Effects of particulate matters on inflammatory markers in the general adult population

Summary: Particulate air pollution is associated with increased cardiovascular risk. The induction of systemic inflammation following particle inhalation represents a plausible mechanistic pathway. The purpose of this study was to assess the associations of short-term exposure to ambient particulate matters of aerodynamic diameter less than 10 μm (PM10) with circulating inflammatory markers in 6183 adults in Lausanne, Switzerland. The results show that short-term exposure to PM10 was associated with higher levels of circulating IL-6 and TNF-α. The positive association of PM10 with markers of systemic inflammation materializes the link between air pollution and cardiovascular risk. Background: Variations in short-term exposure to particulate matters (PM) have been repeatedly associated with daily all-cause mortality. Particle-induced inflammation has been postulated to be one of the important mechanisms for increased cardiovascular risk. Experimental in-vitro, in-vivo and controlled human studies suggest that interleukin 6 (IL-6) and tumor-necrosis-factor alpha (TNF-α) could represent key mediators of the inflammatory response to PM. The associations of short-term exposure to ambient PM with circulating inflammatory markers have been inconsistent in studies including specific subgroups so far. The epidemiological evidence linking short-term exposure to ambient PM and systemic inflammation in the general population is scarce. So far, large-scale population-based studies have not explored important inflammatory markers such as IL-6, IL-1β or TNF-α. We therefore analyzed the associations between short-term exposure to ambient PM10 and circulating levels of high-sensitive CRP (hs-CRP), IL-6, IL-1β and TNF-α in the population-based CoLaus study. Objectives: To assess the associations of short-term exposure to ambient particulate matters of aerodynamic diameter less than 10 μm (PM10) with circulating inflammatory markers, including hs-CRP, IL-6, IL-1β and TNF-α, in adults aged 35 to 75 years from the general population. Methodology: All study subjects were participants to the CoLaus study (www.colaus.ch) and the baseline examination was carried out from 2003 to 2006. Overall, 6184 participants were included. For the present analysis, 6183 participants had data on at least one of the four measured circulating inflammatory markers. The monitoring data was obtained from the website of Swiss National Air Pollution Monitoring Network (NABEL). We analyzed data on PM10 as well as outside air temperature, pressure and humidity. Hourly concentrations of PM10 were collected from 1 January 2003 to 31 December 2006. Robust linear regression (PROC ROBUSTREG) was used to evaluate the relationship between cytokine inflammatory and PM10. We adjusted all analyses for age, sex, body mass index, smoking status, alcohol consumption, diabetes status, hypertension status, education levels, zip code, and statin intake. All data were adjusted for the effects of weather by including temperature, barometric pressure, and season as covariates in the adjusted models. We performed simple and multiple logistic regression analyses. Descriptive statistical analysis used the Wilcoxon rank sum test (for medians). All data analyses were performed using SAS software (version 9.2; SAS Institute Inc., Cary, NC, USA), and a two-sided significance level of 5% was used. Results: PM10 levels averaged over 24 hours were significantly and positively associated with continuous IL-6 and TNF-α levels, in the whole study population both in unadjusted and adjusted analyses. For each cytokine, there was a similar seasonal pattern, with wider confidence intervals in summer than during the other seasons, which might partly be due to the smaller number of participants examined in summer. The associations of PM10 with IL-6 and TNF-α were also found after having dichotomized these cytokines into high versus low levels, which suggests that the associations of PM10 with the continuous cytokine levels are very robust to any distributional assumption and to potential outlier values. In contrast with what we observed for continuous IL-1β levels, high PM10 levels were significantly associated with high IL-1β. PM10 was significantly associated with IL-6 and TNF-α in men, but with TNF-α only in women. However, there was no significant statistical interaction between PM10 and sex. For IL-6 and TNF-α, the associations tended to be stronger in younger people, with a significant interaction between PM10 and age groups for IL-6. PM10 was significantly associated with IL-6 and TNF-α in the healthy group and also in the "non-healthy" group, although the statistical interaction between healthy status and PM10 was not significant. Conclusion: In summary, we found significant independent positive associations of short-term exposure to PM10 with circulating levels of IL-6 and TNF-α in the adult population of Lausanne. Our findings strongly support the idea that short-term exposure to PM10 is sufficient to induce systemic inflammation on a broad scale in the general population. From a public health perspective, the reported association of elevated inflammatory cytokines with short-term exposure to PM10 in a city with relatively clean air such as Lausanne supports the importance of limiting urban air pollution levels.

