Self reported physical activity, public health, and perceived environment: results from a comparative European study

The focus of physical activity promotion is moving from methods for increasing health enhancing physical activity on the individual level to higher level strategies including environmental and policy approaches. Scientific inquiry, traditionally related to individual-based strategies, requires adaptation and refinement when environmental and policy changes become more relevant. The objective of this study is to investigate the significance for behaviour and health of community-based environments that encourage physical activity. DESIGN AND SETTING The article presents data and results from a cross sectional comparative survey of the general population in six European countries (Belgium, Finland, Germany (East and West), Netherlands, Spain, Switzerland). Specifically, the relation between perceived community-based opportunities for physical activity, self reported physical activity, and self rated health status is investigated. PARTICIPANTS Representative samples of general populations (adults 18 years or older). Overall response rate: 53.5%. Sample sizes realised: Belgium: n=389; Finland: n=400; Germany (East): n = 913; Germany (West): n=489; Netherlands: n=366; Spain: n=380; Switzerland: n=406. MAIN RESULTS Analyses show that best opportunities are reported by people who are lightly to moderately physically active. People's self rated health is moderately, but significantly associated with both perceived opportunities, and physical activity itself. These predictors interact in that especially for women, the health impact of physical activity is more pronounced in case of good opportunities. CONCLUSIONS The paper shows the potential of opportunities within residential and community environments with regard to physical activity, both for behaviour and health. Opportunities may enable the population, especially women, to develop an active lifestyle, and thus improve their health. Future studies with objective indicators for physical activity related environments should test the findings that are based on perceptions.

Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. CONCLUSIONS: Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.

Sorafenib as third- or fourth-line treatment of advanced gastrointestinal stromal tumour and pretreatment including both imatinib and sunitinib, and nilotinib: A retrospective analysis.

BACKGROUND: Tyrosine kinase inhibitors (TKI) improve the outcome of patients with advanced gastrointestinal stromal tumour (GIST), but treatment failure is frequent, and prognosis then bleak. Smaller trials in this setting suggested activity for sorafenib, a multikinase inhibitor of receptor tyrosine kinases and RAF serine/threonine kinases. PATIENTS AND METHODS: We retrospectively evaluated the efficacy of sorafenib, starting dose 400mg twice daily, in a large community-based cohort of 124 patients treated in 12 European and one United States (U.S.) cancer centre. All but one patient had a WHO performance score 0-2. All had failed both imatinib and sunitinib, 68 patients nilotinib and 26 had failed investigational therapy, too. RESULTS: Twelve (10%) patients responded to sorafenib and 70 (57%) patients achieved disease stabilisation. Sorafenib was moderately tolerated, and toxicity reported in 56% of the patients. Rash, hand-foot-syndrome and diarrhea occurred frequently. Sorafenib dosage was reduced in a third of patients, but this did not have an impact on progression-free survival (PFS) (p=0.15). Median PFS was 6.4months (95% confidence interval [CI], 4.6-8.0months) and median overall survival (OS) 13.5months (95% CI, 10.0-21.0months). Patients with a good performance status and those who responded to sorafenib had a significant better PFS. CONCLUSION: We conclude that sorafenib is active in GIST resistant to imatinib, sunitinib and nilotinib. These results warrant further investigation of sorafenib or similar molecules in GIST.

Issue review : construction status and operating costs of new corrections beds.

This issue review provides information on the Department of Corrections construction and of proposed staffing for additional beds in the prison system and community-based corrections.

Just the Facts for 2012

There are 20,552 full-time employees who work for the State of Iowa Executive Branch(excluding Fair Authority, Community-Based Corrections, and the Regents employees). These employees are undoubtedly the most valuable resource for providing timely and quality services to Iowans. To strategically manage this resource, state departments and policymakers must have thorough and accurate information. The information in “Just the Facts for 2008” is a snapshot of the workforce, collected,compiled, and presented in a format that will aid agencies and decision makers in strategic planning. In many cases, data cover a number of years and are presented to give the reader a sense of trends. While the Department of Administrative Services, Human Resource Enterprise (DAS/HRE)wants to present data in its purest form so readers can draw their own conclusions, we also have a responsibility to clarify anything that may be confusing or misleading. It is important to highlight workforce trends and explain their significance to the work of Iowa state government. The following chapter summaries are intended to do that.

Lung Function and Risk for Heart Failure Among Older Adults: The Health ABC Study.

