Sudden cardiac death: epidemiology and modern therapy].

Sudden Cardiac Death (SCD) has become an important public health challenge in the Western World. In Switzerland near 10,000 people suffer each year from SCD. The survival from SCD to hospital discharge is discouraging (near 5%). Large majority of events occur unexpectedly in the out-of-hospital environment and are not predicted with great accuracy by risk profiling. Because the majority of SCD occur by the mechanism of ventricular fibrillation, community-based defibrillation strategies have emerged as one approach to SCD problem. Newer strategies of defibrillation designed to respond faster to out-of-hospital cardiac arrest, including public access defibrillation, as well as aggressive primary and secondary prevention of coronary artery disease appears as the best approach for successful management of SCD.

Standardisation of the waist circumference (WC) for each range of body mass index (BMI) in adult outpatients attended to in Endocrinology and Nutrition departments

By this study we seek the expectable range of waist circumference (WC) for every degree of body mass index (BMI), which will serve to studies targeting ascertaining the health risk. We studied 2,932 patients (39.6% men and 60.4% women, between 18 and 96 years ) of the same ethnic group who consecutively attended outpatient departments of our clinics between 2000 and 2004. BMI correlated linearly with the WC (cc: 0.85; p < 0.001). The men, the obese, and diabetics were older (p < 0.001). BMI was greater in women and WC in men. The women had a greater WC if they had diabetes (p < 0.01), being equal to diabetic males. The men had greater WC when they had diabetes (p < 0.001). Waist at risk was detected (men > or = 102 cm and women > or = 88 cm) in 94.3% of the obese, in 32.3% of overweight patients, in 3.8% of patients with BMI < 25, in 84.3% of diabetics, and in 72.6% of patients without diabetes. We made graphic standardisation of WC with regard to BMI, and we calculated the percentiles 10, 25, 50, 75 and 90, grouping in ranges of 2 kg/m(2) of BMI. The diabetic patients are grouped in ranges of 4 kg/m(2). As conclusion we present a standardisation of the WC measurement of patients attended to in our Endocrinology and Nutrition practices distributed in percentiles as a clinically usable tool to define the ranges of WC for every BMI value.

Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update.

The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST), myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.

Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV Cohort Study.

BACKGROUND: Alcohol consumption leading to morbidity and mortality affects HIV-infected individuals. Here, we aimed to study self-reported alcohol consumption and to determine its association with adherence to antiretroviral therapy (ART) and HIV surrogate markers. METHODS: Cross-sectional data on daily alcohol consumption from August 2005 to August 2007 were analysed and categorized according to the World Health Organization definition (light, moderate or severe health risk). Multivariate logistic regression models and Pearson's chi(2) statistics were used to test the influence of alcohol use on endpoints. RESULTS: Of 6,323 individuals, 52.3% consumed alcohol less than once a week in the past 6 months. Alcohol intake was deemed light in 39.9%, moderate in 5.0% and severe in 2.8%. Higher alcohol consumption was significantly associated with older age, less education, injection drug use, being in a drug maintenance programme, psychiatric treatment, hepatitis C virus coinfection and with a longer time since diagnosis of HIV. Lower alcohol consumption was found in males, non-Caucasians, individuals currently on ART and those with more ART experience. In patients on ART (n=4,519), missed doses and alcohol consumption were positively correlated (P<0.001). Severe alcohol consumers, who were pretreated with ART, were more often off treatment despite having CD4+ T-cell count <200 cells/microl; however, severe alcohol consumption per se did not delay starting ART. In treated individuals, alcohol consumption was not associated with worse HIV surrogate markers. CONCLUSIONS: Higher alcohol consumption in HIV-infected individuals was associated with several psychosocial and demographic factors, non-adherence to ART and, in pretreated individuals, being off treatment despite low CD4+ T-cell counts.

Widespread distribution of CTX-M and plasmid-mediated AmpC β-lactamases in Escherichia coli from Brazilian chicken meat