APROS code benchmarking inboiling water reactor accident analyses

Diplomityö käsittelee kiehutusvesilaitosten transienttien ja onnettomuuksien analysointia APROS-ohjelmiston avulla. Työ on tehty Teollisuuden Voima Oy:n (TVO) Olkiluoto 1 ja 2 laitosyksiköiden mallin pohjalta. Raportissa esitetään ohjelmiston käyttämiä yhtälöitäja laskentamalleja yleisellä tasolla. Työssä esitellään laitoksen yleispiirteet turvallisuustoimintoineen ja kuvataan ohjelmaan suureksi osaksi aiemmin luotua laskentamallia. Työssä on luetteloitu voimassa olevatlisensiointianalyysit, joiden joukosta on valittu laskentatapauksia ohjelmiston suorituskyvyn arviointia varten. Lisäksi työhön on valittu laskentatapauksia muilla kuin lisensointiin käytetyillä ohjelmilla lasketuista analyyseistä. Lisäksi on suoritettu vertailulaskuja konservatiivisen ja realistisen mallin erojen esille saamiseksi. Laskentatapauksia ovat mm. ylipainetransientti, jäähdytteen menetysonnettomuus ja oletettavissa oleva käyttöhäiriö, jossa pikasulku ei toimi (ATWS). Diplomityön edetessä laitosmallia on kehitetty edelleen lisäämällä joitakin järjestelmiä ja tarkentamalla joidenkin komponenttien kuvausta. Työssä ilmeni, että APROS soveltuu jäähdytteenmenetysonnettomuuden ja suojarakennuksen yhtäaikaiseen analyysiin. APROS.n vaste nopeisiin transientteihin jäi kuitenkin vertailutasosta. Tämän työn perusteella APROS-mallia kehitys jatkuu edelleen siten, että se soveltuisi entistä paremmin myös nopeiden transienttien ja ATWS-tilanteiden kuvaamiseen. Työssä olevaa lisensointianalyysien kuvausta tullaan käyttämään hyväksi selvitettäessä laitoksen turvallisuuden väliarviossa tarvittavien analyysien määrää ja laatua. Nyt saatuja kokemuksia voidaan hyödyntää myös mahdollisen kolmiulotteisen sydänmallin hankinnassa APROS-ohjelmistoon. Tässä diplomityössä esitettyjä parannuksia voidaan käyttää hyväksi SAFIRtutkimusohjelman hankkeiden suunnittelussa.

Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study.

BACKGROUND: Migration is one of the major causes of tuberculosis in developed countries. Undocumented patients are usually not screened at the border and are not covered by a health insurance increasing their risk of developing the disease unnoticed. Urban health centres could help identify this population at risk. The objective of this study is to assess the prevalence of latent tuberculosis infection (LTBI) and adherence to preventive treatment in a population of undocumented immigrant patients. METHODS: All consecutive undocumented patients that visited two urban healthcare centres for vulnerable populations in Lausanne, Switzerland for the first time were offered tuberculosis screening with an interferon-gamma assay. Preventive treatment was offered if indicated. Adherence to treatment was evaluated monthly over a nine month period. RESULTS: Of the 161 participants, 131 (81.4%) agreed to screening and 125 had complete examinations. Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis. Only five patients with LTBI completed full preventive treatments. Five others initiated the treatment but did not follow through. CONCLUSION: Screening for tuberculosis infection in this hard-to-reach population is feasible in dedicated urban clinics, and the prevalence of LTBI is high in this vulnerable population. However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

