Adhésion au traitement de la maladie rénale chronique chez les québécois âgés de 18 ans ou plus

Introduction La progression de la maladie rénale chronique (MRC) augmente le risque des maladies cardiovasculaires. L’hypertension, le diabète et la dyslipidémie sont à la fois des facteurs de risque et des comorbidités de la MRC. Chez les individus souffrant de MRC, la persistance et l’observance du traitement de ces facteurs de risque, i.e. le traitement antihypertenseur (TAH), le traitement hypolipémiant (THL) et le traitement antidiabétique (TAD) contribuent à réduire le risque de mortalité et de morbidité cardiovasculaires. Néanmoins, la persistance et l’observance de ces traitements restent encore peu étudiées chez les individus ayant la MRC. Objectifs: Spécifiquement pour chacun des trois traitements (TAH, THL et TAD), une étude de cohorte a été menée dans le but : 1) d’estimer la persistance à prendre le traitement un an après le début du traitement; 2) d’estimer l’observance du traitement au cours de l’année suivant le début du traitement chez les persistants; 3) d’identifier les facteurs associés à la persistance; et 4) d’identifier les facteurs associés à l’observance. Méthodologie: Nous avons utilisé les banques de données administratives de la Régie de l’assurance maladie du Québec (RAMQ) pour mener trois études de cohorte chez les personnes âgées de 18 ans ou plus. Une étude a été conduite chez les individus qui ont commencé un TAH, l’autre conduite chez les patients ayant commencé un THL et la dernière menée chez les nouveaux utilisateurs de TAD. Les individus qui poursuivaient encore leur traitement un an après son début ont été considérés persistants. Parmi les persistants, les patients qui ont eu une proportion de jours couverts (PJC) ≥ 80 % ont été considérés observants. Les facteurs associés à la persistance et ceux associés à l’observance ont été identifiés à l’aide d’une régression de Poisson modifiée. Résultats: Parmi les 7 119 patients ayant débuté un TAH, 78,8 % ont été persistants et 87,7 % des persistants ont été observants. Les individus qui étaient plus susceptibles d’être persistants se trouvaient dans le groupe des utilisateurs de monothérapie d’inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (Rapport de prévalences (RP) : 1,20; intervalle de confiance (IC) à 95 % : 1,13-1,27), d’antagonistes du récepteur de l’angiotensine II (ARA) (1,22; 1,14-1,31), de bloquants des canaux calciques (BCC) (1,20; 1,14-1,26), de bêta-bloquants (BB) (1,16; 1,10-1,23) et de multithérapie (1,31; 1,25-1,38) (référence : monothérapie de diurétiques (DIU)). Les individus qui étaient plus susceptibles d’être observants étaient les utilisateurs de monothérapie d’IECA (1,08; 1,03-1,04), de BB (1,10; 1,05-1,15), de BCC (1,10; 1,05-1,15) et de multithérapie. Des 14 607 individus ayant débuté un THL, 80,7 % ont persisté à le prendre; de ces derniers, 88,7 % étaient observants du THL. Les patients qui étaient plus susceptibles d’être persistants étaient ceux ayant un statut socio-économique (SSE) faible (1,03; 1,01-1,06) (référence : SSE élevé) et ceux dont le traitement initial avait été prescrit par un néphrologue (1,06; 1,04-1,09) (référence : omnipraticien). Les individus qui étaient plus susceptibles d’être observants étaient ceux âgés ≥ 66 ans (référence : 18-65) (1,04; 1,01-1,07), ceux ayant un SSE faible (1,08; 1,06-1,10) et ceux qui avaient pris plus de 12 médicaments différents (référence : <7) (1,03; 1.00-1,05). Sur un total de 6 671 individus ayant débuté un TAD, 76,9 % ont persisté à prendre le traitement. Parmi les persistants, 87,9 % étaient observants. Les individus ayant un SSE faible (1,04; 1,01-1,07) (référence : SSE élevé) ou une multithérapie (1,12; 1,08-1,16) (référence : monothérapie de metformine) étaient plus susceptibles d’être persistants, tout comme ceux ayant une comorbidité dont l’hypertension artérielle (1,04; 1,01-1,07), la dyslipidémie (1,06; 1,03-1,10), l’accident vasculaire cérébral (AVC) (1,05; 1,01-1,11) ou la maladie coronarienne (1,03; 1,01-1,06). Les individus plus susceptibles d’être observants étaient ceux ayant un SSE moyen (1,03; 1,01-1,07) ou une multithérapie (1,06; 1,03-1,09). Conclusion: Peu importe le traitement initié par les individus souffrant de MRC, environ 30% des patients ne seraient pas persistants un an après le début du traitement ou observants dans l’année suivant l’initiation. Certains facteurs sont associés de façon consistante à la persistance, par exemple l’AVC, la maladie coronarienne et le nombre de visites médicales, alors que l’âge et le SSE sont associés à l’observance peu importe que le traitement initial soit un TAH, un THL ou un TAD.

