Trends in motor vehicle crash mortality in Europe, 1980-2007.

Recent trends (1980-2007) in mortality from road traffic crashes in European countries, and, for comparative purposes, in the USA and Japan were reviewed. Data came from the World Health Organisation database. Age-standardised rates, at all ages and at 15-24, 25-64, >=65 years, were computed. Joinpoint regression analyses to evaluate significant changes in trends were performed. In the European Union as a whole rates declined from 20.2 in 1987 to 13.5/100,000 in 2007 in men, and from 6.3 to 3.7/100,000 in women; European Union rates remained lower than USA, but higher than Japanese ones. In 2007, the highest male rates were in Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine (29.8), and Latvia (28.5), and the lowest ones in the Netherlands (6.2) and Sweden (6.9); the highest female rates were in the Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and Ukraine (around 8), and the lowest ones in Switzerland (1.7), the UK, and Nordic countries (around 2). Mortality from motor vehicle crashes declined in northern and western European countries and - though to a lesser extent - in southern European countries, too. Mortality trends were also favourable in the Czech Republic and Poland since the mid 1990's, whereas they were still upwards in Romania and the Russian Federation. No trend was observed in Hungary and Ukraine. Trends were consistent in various age groups considered. Thus, additional urgent and integrated intervention is required to prevent avoidable deaths from motor vehicle crashes, particularly in selected central and eastern European countries.

A clinical study of annular cyclitis.

PURPOSE: To investigate six cases of annular cyclitis. METHODS: All patients with impairment of visual acuity underwent complete ophthalmologic examination, color fundus photography, laboratory tests and fluorescein angiography. Indocyanine green (ICG) angiography and B-scan ultrasonography were also performed in three cases in order to diagnose the disease. RESULTS: All patients presented a unilateral or bilateral granulomatous uveitis, associated with inflammatory annular cyclitis. They had a shallow anterior chamber, a mildly elevated intraocular pressure (under 25 mm Hg) and an annular serous retinal detachment. A resolution was observed after specific therapy associated with systemic prednisolone therapy and antiglaucomatous drops. CONCLUSION: This is the first description of an observational study of six patients with inflammatory annular cyclitis.

Alkaline mineral water lowers bone resorption even in calcium sufficiency: alkaline mineral water and bone metabolism.

BACKGROUND: Dietary acid charge enhances bone loss. Bicarbonate or alkali diet decreases bone resorption in humans. We compared the effect of an alkaline mineral water, rich in bicarbonate, with that of an acid one, rich in calcium only, on bone markers, in young women with a normal calcium intake. METHODS: This study compared water A (per litre: 520 mg Ca, 291 mg HCO(3)(-), 1160 mg SO(4)(-), Potential Renal Acid load (PRAL) +9.2 mEq) with water B (per litre: 547 mg Ca, 2172 mg HCO(3)(-), 9 mg SO(4)(-), PRAL -11.2 mEq). 30 female dieticians aged 26.3 yrs (SD 7.3) were randomized into two groups, followed an identical weighed, balanced diet (965 mg Ca) and drank 1.5 l/d of the assigned water. Changes in blood and urine electrolytes, C-telopeptides (CTX), urinary pH and bicarbonate, and serum PTH were measured after 2 and 4 weeks. RESULTS: The two groups were not different at baseline, and showed a similar increase in urinary calcium excretion. Urinary pH and bicarbonate excretion increased with water B, but not with water A. PTH (p=0.022) and S-CTX (p=0.023) decreased with water B but not with water A. CONCLUSION: In calcium sufficiency, the acid calcium-rich water had no effect on bone resorption, while the alkaline water rich in bicarbonate led to a significant decrease of PTH and of S-CTX.

Treatment deviating from guidelines does not influence status epilepticus prognosis.

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (± 30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ≥ 3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ≥ 3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches.

Un peuple réfractaire à l'industrie ? Fabriques et ouvriers dans les montagnes valaisannes

L'image que l'on associe traditionnellement au Valais ressort plutôt de ses paysages alpins ou de ses agriculteurs de montagne que de ses industries. Celles-ci forment pourtant un maillon essentiel dans l'histoire du développement du canton. Au Moyen Age déjà, la prospection du fer, du plomb et surtout de l'argent donnait lieu a de sévères concurrences. Mais c'est l'arrivée des grandes industries chimiques et métallurgiques, vers 1900, qui a provoqué la reconversion en masse de centaines de paysans en ouvriers d'usines. Dans la complexité d'un marché devenu mondial, ces industries ont dû évoluer, certaines ont disparu, d'autres sont en passe de l'être. C'est ce regard sur un Valais méconnu qu'une dizaine d'historiens, avec l'oeil complice de plusieurs photographes, proposent à votre lecture.