Laadullinen tutkimus metsäteollisuuden ohjelmistotoimittajista Kaakkois-Suomessa: Nykytilanne

Tutkimuksen tavoitteena on selvittää paikallisten metsäteollisuuteen toimittavien pienten ja keskisuurten ohjelmistoyritysten nykytilannetta, hyviä käytäntöjä ja toiminnan ongelmia. Tunnistamalla pienten ja keskisuurten ohjelmistoyritysten nykytilanne on mahdollista suunnitella konkreettisia yrityksille suunnattavia kehittämistoimenpiteitä. Työssä on keskitytty tutkimaan metsäteollisuuteen toimittavia kaakkoissuomaisia pieniä ja keskisuuria ohjelmistoyrityksiä. Työn viitekehyksenä esitellään metsäteollisuuden nykytilannetta, kehitystrendejä sekä kehitystrendien vaikutusta metsäteollisuusyritysten tietojärjestelmätarpeisiin. Lisäksi työn viitekehyksessä esitellään tutkimuksessa käytetyt kvalitatiiviset tutkimusmenetelmät.Tutkimus on luonteeltaan kvalitatiivinen eli laadullinen ja tutkimusotteeltaan deskriptiivinen eli kuvaileva. Tutkimusaineisto koostui 19 asiantuntijahaastattelusta ja dokumenttiaineistosta. Tutkimusaineiston analysoinnissa käytin aineistopohjaista meneelmää ja tapaustutkimusta. Tutkimustulosten perusteella pystyttiinkuvaamaan tutkimuksessa mukana olleille 10 paikalliselle pienelle ja keskisuurelle ohjelmistoyritykselle yhteisiä ominaisuuksia. Tämän lisäksi pystyttiin tunnistamaan ohjelmistoyrityksistä kolme erilaista tyyppiä ja luonnehtimaan kunkin tyypin nykytilannetta, hyviä käytäntöjä ja toiminnan ongelmia. Tunnistetut paikallisten pienten ja keskisuurten ohjelmistoyritysten tyypit ovat: erikoistuja, ennakoija ja keräilijä. Tutkimustulokset antavat hyvän lähtökohdan tulevaisuuden kehitystrendien tunnistamisessa ja toiminnankehitystoimenpiteiden suunnittelussa.

Genetic association analyses reveal a role for vitamin D insufficiency in hepatitis C virus-associated hepatocellular carcinoma development

Background: V itamin D insufficiency has been associated with the occurrence of various types of cancer, but causal relationships remain elusive. Methods: Associations between t he r isk o f HCV-related HCC development and CYP2R1 , GC, and DHCR7 genotypes, which are genetic determinants of reduced 25-OH-vitamin D3 (25[OH]D3) serum levels, were determined. Results: A t otal of 5604 HCV-infected patients, 1279 with a nd 4325 without progression to HCC, w ere identified. The well-known association between 25(OH)D3 s erum levels and variations in CYP2R1 ( rs1993116, rs10741657), GC ( rs2282679), a nd DHCR7 ( rs7944926, rs12785878) g enotypes was also apparent in patients w ith chronic hepatitis C. The same genotypes of t hese single nucleotide polymorphisms (SNPs), w hich are associated with reduced 25(OH)D3 s erum levels, were significantly associated with HCV-associated HCC (P=0.07 [OR=1.13] for CYP2R1 , P=0.007 [OR=1.56] for GC, P=0.003 [OR=1.42] for DHCR7; ORs for risk genotypes). In contrast, no association between t hese genetic variations and the o utcome of antiviral therapy with pegylated interferon-α and ribavirin ( P>0.2 for e ach SNP) or liver fibrosis progression rate (P>0.2 for each SNP) was observed, s uggesting a specific influence o f the genetic d eterminants of 25(OH)D3 s erum levels o n hepatocarcinogenesis. Conclusions: Our data suggest a relatively weak but functionally relevant role for vitamin D in the prevention of HCV-related HCC development. Controlled clinical trials to assess the benefit of vitamin D supplementation in HCVinfected patients with advanced liver fibrosis or cirrhosis are warranted.