Prevalencia de síndrome metabólico y factores de riesgo asociados en trabajadores y empleados del Hospital Vicente Corral Moscoso, 2006

Se realizó un estudio transversal; en un universo de 623 personas con una muestra de 200 calculada al azar sobre la base de una prevalencia del síndrome metabólico del 25, con un nivel de confianza del 95y un error de inferencia del 5. Los datos se obtuvieron por entrevista directa y se analizaron con el software Epi-Info. La prevalencia general del síndrome metabólico fue del 27.5, con un intervalo al 95de confianza entre 21.32 y 33.68 (IC 95). La asociación con el sedentarismo proporcionó una p=0.54, razón de prevalencia PR 1.15 (IC 950.73-1.81 y con el sobrepeso p= 0.018 PR 2.12 (IC95 1.07-4.18). La prevalencia del símbolo estratificada por áreas de trabajo fue del 24.8(IC 9517.46-32.14) en las personas que trabajan en departamentos y la estratificada por grupos de edad demostró que la prevalencia se encrementa con los años y la mas alta fue del 60en las personas mayores de 60 años. Conclusión: la prevalencia del síndrome metabólico fue del 27.5(IC9521.32-33-68). Se encontró asociación significativa con el sobrepeso y no significativa con el sedentarismo

Prevalencia y factores de riesgo en amenaza de parto pretérmino en las pacientes atendidas en el Hospital Vicente Corral Moscoso en el año 2006

Se realizó un estudio observacional de tipo transversal. Se analizaron como factores de riesgo asociados: parto pretérmino previo, infección de vías urinarias, anemia, embarazo múltiple, trastornos hipertensivos, control prenatal y edad. La muestra fue propositiva, no aleatoria (728 mujeres) se calculó mediante Epi Info v 3.2.2 con los siguientes criterios: tamaño poblacional 4000 partos, prevalencia esperada 10, precisión 2, nivel de confianza 95La información fue obtenida directamente de las pacientes por medio de encuestas y exámenes clínicos y de laboratorio correspondientes. Los datos se procesaron en Epi Info. Resultados: la prevalencia de Amenaza de Parto pretérmino fue del 13. Los factores de riesgo asociados fueron: parto pretérmino previo (RP 3.05, IC 951.8-4.9), infección de vías urinarias (RP 3.99 IC 952.7-5.8); anemia (RP 1.70 IC 951.17-2.47). El control prenatal (RP 1.41 IC 950.96-2.08), embarazo múltiple (RP 2.34 IC 950.89-6.15), son factores asociados pero no estadísticamente significativa. En tanto que los trastornos hipertensivos (RP 0.45 IC 950.19-1.07) y la edad menor de 19 o mayores de 35 años (RP 0.92 IC 950.60-1.42) son factores protectores pero no estadísticamente significativa. Conclusiones: la prevalencia de APP en el HVCM es de 13. Los factores asociados son: el antecedente de parto pretérmino, la infección de vías urinarias y la anemia