BACKGROUND: The impact of abnormal spirometric findings on risk for incident heart failure among older adults without clinically apparent lung disease is not well elucidated.METHODS: We evaluated the association of baseline lung function with incident heart failure, defined as first hospitalization for heart failure, in 2125 participants of the community-based Health, Aging, and Body Composition (Health ABC) Study (age, 73.6 +/- 2.9 years; 50.5% men; 62.3% white; 37.7% black) without prevalent lung disease or heart failure. Abnormal lung function was defined either as forced vital capacity (FVC) or forced expiratory volume in 1(st) second (FEV1) to FVC ratio below lower limit of normal. Percent predicted FVC and FEV1 also were assessed as continuous variables.RESULTS: During follow-up (median, 9.4 years), heart failure developed in 68 of 350 (19.4%) participants with abnormal baseline lung function, as compared with 172 of 1775 (9.7%) participants with normal lung function (hazard ratio [HR] 2.31; 95% confidence interval [CI], 1.74-3.07; P <.001). This increased risk persisted after adjusting for previously identified heart failure risk factors in the Health ABC Study, body mass index, incident coronary heart disease, and inflammatory markers (HR 1.83; 95% CI, 1.33-2.50; P <.001). Percent predicted (%) FVC and FEV 1 had a linear association with heart failure risk (HR 1.21; 95% CI, 1.11-1.32 and 1.18; 95% CI, 1.10-1.26, per 10% lower % FVC and % FEV1, respectively; both P <.001 in fully adjusted models). Findings were consistent in sex and race subgroups and for heart failure with preserved or reduced ejection fraction.CONCLUSIONS: Abnormal spirometric findings in older adults without clinical lung disease are associated with increased heart failure risk. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 334-341

Communicating Highway Safety: What Works, 2002

Few topics in transportation are of greater significance, now and in the future, than making today’s roads safe for those who use them. This study aims to assist the formulation of policy by examining the empirical evidence currently available on the ability of several forms of communication efforts and activities to increase knowledge about and affect attitudes and behavior toward highway safety practices. The objective of this effort is to provide a comparative synthesis of what works and what does not in highway safety campaigns across a large number of topical areas that have a mass media component. This was accomplished by conducting an extensive literature review to determine the current state of knowledge concerning what works and what has significant potential for wide use in future highway safety campaigns. An analytic framework for investigating highway safety campaigns was created. The framework includes (1) the types of media components, (2) the types of collaborations, (3) the context in which the campaign is intended to have impact, (4) the structure or procedural steps into which campaigns are organized, (5) the principles for what works in a campaign, and (6) the desired impact of a campaign on its target audience. The report reveals 25 characteristics of successful communication campaigns, strategies that stand a chance of achieving changes in knowledge, attitude, and behavior. The actual impact of mass communication remains unproven because of a perceived lag in the development of adequate evaluation techniques. Education by itself has not generally resulted in significant changes in the behaviors targeted, but education of the public and advocacy groups has often helped enact necessary legislation, transmit knowledge about the provisions and penalties of laws in ways that increase their deterrent effect, and generate public support for law enforcement programs. Even in such cases, however, when enforcement is inconsistent, public compliance frequently decreases with time. Approaches to traffic safety that emphasize the need for long-term individual- and community-based measures are found to be especially crucial for addressing complex problems like drinking and driving that are determined by a myriad of lifestyle and psychosocial factors.

Access to Recovery Iowa: Provider Manual, October 2014

Access to Recovery - Iowa (ATR) is a three year grant awarded to the Iowa Department of Public Health (IDPH) by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA) in October 2014. ATR provides funding to individuals to purchase services and supports linked to their recovery from substance abuse. ATR emphasizes client choice and increases the array of available community-based services, supports, and providers.

Diagnostics VIH tardifs en 2009 en Suisse: motivation a un dépistage systématique du VIH [Late diagnoses of HIV infection in 2009 in Switzerland: towards a universal HIV testing?]

Individuals who are unaware of their HIV infection constitute a fragile and a critical population both from a personal and from a community-based point of view: if the infection is diagnosed too late, the outcome can be complicated by AIDS-defining diseases, whose prognosis may remain unfavourable even after the initiation of a potent antiretroviral therapy. These patients contribute to the virus spreading into the community, owing to a high viral load. It is now necessary to recognise the limits of a risk behaviour and disease-driven HIV screening policy. Since 2006, the American guidelines recommend a routine HIV testing for all patients age 13 to 64 years unless they specifically refuse the test (opt-out). In Switzerland, the recommendations remain so far risk-centred.

Rétablissement postopératoire optimisé, applique aux patients après cystectomie [Enhanced recovery after surgery applied to cystectomy patients].

Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre, intra and postoperative evidence-based care elements to reduce surgical stress. ERAS pathways have been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colorectal surgery. It is therefore considered standard of care in this specialty. There can be no doubt that ERAS principles can be applied also in other major surgeries. However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ considerably. This article reports on the first steps of an ERAS project and his introduction in urology.

Distribution and risk factors for Plasmodium and helminth co-infections: a cross-sectional survey among children in Bagamoyo district, coastal region of Tanzania.