Alteration of neuromuscular function in squash

The alteration in neuromuscular function of knee extensor muscles was characterised after a squash match in 10 trained players. Maximal voluntary contraction (MVC) and surface EMG activity of vastus lateralis (VL) and vastus medialis (VM) muscles were measured before and immediately after a 1-h squash match. M-wave and twitch contractile properties were analysed following single stimuli. MVC declined (280.5+/-46.8 vs. 233.6+/-35.4 Nm, -16%; P<0.001) after the exercise and this was accompanied by an impairment of central activation, as attested by decline in voluntary activation (76.7+/-10.4 vs. 71.3+/-9.6%, -7%; P<0.05) and raw EMG activity of the two vastii (-17%; P<0.05), whereas RMS/M decrease was lesser (VL: -5%; NS and VM: -12%; P=0.10). In the fatigued state, no significant changes in M-wave amplitude (VL: -9%; VM: -5%) or duration were observed. Following exercise, the single twitch was characterised by lower peak torque (-20%; P<0.001) as well as shorter half-relaxation time (-13%; P<0.001) and reduced maximal rate of twitch tension development (-23%; P<0.001) and relaxation (-17%; P<0.05). A 1-h squash match play caused peripheral fatigue by impairing excitation-contraction coupling, whereas sarcolemmal excitability seems well preserved. Our results also emphasise the role of central activation failure as a possible mechanism contributing to the torque loss observed in knee extensors. Physical conditioners should consider these effects when defining their training programs for squash players.

Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory assist in infants and children.

OBJECTIVES: To document the prevalence of asynchrony events during noninvasive ventilation in pressure support in infants and in children and to compare the results with neurally adjusted ventilatory assist. DESIGN: Prospective randomized cross-over study in children undergoing noninvasive ventilation. SETTING: The study was performed in a PICU. PATIENTS: From 4 weeks to 5 years. INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support (PS), three levels of expiratory trigger (ETS) setting were compared: initial ETS (PSinit), and ETS value decreased and increased by 15%. Of the three sessions, the period allowing for the lowest number of asynchrony events was defined as PSbest. Neurally adjusted ventilator assist level was adjusted to match the maximum airway pressure during PSinit. Positive end-expiratory pressure was the same during pressure support and neurally adjusted ventilator assist. Asynchrony events, trigger delay, and cycling-off delay were quantified for each period. RESULTS: Six infants and children were studied. Trigger delay was lower with neurally adjusted ventilator assist versus PSinit and PSbest (61 ms [56-79] vs 149 ms [134-180] and 146 ms [101-162]; p = 0.001 and 0.02, respectively). Inspiratory time in excess showed a trend to be shorter during pressure support versus neurally adjusted ventilator assist. Main asynchrony events during PSinit were autotriggering (4.8/min [1.7-12]), ineffective efforts (9.9/min [1.7-18]), and premature cycling (6.3/min [3.2-18.7]). Premature cycling (3.4/min [1.1-7.7]) was less frequent during PSbest versus PSinit (p = 0.059). The asynchrony index was significantly lower during PSbest versus PSinit (40% [28-65] vs 65.5% [42-76], p < 0.001). With neurally adjusted ventilator assist, all types of asynchronies except double triggering were reduced. The asynchrony index was lower with neurally adjusted ventilator assist (2.3% [0.7-5] vs PSinit and PSbest, p < 0.05 for both comparisons). CONCLUSION: Asynchrony events are frequent during noninvasive ventilation with pressure support in infants and in children despite adjusting the cycling-off criterion. Compared with pressure support, neurally adjusted ventilator assist allows improving patient-ventilator synchrony by reducing trigger delay and the number of asynchrony events. Further studies should determine the clinical impact of these findings.

Efeitos do CPPU e GA3 no cultivo de uva-'Itália' na região do submédio São Francisco, nordeste do Brasil