Effectiveness of inulin intake on indicators of chronic constipation; a meta-analysis of controlled randomized clinical trials

Background: Constipation is an intestinal dysfunction. Prebiotics, such as inulin, can improve bowel function by positively influencing intestinal biota. Aim: To analyze the scientific evidence for the role of inulin in improving bowel function in patients with chronic constipation. Methods: A meta-analysis of randomized controlled clinical trials was conducted, grounded on a literature search for the period 1995-2013 (descriptors: inulin & constipation) on PubMed, ScieLo and Central Trials Register Cochrane databases. A total of 24 articles were found, 5 of them were selected for this meta-analysis, involving 252 subjects (experimental group: n = 144, control group: n = 108). The quality of the studies was assessed using the Jadad scale. Results: We found a significant overall effect of inulin on stool frequency (DEM = 0.69, 95%CI: 0.04, 1.34), stool consistency (Bristol scale) (DEM = 1.07, 95% CI: 0.70, 1.45), transit time (DEM = -0.57, 95% CI: -0.99, -0.15) and hardness of stool (RR = 0.42, 95% CI: 0.26, 0.70). Pain and bloating do not improve with inulin intake. Conclusions: inulin intake has a positive effect on bowel function.

Market work and household production in Brazil

This thesis is composed of three papers in which the research questions are related to the double burden that accrues to Brazilian women. The first and second papers address this issue by looking at expenditure decisions about home production. The first paper examines whether the expenditure decisions about production goods, such as white appliances, relative to entertainment goods, such as TVs, are the outcome of a bargaining process between husbands and wives. The second paper looks at the demand for maid services and for production durable goods, examining the extent to which other household members substitute for maid services and durable goods in home production. The third paper addresses the effects of Brazilian women's double burden on their labor market participation by examining whether the occupational choice of Brazilian women is affected by their gender roles and whether entry into other occupations that are not identified as female occupations has become easier since the introduction of anti-discrimination laws in the labor market. The first paper combines two Brazilian data sets: a Brazilian household expenditure survey, Pesquisa de Orçamento Familiares (POF), and a Brazilian household survey, Pesquisa Nacional Por Amostra de Domicílios (PNAD). The results of the first paper indicate that the decision about durable goods ownership is the outcome of a bargaining process between husband and wife. The test on the coefficients of the marriage market variable and the indicators of households in which only the wife and households in which only the husband makes expenditure decisions corroborate the expectations about wives' preferences for production goods. The same data sets as the first paper are used in the second paper. The finding of the second paper indicates that if the marriage market is favorable to women, that is if the ratio of women to men goes from 1.07 to 0.96, the increment in the household probability of owning at least one maid's substitute durable goods is equivalent to 24% the impact of moving a household up one income quintile. Moreover, the results indicate that daughters' time substitutes for wives' time and maid services in home production. Parents may want daughters trained in home production to be able to perform their future role as wives. However, this training comes at a cost to daughters' investment in formal education, narrowing their future career options. The data used in the third paper come from a Brazilian household survey, Pesquisa Nacional Por Amostra de Domicílios (PNAD). Gender roles are responsible for women to choose female-dominated occupations, married women are 1.14 times more likely to work in female-dominated occupations and having a child six years and older increases on average by 12% the probability that women work in female-dominated occupations instead of genderintegrated occupations in 2001. However, it becomes easier for all types of women to enter into male-dominated and gender-integrated occupations in 2001 compared to 1981.