Uudistumiskykyinen strategian toteuttaminen, case Oy Hartwall Ab

Tutkielman tutkimusongelmana oli, miten organisaatio voi toteuttaa strategiaansa uudistumiskykyisesti. Tutkimusongelmaa tutkittiin kartoittavasti, kuvailevasti ja selittävästi. Tutkimuksessa lähdettiin liikkeelle strategian toteuttamisen teoreettisen tarkastelupohjan rakentamisesta. Strategian toteuttamisen näkökulmat yhdistettiin Ståhlen (1999) kehittämään kolmiulotteiseen tietoympäristömalliin. Tämänsynteesin pohjalta luotiin uudistumiskykyinen strategian toteuttaminen -malli. Mallin perusteella vastattiin tutkimusongelmaan ja ehdotettiin case-yritykselle strategian toteuttamisen kehittämistoimenpiteitä. Tutkielman tutkimusstrategiana käytettiin Survey-tutkimusta. Tällä pyrittiin tutkimaan case-yrityksen myyntiorganisaation uudistumiskyvyn tasoa ja analysoimaanuudistumiskyky -mittauksen tulosten pohjalta organisaation uudistumiskykyistä strategian toteuttamista. Tutkimuksen metodiksi valittiin kyselylomakepohjainen KM-factor¿-mittari. KM-factor¿-mittaus suoritettiin case-yritys Oy Hartwall Ab:ssä kevään 2004 aikana. Mittauksen perusjoukkona oli Oy Hartwall Ab:n myyntiorganisaatio. Mittauksen otoskoko oli N=64, henkilöstö: N=49, johto: N=15. Henkilöstönvastausprosentti oli 71 %:a ja johdon 78 %:a. Kyselylomake oli internet-pohjainen. KM-factor¿-mittauksen tulokset analysoi businessXray Oy. Tutkielman tekijä analysoi KM-factor¿-mittauksen tuloksia hyödyntämällä uudistumiskykyinen strategian toteuttaminen -mallia. Organisaatio voi toteuttaa strategiaansa uudistumiskykyisesti toteuttamalla ja uudistamalla strategiaansa yhtenäisesti strategisen fokuksensa mukaisesti. Tämä onnistuu toteuttamalla strategiaa uudistumiskykyisen strategian toteuttamisen -mallin mukaisesti. Mallia hyödyntämällä organisaation johto kykenee organisoimaanstrategian toteutuksen yrityksen strategisen fokuksen mukaisesti.

Longitudinal analyses of immune responses to Plasmodium falciparum derived peptides corresponding to novel blood stage antigens in coastal Kenya

We have recently described 95 predicted alpha-helical coiled-coil peptides derived from putative Plasmodium falciparum erythrocytic stage proteins. Seventy peptides recognized with the highest level of prevalence by sera from three endemic areas were selected for further studies. In this study, we sequentially examined antibody responses to these synthetic peptides in two cohorts of children at risk of clinical malaria in Kilifi district in coastal Kenya, in order to characterize the level of peptide recognition by age, and the role of anti-peptide antibodies in protection from clinical malaria. Antibody levels from 268 children in the first cohort (Chonyi) were assayed against 70 peptides. Thirty-nine peptides were selected for further study in a second cohort (Junju). The rationale for the second cohort was to confirm those peptides identified as protective in the first cohort. The Junju cohort comprised of children aged 1-6 years old (inclusive). Children were actively followed up to identify episodes of febrile malaria in both cohorts. Of the 70 peptides examined, 32 showed significantly (p<0.05) increased antibody recognition in older children and 40 showed significantly increased antibody recognition in parasitaemic children. Ten peptides were associated with a significantly reduced odds ratio (OR) for an episode of clinical malaria in the first cohort of children and two of these peptides (LR146 and AS202.11) were associated with a significantly reduced OR in both cohorts. LR146 is derived from hypothetical protein PFB0145c in PlasmoDB. Previous work has identified this protein as a target of antibodies effective in antibody dependent cellular inhibition (ADCI). The current study substantiates further the potential of protein PFB0145c and also identifies protein PF11_0424 as another likely target of protective antibodies against P. falciparum malaria