BACKGROUND: Plasmodium and soil transmitted helminth infections (STH) are a major public health problem, particularly among children. There are conflicting findings on potential association between these two parasites. This study investigated the Plasmodium and helminth co-infections among children aged 2 months to 9 years living in Bagamoyo district, coastal region of Tanzania. METHODS: A community-based cross-sectional survey was conducted among 1033 children. Stool, urine and blood samples were examined using a broad set of quality controlled diagnostic methods for common STH (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, Enterobius vermicularis, Trichuris trichura), schistosoma species and Wuchereria bancrofti. Blood slides and malaria rapid diagnostic tests (mRDTs) were utilized for Plasmodium diagnosis. RESULTS: Out of 992 children analyzed, the prevalence of Plasmodium infection was 13% (130/992), helminth 28.5% (283/992); 5% (50/992) had co-infection with Plasmodium and helminth. The prevalence rate of Plasmodium, specific STH and co-infections increased significantly with age (p < 0.001), with older children mostly affected except for S. stercoralis monoinfection and co-infections. Spatial variations of co-infection prevalence were observed between and within villages. There was a trend for STH infections to be associated with Plasmodium infection [OR adjusted for age group 1.4, 95% CI (1.0-2.1)], which was more marked for S. stercoralis (OR = 2.2, 95% CI (1.1-4.3). Age and not schooling were risk factors for Plasmodium and STH co-infection. CONCLUSION: The findings suggest that STH and Plasmodium infections tend to occur in the same children, with increasing prevalence of co-infection with age. This calls for an integrated approach such as using mass chemotherapy with dual effect (e.g., ivermectin) coupled with improved housing, sanitation and hygiene for the control of both parasitic infections.

Sisäinen muutosviestintä fuusiotilanteessa - Kansallis-Osake-Pankki Oy:n ja Suomen Yhdyspankki Oy:n fuusion käsittely KOP:n sisäisessä henkilöstöviestinnässä

Tutkielma pyrkii selvittämään millaista viestinnällistä järjestelmää käytettiin kerrottaessa Kansallis-Osake-Pankin henkilöstölle Kansallis-Osake-Pankin ja Suomen Yhdyspankin fuusiosta. Näkökulmana on henkilöstön asema viestin vastaanottajana. Tutkielma hahmottaa johdon taholta tulleita sisäisen viestinnässä käytettyjä äänenpainoja ja sävyjä. Lisäksi tutkielma etsii kahden pankin pääjohtajien muutospuheista sisällöllisiä eroja ja kunkin organisaation totuttuja viestintäkäytänteitä. Tutkimusmenetelmänä käytetään kvalitatiivista tutkimusta ja tutkimusinstrumenttina tässä tutkielmassa toimii diskurssianalyysi. Diskurssianalyysi on teoreettinen viitekehys, jonka tarkoituksena on etsiä mitä merkityksiä teksteissä tuotetaan ja nähdä kieli todellisuuden rakentajana. Tutkimusaineistona on Kansallis-Osake-Pankin henkilöstölehdet, Kansallis-Osake-Pankin ja Suomen Yhdyspankin vuosikertomukset, fuusioesite ja valikoidut aiheesta kirjoitetut lehtiartikkelit. Kansallis-Osake-Pankin sisäistä viestintää leimasi fuusiouutisen julkitultua kriisiviestinnän piirteet: huhujen karkoittaminen ja virallisen tiedon voimakas levittäminen. Fuusiouutisen alkushokin jälkeen KOP:n viestinnästä nousi esiin viisi teemaa: viestien henkilöityminen pääjohtajaan, empatia henkilöstöä kohtaan vaikeissa tilanteissa, yhteisöllisyys, henkilön huomioonottaminen ja läheisyys.

Did Dumbo suffer a heart attack? independent association between earlobe crease and cardiovascular disease.

BACKGROUND: Earlobe crease (ELC) has been associated with cardiovascular diseases (CVD) or risk factors (CVRF) and could be a marker predisposing to CVD. However, most studies studied only a small number of CVRF and no complete assessment of the associations between ELC and CVRF has been performed in a single study. METHODS: Population-based study (n = 4635, 46.7 % men) conducted between 2009 and 2012 in Lausanne, Switzerland. RESULTS: Eight hundred six participants (17.4 %) had an ELC. Presence of ELC was associated with male gender and older age. After adjusting for age and gender (and medication whenever necessary), presence of ELC was significantly (p < 0.05) associated with higher levels of body mass index (BMI) [adjusted mean ± standard error: 27.0 ± 0.2 vs. 26.02 ± 0.07 kg/m(2)], triglycerides [1.40 ± 0.03 vs. 1.36 ± 0.01 mmol/L] and insulin [8.8 ± 0.2 vs. 8.3 ± 0.1 μIU/mL]; lower levels of HDL cholesterol [1.61 ± 0.02 vs. 1.64 ± 0.01 mmol/L]; higher frequency of abdominal obesity [odds ratio and (95 % confidence interval) 1.20 (1.02; 1.42)]; hypertension [1.41 (1.18; 1.67)]; diabetes [1.43 (1.15; 1.79)]; high HOMA-IR [1.19 (1.00; 1.42)]; metabolic syndrome [1.28 (1.08; 1.51)] and history of CVD [1.55 (1.21; 1.98)]. No associations were found between ELC and estimated cardiovascular risk, inflammatory or liver markers. After further adjustment on BMI, only the associations between ELC and hypertension [1.30 (1.08; 1.56)] and history of CVD [1.47 (1.14; 1.89)] remained significant. For history of CVD, further adjustment on diabetes, hypertension, total cholesterol and smoking led to similar results [1.36 (1.05; 1.77)]. CONCLUSION: In this community-based sample ELC was significantly and independently associated with hypertension and history of CVD.