Prevalencia de la periodontitis y factores de riesgo en los trabajadores de la compañía GUAPAN, entre agosto del 2002 y marzo del 2003

Se estudia la prevalencia de la periodontitis con el íncice periodontal CPITN [Indice Comunitario de Necesidades de Tratamiento Periodontal] recomendado por la Organización Mundial de la Salud [OMS] y factores de riesgo en 243 trabajadores entre 25-76 años de edad, de la Compañía Industria Guapán S.A. [CIGSA], ubicada en la ciudad de Azogues, provincia del Cañar, Ecuador, Sur América. El trabajo fue aprobado por el Comité de Etica de la Facultad de Ciencias Médicas de la Universidad de Cuenca y el consentimiento se recibió en forma verbal. La prevalencia de la periodontitis fue de 25.5 por ciento; luego se analizó la relación entre la presentación o no de la periodontitis y la exposición o no al factor de riesgo; la relación entre el factor y la periodontitis, así como, el grado de esa asociación se determinó mediante el parámetro razón de la prevalencia [RP], con su respectivo IC al 95 por ciento, obteniendo los siguientes resultados: Mal hábito de higiene oral RP 4.71, IC 95 por ciento, 1.20-18.37; incremento de edad RP 1.83, IC 95 por ciento 1.09-3.10; bajo nivel de instrucción RP 1.89, IC 95 por ciento 1.07-3.34; prótesis parcial removible defectuosa [PPRD] RP 1.75, IC 95 por ciento 1.13-2.69; y, hábito de fumar RP 1.59, IC 95 por ciento 1.02-2.46; por tanto, al relacionar la periodontitis con los factores de riesgo estudiados, se encontró una asociación significativa con cada uno de ellos

Caractérisation des maladies respiratoires en lien avec les problématiques d’humidité excessive ou de moisissures dans les logements des étudiants universitaires

Résumé : PROBLÉMATIQUE: L’exposition résidentielle à l’humidité excessive ou aux moisissures est maintenant reconnue comme un facteur important influençant la santé respiratoire. Cette problématique a été peu étudiée chez les étudiants universitaires, bien que vulnérables par leur faible revenu et leur statut de locataire. OBJECTIFS: Cette maîtrise vise à décrire la prévalence (a) de l’exposition résidentielle à l’humidité excessive ou aux moisissures et (b) des maladies respiratoires chez les étudiants universitaires, ainsi qu’à (c) examiner l’association entre l’exposition résidentielle à l’humidité excessive ou aux moisissures et ces maladies. MÉTHODES: En 2014, une enquête électronique a été réalisée auprès de 2097 étudiants enregistrés à l’Université de Sherbrooke (Québec, Canada). Lorsque possible, des questions et des scores validés ont été utilisés pour estimer les prévalences des maladies respiratoires (rhinite allergique, asthme et infections respiratoires), de l’exposition résidentielle à l’humidité excessive ou aux moisissures et des covariables (ex. : revenu annuel familial, statut tabagique, atopie familiale, caractéristiques de l’étudiant). Les associations entre cette exposition et ces maladies ont d’abord été examinées par des tests de chi-carré en utilisant un seuil alpha de 0,05. Des régressions logistiques multivariées ont ensuite été utilisées pour déterminer les associations brutes et ajustée entre cette exposition et les maladies respiratoires. Les analyses descriptives ont été pondérées pour le sexe, l’âge et le campus d’étude. RÉSULTATS: L’exposition à l’humidité excessive ou aux moisissures était fréquente parmi les participants (36,0%; Intervalle de confiance (IC)95% : 33,9-38,1). Ceux-ci ont également été nombreux à rapporter une rhinite allergique (23,9%; IC95% :22,0-25,8), de l’asthme (32,6%; IC95% : 30,5-34,7) et des infections respiratoires (19,4%; IC95% :17,7-21,2) au cours de la dernière année. Après ajustement, les associations demeuraient significatives entre l’exposition à l’humidité excessive ou aux moisissures et la rhinite allergique (Rapport de cote (RC) : 1,30; IC95% : 1.05-1.60), l’asthme RC : 1,75; IC95% : 1,42-2,16), mais pas les infections respiratoires (RC : 1,07; IC95% : 0,85-1.35). CONCLUSIONS: La prévalence élevée de l’exposition résidentielle des étudiants universitaires à l’humidité excessive ou aux moisissures, de même que son association avec l’asthme et la rhinite allergique, mettent en lumière sa contribution potentielle à la forte prévalence des maladies respiratoires ayant une composante allergique dans cette population. Cette étude fournit un nouveau levier pour les organisations de santé publique et leurs partenaires afin d’adapter les stratégies préventives ciblant les logements insalubres, particulièrement chez les populations vulnérables.