Les pédagogues de Port-Royal : Saint-Cyran, de Saci, Lancelot, Guyot, Coustel, Le Maitre, Nicole, Arnauld, etc., Jacqueline Pascal, histoire des "Petites écoles" ([Reprod.]) / notices, extraits et analyses avec des notes par I. [Irénée] Carré,...

Collection : Archives de la linguistique française ; 75

Short communication. SNP analyses of the 5HT1R and STAT genes in Pacific white shrimp, Litopenaeus vannamei

La industria de la producción de camarón es una de las industrias acuícolas que se encuentra en más crecimiento en la actualidad. Los estudios para encontrar marcadores genéticos son muy efectivos para la mejora de sus propiedades y de gran interés para los productores de camarón. En este trabajo se utilizaron seis individuos de una población de Litopenaeus vannamei, donde se encontraron cuatro polimorfismos de nucleótido único (SNPs) en el gen 5HT1R (5-hidroxitriptamina receptor1) y un SNP en el gen STAT (transductor de señal y activador de la transcripción). Sin embargo, el polimorfismo en el gen STAT resultó ser homocigoto en una población diferente utilizada para análisis de asociación. Los presentes análisis revelaron que el alelo C, en dos polimorfismos SNP (C109T y C395G) del gen 5HT1R, tiende a estar asociado con el aumento del peso corporal. Consideramos que hay necesidad de hacer nuevos estudios utilizando una muestra más amplia y diversa de la población en cuestión.

Administrations publiques et autorités cantonales : analyses sur la base des résultats de l'enquête BADAC sur les administrations cantonales 2004

Les administrations publiques et les autorités politiques sont méconnues sur le plan suisse, notamment au niveau cantonal. Les thèmes traités dans cette étude couvrent les structures administratives, le personnel de la fonction publique ainsi que les autorités politiques cantonales (gouvernements et parlements). L'étude dresse le portrait des acteurs du secteur public en tenant compte de l'âge, du sexe, de l'expérience et du statut d'emploi. Elle présente également la force des partis dans les parlements et les gouvernements sous forme de graphiques, de cartes et de tableaux. L'étude s'inscrit dans le cadre des travaux d'analyses de la BADAC (Base de données des cantons et des villes suisses). Elle présente les résultats de la dernière enquête sur les administrations cantonales (ESAC04), complétés par des données de l'Office fédéral de la statistique. Les résultats sont ventilés par canton mais aussi selon la langue majoritaire dans le canton. La plupart des données peuvent être téléchargées depuis le site de la BADAC (www.badac.ch ). Les indicateurs retenus possèdent des codes d'identification avec un système de renvoi aux sources et aux méthodes de calculs.

Identification and mutational analyses of phosphorylation sites of the calcineurin-binding protein CbpA and the identification of domains required for calcineurin binding in Aspergillus fumigatus.