The dissemination of plasmid-mediated antimicrobial resistance genes may pose a substantial public health risk. In the present work, the occurrences ofblaCTX-M and plasmid-mediated ampCand qnrgenes were investigated in Escherichia colifrom 16 chicken carcasses produced by four commercial brands in Brazil. Of the brands tested, three were exporters, including one of organic chicken. Our study assessed 136 E. coli isolates that were grouped into 77 distinct biotypes defined by their origin, resistance profiling, the presence of β-lactamase and plasmid-mediated quinolone resistance genes and enterobacterial repetitive intergenic consensus-polimerase chain reaction typing. TheblaCTX-M-15, blaCTX-M-2 andblaCTX-M-8 genes were detected in one, 17 and eight different biotypes, respectively (45 isolates). Twenty-one biotypes (46 isolates) harboured blaCMY-2.Additionally, blaCMY-2 was identified in isolates that also carried either blaCTX-M-2 orblaCTX-M-8. The qnrB and/orqnrS genes occurred in isolates carrying each of the four types of β-lactamase determinants detected and also in oxyimino-cephalosporin-susceptible strains. Plasmid-mediated extended-spectrum β-lactamase (ESBL) and AmpC determinants were identified in carcasses from the four brands tested. Notably, this is the first description ofblaCTX-M-15 genes in meat or food-producing animals from South America. The blaCTX-M-8, blaCTX-M-15 andblaCMY-2 genes were transferable in conjugation experiments. The findings of the present study indicate that plasmid-mediated ESBL and AmpC-encoding genes are widely distributed in Brazilian chicken meat.

Adhésion thérapeutique du patient chronique: des concepts a la prise en charge ambulatoire [Medication adherence in chronic patients: from its concepts to its management in primary care].

Medication nonadherence is common and its determinants are diverse. Adherence is influenced by many parameters, such as patient's self-efficacy, knowledge of health risk, outcome expectations, benefits of change, and barriers and facilitators. The sociocognitive theory helps professionals to structure their approach and to support patients in managing their treatment. Professionals need skills and time, and benefit from coordination in care, in particular between physicians and pharmacists. This article presents the key elements of a medication adherence program as well as tools and some useful questions.

Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study.

BACKGROUND: Alcohol consumption may affect the course of HIV infection and/or antiretroviral therapy (ART). The authors investigated the association between self-reported alcohol consumption and HIV surrogate markers in both treated and untreated individuals. DESIGN: Prospective cohort study. METHODS: Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures. RESULTS: The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group. CONCLUSIONS: No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.

Financement des hôpitaux par APDRG et compensation des risques entre assureurs

Ce rapport analyse les données (coût par patient et par assureur) du CHUV (Centre hospitalier universitaire vaudois) pour 2002 et 2003 et conclue que la facturation en APDRG n'a pas n'effet de désolidarisation entre les assureurs.

My older sibling was drunk - younger siblings' drunkenness in relation to parental monitoring and the parent-adolescent relationship.

This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.

Inundações urbanas: desafios ao ordenamento do território. O caso da Cidade da Praia (Cabo Verde)

Pela sua posição geográfica e particulares condições climáticas, devidas à sua inserção na faixa saheliana com caraterísticas de marcada aridez, Cabo Verde é um arquipélago com condições naturais adversas, pautado principalmente pela seca prolongada. Muitas vezes esta conjuntura é interpolada por curtos períodos de fortes chuvadas que podem originar cheias e inundações nos principais centros urbanos. Os eventos ocorridos revelam consequências graves, desde prejuízos na agricultura, perda de animais, destruição de infra-estruturas, perda de bens materiais e, mesmo, vítimas humanas mortais. Este estudo tem como objetivos principais: (i) perceber os problemas e desafios que se colocam à cidade da Praia (maior centro urbano do país, com forte crescimento e expansão urbana) perante situações de inundação; (ii) contribuir para o maior conhecimento das causas e consequências dessas inundações; (iii) definir quais as áreas de maior suscetibilidade às cheias e quais as que possuem um maior risco potencial. Optou-se por uma metodologia integrada, através do levantamento bibliográfico, cartográfico, numérico e percetivo (com base em entrevistas e inquéritos). Para o estudo das bacias hidrográficas foram calculados índices morfométricos, definidas classes de permeabilidade do substrato geológico e aplicado o método multicritério de Reis (2011) para a definição das áreas suscetíveis às cheias. Analisaram-se as precipitações máximas diárias anuais e respetivos períodos de retorno, com a aplicação do método de Gumbel. A análise de notícias de jornais, referentes ao período compreendido entre 1980 e 2011, foi fundamental para o conhecimento da distribuição espácio-temporal dos eventos perigosos de inundação em Cabo Verde e na cidade da Praia. Os resultados obtidos revelam um significativo grau de suscetibilidade às cheias na cidade da Praia. As áreas de maior risco potencial às inundações encontram-se no setor central da cidade, resultante da conjugação da convergência do escoamento das três ribeiras principais, da elevada densidade populacional e de construção desordenada nos leitos de cheia e nas áreas deprimidas, onde se acumulam as águas.