Produção de carboidratos a partir do efluente de laticínios tratado por cianobactéria

Nesta tese foi demonstrado o potencial de produção de carboidratos por Aphanothece microscopica Nägeli cultivada no efluente oriundo de uma indústria de laticínios. Para tanto, o trabalho é composto de quatro artigos que objetivaram avaliar a produção de carboidratos em função da temperatura, inóculo e razões C/N e N/P do elfluente, bem como a possibilidade de reúso da água residuária. Foram utilizadas temperaturas de (10, 20 e 30ºC) e inóculo (100, 200 e 300 mg.L-1). A melhor condição indicada foi quando utilizou-se a temperatura de 30°C e 200 mg.L-1 de inóculo. Na sequência, considerando a temperatura e a concentração celular selecionada, foi estudada a influência das razões C/N e N/P na produção de carboidratos. Para tal, C/N (20, 40 e 60) e N/P (5, 10 e 15) na produção de carboidratos extracelulares foram avaliadas em cultivos a 30°C, tendo como inóculo 200 mg.L-1. Os melhores resultados obtidos, foram quando foi utilizado C/N 60 e N/P 10. Uma vez definidas as melhores condições de produção de carboidratos, foi estudado o processo de separação de biomassa do meio de cultivo, a partir dos coagulantes FeCl3, Al2(SO4)3 e tanino. O efeito dos coagulantes na separação da biomassa foram estudados, quanto ao pH (6,0, 7,0 e 8,0) e concentração de coagulantes (50, 300 e 550 mg.L-1), utilizando como parâmetro de medida, a eficiência de remoção de DQO, turbidez e sólidos suspensos (SS). Os resultados demonstraram que as concentrações de coagulantes influenciaram significativamente ao nível de significância de 5 %, na separação da biomassa, com eficiência significativa na remoção da DQO, turbidez e SS. A melhor condição avaliada foi a que utilizou tanino na concentração de 300 mg.L-1 e pH 7,0, o que resultou em uma água residuária com remoção média de 96 % da turbidez, com potencial de ser reutilizada. Por fim, foi realizada a identificação de carboidratos gerados por Aphanothece microscopica Nägeli. Os resultados evidenciaram uma biomassa com até 33,5 % de carboidratos totais, perfazendo uma fração de carboidratos extracelulares, na fase estacionária de crescimento celular, de aproximadamente 25 % e 8 % os carboidratos da parede celular. Ficou demonstrado ainda que a composição dos carboidratos extracelulares do microorganismo em estudo é constituído por mono e dissacarídeos perfazendo concentrações na ordem de 12,88 % de glicose, 3,54 % de rafinose, 3,43 % sacarose, 2,13 % de frutose e 2,45 % de ribose. Ficou demonstrado o potencial de produção de carboidratos por Aphanothece microscopica Nägeli quando cultivada no efluente da indústria de laticínios.

Comunidade fitoplanctônica e qualidade da água da Lagoa do Jiqui, Parnamirim, RN

It is important to evaluate the quality of water for proper management of these resources, since the increase of environmental degradation and the multiple use of water resources are decreasing the quality of water consumed by living beings. The objective of this study was to characterize the phytoplankton community and its variations during periods of dray and rain in Jiqui Lake located in Parnamirim, RN. It was also aimed to analyze the physical and chemical factors of this environment, in order to contribute to the knowledge of water quality used for human consumption. The collection of water samples were carried out in September 2008 to August 2009. The collection of the phytoplankton community was carried out in four sampling sites (surface, bottom, margin of the lake without macrophytes and site dominated by macrophytes). Phytoplankton was collected using plankton net of 20m. The analysis of nutrients and identification of phytoplankton were performed in the laboratory. The results indicate that concentration of chlorophyll a was high in the bottom with mean value of 1.07 μgL-1 (SD ± 1.61). During the study period there was a dominance of the following species: Euglena gracilis, Trachelomonas sp, Cyclotellas sp, Gomphonema apuncto, Navicula cuspidata var. cuspidata, Navicula sp, Rhopalodia gibba. There was homogeneity between limnological values in the four study sites, with significant difference between the periods of drought and rain. The Jiqui Lake is considered oligotrophic due to its low concentrations of chlorophyll a, high transparency and low levels of nutrients. The values of BOD and chlorophyll a concentration remained below the permitted standards existing for freshwaters in Brazil, thus the water from Lake Jiqui is of good quality, suitable for human consumption.