Na região do submédio do São Francisco, a uva-'Itália' destaca-se com 63,2% da área total plantada. Atualmente, é a principal variedade para exportação. O objetivo principal deste trabalho foi avaliar o efeito das doses do CPPU (forchlorfenuron) e GA3, no aumento do tamanho da baga, que foram aplicadas por meio de pulverização dirigida sobre os cachos durante a fase de pegamento dos frutos, quando as bagas haviam atingido, aproximadamente, 8 mm de diâmetro. Este experimento foi conduzido na Fazenda Cooperyama, no município de Juazeiro-BA. O delineamento experimental foi o inteiramente casualizado, com oito tratamentos e três repetições, avaliando-se 15 cachos por tratamento com as seguintes doses: 1- Testemunha absoluta; 2- GA3 20 mg/l;3- GA3 20 mg/l+ CPPU 3 mg/l; 4- GA3 20 mg/l + CPPU 5 mg/l; 5- GA3 20 mg/l + CPPU 10 mg/l; 6- CPPU 3 mg/l; 7- CPPU 5 mg/l; 8- CPPU 10 mg/l.O melhor resultado obtido no crescimento da baga deu-se com a aplicação do CPPU 10 mg/l. Este tratamento diferiu significativamente da testemunha e da aplicação convencional com GA3 20 mg/l, aumentando 8% e 4,6% o comprimento da baga, 13,6% e 7,3% sua largura, e o peso de baga em 32% e 16,3%, respectivamente. Nos tratamentos com CPPU aplicado isoladamente e/ou associado com GA3, a colheita foi retardada em oito dias. Não se verificou diferença significativa para os teores de sólidos solúveis; no entanto, foi constatado que a acidez titulável obteve valores mais elevados na testemunha e no tratamento com GA3, aplicando 20 mg/l. Com relação ao peso do engaço, não foi verificada diferença estatística entre os tratamentos.

Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone

Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin ≥2 µg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance

Caracterização tecnológica de jabuticabas 'Sabará' provenientes de diferentes regiões de cultivo

Características fisico-químicas de jabuticabas 'sabará', provenientes de 10 diferentes regiões de cultivo localizadas no Estado de São Paulo, foram analisadas de agosto a setembro de 2001 para determinação de sua qualidade. De cada local de cultivo foram colhidos 3 kg de frutos. Diferenças significativas foram observadas em todas as características avaliadas. A média de peso por fruto variou de 3,56 a 7,40g, e os frutos oriundos de pomar situado na cidade de Casa Branca - SP foram os que apresentaram os maiores pesos. As médias do índice de formato e do fruto e do diâmetro oscilaram de 0,962 a 0,990 e de 2,45 a 1,73 cm, respectivamente. A coloração dos frutos foi mais roxa-escura do que roxa. A firmeza dos frutos variou de firme a mole, e os frutos colhidos em pomares situados nas regiões de Casa Branca - SP, Pedregulho - SP e Miguelópolis -SP apresentaram-se mais firmes, sugerindo um maior potencial de conservação pós-colheita. O teor de sólidos solúveis totais variou de 11,6 a 17,9, o pH de 2,91 a 3,70 sendo maiores em jabuticabas colhidas em pomares situados nas cidades de Guaíra-SP e Ituverava-SP. A acidez total titulável, expressa em g de ácido cítrico por 100g, variou de 0,888 a 1,625, os teores de vitamina C variaram de 14,86 a 24,67 mg de ácido ascórbico por 100g, e os de carboidrato solúvel de 0,91 a 11,39g de glicose por 100g, respectivamente. Os resultados levam a concluir que as jabuticabas provenientes de pomares situados na cidade de Casa Branca-SP apresentaram melhor qualidade, sendo adequadas tanto para a indústria como para o consumo de fruta fresca e com maior potencial de conservação pós-colheita.

Overweight in Swiss children and associations with children's and parents' characteristics et Worldwide trends in childhood obesity