Calcineurin is a key protein phosphatase required for hyphal growth and virulence in Aspergillus fumigatus, making it an attractive antifungal target. However, currently available calcineurin inhibitors, FK506 and cyclosporine A, are immunosuppressive, limiting usage in the treatment of patients with invasive aspergillosis. Therefore, the identification of endogenous inhibitors of calcineurin belonging to the calcipressin family is an important parallel strategy. We previously identified the gene cbpA as the A. fumigatus calcipressin member and showed its involvement in hyphal growth and calcium homeostasis. However, the mechanism of its activation/inhibition through phosphorylation and its interaction with calcineurin remains unknown. Here we show that A. fumigatus CbpA is phosphorylated at three distinct domains, including the conserved SP repeat motif (phosphorylated domain-I; PD-I), a filamentous fungal-specific domain (PD-II), and the C-terminal CIC motif (Calcipressin Inhibitor of Calcineurin; PD-III). While mutation of three phosphorylated residues (Ser208, Ser217, Ser223) in the PD-II did not affect CbpA function in vivo, mutation of the two phosphorylated serines (Ser156, Ser160) in the SP repeat motif caused reduced hyphal growth and sensitivity to oxidative stress. Mutational analysis in the key domains in calcineurin A (CnaA) and proteomic interaction studies confirmed the requirement of PxIxIT motif-binding residues (352-NIR-354) and the calcineurin B (CnaB)-binding helix residue (V371) for the binding of CbpA to CnaA. Additionally, while the calmodulin-binding residues (442-RVF-444) did not affect CbpA binding to CnaA, three mutations (T359P, H361L, and L365S) clustered between the CnaA catalytic and the CnaB-binding helix were also required for CbpA binding. This is the first study to analyze the phosphorylation status of calcipressin in filamentous fungi and identify the domains required for binding to calcineurin.

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

Background: Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region. Methods: Population-based (n = 206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4 months and when patients withdrew more than 80% of the packs required. Results: 5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives = 3 months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42). Conclusions: In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.

Perusterveydenhuollon ja erikoissairaanhoidon käytön seuranta ja ennakointi kuntanäkökulmasta

Follow-up of utilisation and prediction of primary health care and hospital care from the municipality point of view. Planning, follow-up, and evaluation of primary health care within municipality entail comprehensive information about factors that influence health. In addition to populationbased research, various statistical data and registries serve as sources of information. The present study examined utilisation of primary health care and hospital care with the existing databases, registries, and categorization of Diagnosis Related Groups (DRGs) from the municipality (purchaser) point of view. Research involving the cases of Paimio, Sauvo, and Turku as examples of municipalities pointed out that, even in the small municipalities, it is possible to assess and predict health services to be offered to the inhabitants by following databases and registries. Health-related databases and registries include a plenty of possible uses that have not adequately been employed at the level of municipality. Descriptive futures research and community analysis formed the framework of the study. Descriptive futures research may be used to establish predictions based on past developmental traditions, and quantitative time trend analyses may be employed to make estimations about future events. Community analysis will assist in making conclusions about population- based health care needs, in assessing the functionality or effectiveness of the health care system, and in appropriately targeting limited resources. The aim of the present study was to describe the health service profile so that the arrangements and planning of health services as well as the contract negotiations of hospital care become easier within municipalities. Another aim was to assess the application of Hilmo (registry for posting hospital care periods), Aitta and Sotka (statistical databases) for the purposes of resource planning in the procurement of hospital care. A third aim was to evaluate how the system of the DRGs adapts in the prediction of retaining health services within short (1-year), intermediate (5-year) and long range (10-15-year) intervals. The findings indicated that the follow-up of primary health care utilisation combined with follow-up of hospital care utilisation allows municipalities to plan and predict health services when databases are applied. Information about the past contacts with the databases has indicated that the health care culture and incidence of disease change rather slowly in the area of investigation. For the purposes of health care research, it is recommended that methods of application used in making predictions about health care utilisation need to be further developed

Data triangulation in the context of opioids monitoring via wastewater analyses.

BACKGROUND: The need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area. METHODS: Wastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed. RESULTS: Methadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys. CONCLUSIONS: The results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13gday(-1) (118gday(-1) at street level).