Sensitivity and specificity of the Gastrointestinal Short Form Questionnaire in diagnosis of gastroesophageal reflux disease

Introduction: Gastrointestinal Short Form Questionnaire (GSFQ) is a questionnaire for gastroesophageal reflux disease (GERD) diagnosis, with a version in Spanish language, not yet compared to an objective test. Aims: To establish GSFQ diagnostic performance against 24-hour pH monitoring carried out in two tertiary care hospitals. Methods: Consecutive adult patients with typical GERD symptoms (heartburn, regurgitation) referred for pH monitoring fulfilled the GSFQ (score range 0-30, proportional to probability of GERD). Diagnosis of GERD was established when acid exposure time in distal esophagus was superior to 4.5% or symptom association probability was greater than 95%. Receiver-operator characteristic (ROC) curves were calculated and best cut-off score determined, with corresponding sensitivity, specificity and likelihood ratios (LR) (95% confidence interval for each). Results: One hundred and fifty-two patients were included (59.9% women, age 47.9 ± 13.9; 97.4% heartburn; 71.3% regurgitation). pH monitoring was abnormal in 65.8%. Mean GSFQ score was 11.2 ± 6. Area under ROC was 56.5% (47.0-65.9%). Optimal cut-off score was 13 or greater: sensitivity 40% (30.3-50.3%), specificity 71.2% (56.9-82.9%), positive LR 1.39 (0.85-2.26) and negative LR 0.84 (0.67-1.07). Exclusion of questions 1 and 3 of the original GSFQ, easily interpreted as referred to dyspepsia and not GERD, improved only marginally the diagnostic performance: AUROC 59.1%. Conclusion: The GSFQ does not predict results of pH monitoring in patients with typical symptoms in a tertiary care setting.

MAGIC observations of the February 2014 flare of 1ES 1011+496 and ensuing constraint of the EBL density

Context. In February-March 2014, the MAGIC telescopes observed the high-frequency peaked BL Lac 1ES 1011+496 (z=0.212) in flaring state at very-high energy (VHE, E>100GeV). The flux reached a level more than 10 times higher than any previously recorded flaring state of the source. Aims. Description of the characteristics of the flare presenting the light curve and the spectral parameters of the night-wise spectra and the average spectrum of the whole period. From these data we aim at detecting the imprint of the Extragalactic Background Light (EBL) in the VHE spectrum of the source, in order to constrain its intensity in the optical band. Methods. We analyzed the gamma-ray data from the MAGIC telescopes using the standard MAGIC software for the production of the light curve and the spectra. For the constraining of the EBL we implement the method developed by the H.E.S.S. collaboration in which the intrinsic energy spectrum of the source is modeled with a simple function (< 4 parameters), and the EBL-induced optical depth is calculated using a template EBL model. The likelihood of the observed spectrum is then maximized, including a normalization factor for the EBL opacity among the free parameters. Results. The collected data allowed us to describe the flux changes night by night and also to produce di_erential energy spectra for all nights of the observed period. The estimated intrinsic spectra of all the nights could be fitted by power-law functions. Evaluating the changes in the fit parameters we conclude that the spectral shape for most of the nights were compatible, regardless of the flux level, which enabled us to produce an average spectrum from which the EBL imprint could be constrained. The likelihood ratio test shows that the model with an EBL density 1:07 (-0.20,+0.24)stat+sys, relative to the one in the tested EBL template (Domínguez et al. 2011), is preferred at the 4:6 σ level to the no-EBL hypothesis, with the assumption that the intrinsic source spectrum can be modeled as a log-parabola. This would translate into a constraint of the EBL density in the wavelength range [0.24 μm,4.25 μm], with a peak value at 1.4 μm of λF_ = 12:27^(+2:75)_ (-2:29) nW m^(-2) sr^(-1), including systematics.

Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees

International audience

Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees

Background In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model – effort, rewards and ERI – are associated with the co-occurrence of lifestyle risk factors. Methods Based on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational -level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index ≥25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models. Results After adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously ≥3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors. Conclusion This study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.

Long-Term In Situ Survey of Reactive Iron Concentrations at the EMSO-Azores Observatory

A study of the temporal dynamics of iron concentrations and temperature on a faunal assemblage at the Lucky Strike vent was performed using the Tempo ecological module at the EMSO-Azores deep-sea observatory. The CHEMINI in situ analyzer was implemented on this structure to determine reactive iron concentrations in unfiltered seawater samples along with a temperature probe. Stability tests were performed on the CHEMINI analyzer before deployment (optical module, hyperbaric tests, and deep-sea calibration) for long-term in situ analysis of reactive iron (six months, 2013–2014) at the Tour Eiffel active edifice. Recorded daily, the in situ standard (25 \mu mol.L {}^{-1} ) showed excellent reproducibility (1.07%, n=522 ), confirming satisfactory analytical performance of the CHEMINI analyzer and thus validating the iron concentrations measured by the instrument. Furthermore, the analyzer proved to be reliable and robust over time. The averaged reactive iron concentration for the six-month period remained low ([Fe] =text{7.12}\pm text{2.11} \mu mol.L {}^{-1} , n=519 ), but showed some noticeable variations with temperature. Reactive iron concentrations and temperature were significantly correlated emphasizing reactive iron stabilization over the time of deployment. Period spectra indicated strong tidal influence and relevant frequencies of four to five days for both variables.

Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke

Background Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared the efficacy and safety of two antiplatelet regimens — aspirin plus extendedrelease dipyridamole (ASA–ERDP) versus clopidogrel. Methods In this double-blind, 2-by-2 factorial trial, we randomly assigned patients to receive 25 mg of aspirin plus 200 mg of extended-release dipyridamole twice daily or to receive 75 mg of clopidogrel daily. The primary outcome was first recurrence of stroke. The secondary outcome was a composite of stroke, myocardial infarction, or death from vascular causes. Sequential statistical testing of noninferiority (margin of 1.075), followed by superiority testing, was planned. Results A total of 20,332 patients were followed for a mean of 2.5 years. Recurrent stroke occurred in 916 patients (9.0%) receiving ASA–ERDP and in 898 patients (8.8%) receiving clopidogrel (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11). The secondary outcome occurred in 1333 patients (13.1%) in each group (hazard ratio for ASA–ERDP, 0.99; 95% CI, 0.92 to 1.07). There were more major hemorrhagic events among ASA–ERDP recipients (419 [4.1%]) than among clopidogrel recipients (365 [3.6%]) (hazard ratio, 1.15; 95% CI, 1.00 to 1.32), including intracranial hemorrhage (hazard ratio, 1.42; 95% CI, 1.11 to 1.83). The net risk of recurrent stroke or major hemorrhagic event was similar in the two groups (1194 ASA–ERDP recipients [11.7%], vs. 1156 clopidogrel recipients [11.4%]; hazard ratio, 1.03; 95% CI, 0.95 to 1.11). Conclusions The trial did not meet the predefined criteria for noninferiority but showed similar rates of recurrent stroke with ASA–ERDP and with clopidogrel. There is no evidence that either of the two treatments was superior to the other in the prevention of recurrent stroke. (ClinicalTrials.gov number, NCT00153062.)