(1) Surpoids chez les enfants suisses et associations avec certaines caractéristiques chez les enfants et leurs parents Le but de cette étude était de mesurer la prévalence du surpoids et de l?obésité chez les enfants de sixième année du canton de Vaud (âge moyen de 12 ans) et les facteurs associés au surpoids. Les données ont été récoltées lors d?une étude menée par l?Institut universitaire de médecine sociale et préventive. Tous les enfants scolarisés en 6ème année à l?école publique du canton de Vaud entre septembre 2005 et mai 2006 étaient éligibles à participer à cette étude. Le taux de participation a atteint 76% (soit 5207 enfants de 12,3 ans en moyenne). Le poids et la taille des enfants ont été mesurés à l?école par des assistants de recherche et les enfants ont rempli, en classe, un questionnaire structuré sur leur mode de vie (notamment : temps quotidien passé à regarder la télévision, à jouer à des jeux sur écran; fréquence de la pratique de diverses activités physiques; fréquence de la consommation de fruits ou de légumes). Des informations sur les parents (niveau d?éducation, nationalité, poids et taille) ont été récoltées au moyen d?un questionnaire structuré envoyé par courrier à ceux-ci. Nous avons utilisé les critères de l?International Obesity Task Force, qui définit les valeurs-seuils de l'indice de masse corporelle pour le surpoids et pour l?obésité, par age et par sexe. La prévalence du surpoids (obésité incluse) dans la population était de 15% chez les garçons et de 12% chez les filles, et la prévalence de l?obésité était de 2% dans les deux sexes. Nous avons trouvé que le surpoids était associé de façon indépendante avec le temps passé à regarder la télévision, ainsi qu?avec certaines caractéristiques des parents, comme le surpoids, un bas niveau d?éducation et une nationalité étrangère. En conclusion, un enfant sur sept est en surpoids ou obèse dans le canton de Vaud. Ces chiffres indiquent un important défi de santé publique, même si cette prévalence dans le canton de Vaud est, actuellement, moindre que dans beaucoup d?autres pays d?Europe, et bien moindre qu?en Amérique du Nord. Les associations entre le surpoids infantile et le temps passé à regarder la télévision, ainsi que les associations avec des variables liées au milieu socio-culturel des parents indiquent plusieurs pistes d?intervention pour prévenir le surpoids chez les enfants. Il est probable que les mesures de prévention ne devraient pas se limiter aux approches individuelles, mais devraient aussi inclure des mesures structurelles sur l?environnement social, physique et économique visant à réduire les facteurs obésogènes dans la société.<br/><br/>Objective: The objective was to assess the prevalence of overweight and obesity in children in a canton of Switzerland and the association with various characteristics of the parents and the children. Research Methods and Procedures: A cross-sectional survey was conducted in all children of the sixth school grade of the canton of Vaud, Switzerland. Weight and height were measured, and selected lifestyle variables were assessed with a self-administered semiquantitative questionnaire. Information on children?s parents was gathered through a mailed structured questionnaire. Overweight and obesity were based on the International Obesity Task Force criteria. Results: Of 6873 eligible children, 5207 (76%) participated (2621 boys, 2586 girls; mean age, 12.3 years; standard deviation, 0.5 year). The prevalence of overweight (including obesity) was 15.0% (95% confidence interval, 13.7% to 16.4%) in boys and 12.4% (11.1% to 13.7%) in girls, and the prevalence of obesity was 1.8% (1.3% to 2.3%) and 1.7% (1.2% to 2.2%), respectively. In both univariate and multivariate analyses, overweight was strongly associated with high television viewing time and selected characteristics of the parents (overweight, low educational level, and foreign nationality). Discussion: The prevalence of pediatric overweight and obesity was lower in this region of Switzerland than in several European countries. The correlates of overweight found in this region suggest areas for potential interventions.

Caracterização física e de produção de acerola do banco ativo de germoplasma em Pernambuco

Este trabalho teve por objetivo avaliar as características físicas dos frutos e a produção de doze genótipos de aceroleiras do Banco Ativo de Germoplasma da Universidade Federal Rural de Pernambuco. Frutos colhidos nas safras Inverno/1999, Verão/2000 e Verão/2001 foram avaliados quanto a massa, altura e diâmetro médio, bem como as características de produção e o número médio de frutos/genótipo. A análise conjunta (média das safras) revelou uma variação média na massa de 3,88 a 7,11g, na altura de 1,74 a 2,07cm e no diâmetro de 1,94 a 2,46cm. A variação na produção anual dos 12 genótipos, no ano de 1999, compreendeu valores entre 3,23 e 10,31kg de fruto/planta, enquanto no ano de 2000 esta variação foi de 6,73 a 44,70kg de fruto/planta. Nos anos de 1999 e 2000, cerca de 50% da produção anual ficou concentrada nos meses de outubro, novembro e dezembro. Os genótipos 012-CPA, 013-CPA e 014-CPA destacaram-se como potencialmente promissores por terem sido os mais produtivos além de terem apresentado características físicas, referentes à massa e do diâmetro dos frutos, exigidas pelas indústrias de transformação.

Mudanças fisiológicas e químicas em bananas 'Nanica' e 'Pacovan' tratadas com carbureto de cálcio

O objetivo deste trabalho foi avaliar mudanças fisiológicas e químicas em bananas 'Nanica' e 'Pacovan' tratadas com elevadas doses de carbureto de cálcio (CaC2), para geração de acetileno. Os frutos foram colhidos no estádio de maturação II (verdes com leves traços amarelos). As pencas foram acondicionadas em caixas de madeira (50 x 50 x 40 cm), revestidas internamente com papel alumínio, hermeticamente fechadas e tratadas com quatro doses de CaC2 (0; 15; 30 e 45 g.m-3) e (0; 7; 15 e 30 g.m-3) para 'Nanica' e 'Pacovan', respectivamente. Foi utilizado um delineamento inteiramente casualizado, em esquema fatorial 4 x 6 (4 doses e 6 períodos de avaliação), com três repetições. As características avaliadas foram: atividade respiratória, conteúdos de amido, açúcares redutores (AR) e clorofila total, e evolução da coloração do fruto (escala de 1-7). O acetileno liberado do CaC2 resultou em aumento da taxa respiratória, degradação do amido e elevação dos teores de AR, degradação da clorofila e intensificação da coloração amarela, uniformizando o amadurecimento, sobretudo para a cultivar Pacovan.