Aspirin and folic acid for the prevention of recurrent colorectal adenomas

BACKGROUND & AIMS: Although observational studies have found regular aspirin use to be associated with a reduced risk of colorectal neoplasia, results from randomized trials using aspirin have been inconsistent. Dietary folate intake also has been found to be associated with a reduced risk of colorectal neoplasms in observational studies.

METHODS: A multicenter, randomized, double-blind trial of aspirin (300 mg/day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 2 x 2 factorial design. All patients had an adenoma (>/=0.5 cm) removed in the 6 months before recruitment and were followed-up at 4-month intervals with a second colonoscopy after approximately 3 years. The primary outcome measure was a colorectal adenoma diagnosed after baseline.

RESULTS: A total of 945 patients were recruited into the study, of whom 853 (90.3%) underwent a second colonoscopy. In total, 99 (22.8%) of 434 patients receiving aspirin had a recurrent adenoma compared with 121 (28.9%) of 419 patients receiving placebo (relative risk, 0.79; 95% confidence interval [CI], 0.63-0.99). A total of 104 patients developed an advanced colorectal adenoma; 41 (9.4%) of these were in the aspirin group and 63 (15.0%) were in the placebo group (relative risk, 0.63; 95% CI, 0.43-0.91). Folate supplementation was found to have no effect on adenoma recurrence (relative risk, 1.07; 95% CI, 0.85-1.34).

CONCLUSIONS: Aspirin (300 mg/day) but not folate (0.5 mg/day) use was found to reduce the risk of colorectal adenoma recurrence, with evidence that aspirin could have a significant role in preventing the development of advanced lesions.

Enhancing performance: The moderating effect of environmental integration and environmental capabilities on the performance outcomes of pollution prevention

Over the last two decades there has been ongoing debate about the impact of environmental practices on operational performance. In recent years, studies have started to move beyond assessing the direct impact of environmental management on different dimensions of performance to consider factors that might moderate or mediate this relationship. This study considers the extent to which environmental integration and environmental capabilities moderate the relationship between pollution prevention and environmental performance outcomes. The mediating influence of environmental performance on the relationship between pollution prevention and cost and flexibility performance is also considered. Data were collected from a sample of UK food manufacturers and analysed using multiple regression analysis. The findings indicate the existence of some moderated and mediated relationships suggesting that there is more to improving performance than implementing environmental practices.

The effects of pollution prevention on performance

As pressure for companies to improve their environmental performance has intensified in recent years, research attention has shifted away from establishing a link between environmental practices and performance towards consideration of other factors that might facilitate performance improvements. This paper has two key purposes; firstly, to investigate whether internal support processes interact with pollution prevention by positively moderating the relationship between pollution prevention and environmental performance, and; secondly, to assess whether the relationship between pollution prevention and cost performance is mediated by environmental performance.

Design/methodology/approach
It uses a cross-sectional survey of 1,200 UK-based food processing firms to gather information on environmental practices and performance. Regression analysis was conducted on a sample of 149 responding firms to assess the hypothesised relationships.

Findings
Support was found for two of the four moderated relationships hypothesised namely, suggesting that internal support processes support the environmental performance of some pollution prevention practices. Strong support for a mediated relationship between pollution prevention, environmental performance and cost performance was provided by the results.

Originality/value
This study provides an original contribution to the literature on the performance outcomes of environmental practices by considering a number indirect relationships between environmental practices and performance. This has implications for the interpretation of the relationship between environmental practices and performance.

Evaluating early administration of the hydroxymethylglutaryl-CoA reductase inhibitor simvastatin in the prevention and treatment of delirium in critically ill ventilated patients (MoDUS trial): Study protocol for a randomized controlled trial

Background: The incidence of delirium in ventilated patients is estimated at up to 82%, and it is associated with longer intensive care and hospital stays, and long-term cognitive impairment and mortality. The pathophysiology of delirium has been linked with inflammation and neuronal apoptosis. Simvastatin has pleiotropic properties; it penetrates the brain and, as well as reducing cholesterol, reduces inflammation when used at clinically relevant doses over the short term. This is a single centre randomised, controlled trial which aims to test the hypothesis that treatment with simvastatin will modify delirium incidence and outcomes. 

Methods/Design: The ongoing study will include 142 adults admitted to the Watford General Hospital Intensive Care Unit who require mechanical ventilation in the first 72 hours of admission. The primary outcome is the number of delirium- and coma-free days in the first 14 days. Secondary outcomes include incidence of delirium, delirium- and coma-free days in the first 28 days, days in delirium and in coma at 14 and 28 days, number of ventilator-free days at 28 days, length of critical care and hospital stay, mortality, cognitive decline and healthcare resource use. Informed consent will be taken from patient's consultee before randomisation to receive either simvastatin (80 mg) or placebo once daily. Daily data will be recorded until day 28 after randomisation or until discharge from the ICU if sooner. Surviving patients will be followed up on at six months from discharge. Plasma and urine samples will be taken to investigate the biological effect of simvastatin on systemic markers of inflammation, as related to the number of delirium- and coma-free days, and the potential of cholinesterase activity and beta-amyloid as predictors of the risk of delirium and long-term cognitive impairment. 

Discussion: This trial will test the efficacy of simvastatin on reducing delirium in the critically ill. If patients receiving the statin show a reduced number of days in delirium compared with the placebo group, the inflammatory theory implicated in the pathogenesis of delirium will be strengthened. 

Evaluating the effectiveness of domestic abuse prevention education: Are certain children more or less receptive to the messages conveyed?

Purpose
A number of school-based domestic abuse prevention programmes have been developed in the United Kingdom, but evidence as to the effectiveness of such programmes is limited. The aim of the research was to evaluate the effectiveness of one such programme and to see whether the outcomes differ by gender and experiences of domestic abuse.

Method
Pupils aged 13–14 years, across seven schools, receiving a 6-week education programme completed a questionnaire to measure their attitudes towards domestic violence at pre-, post-test, and 3-month follow-up, and also responded to questions about experiences of abuse (as victims, perpetrators, and witnesses) and help seeking. Children in another six schools not yet receiving the intervention responded to the same questions at pre- and post-test. In total, 1,203 children took part in the research.

Results
Boys and girls who had received the intervention became less accepting of domestic violence and more likely to seek help from pre- to post-test compared with those in the control group; outcomes did not vary by experiences of abuse. There was evidence that the change in attitudes for those in the intervention group was maintained at 3-month follow-up.

Conclusions
These findings suggest that such a programme shows great promise, with both boys and girls benefiting from the intervention, and those who have experienced abuse and those who have not (yet) experienced abuse showing a similar degree of attitude change.

Primary care organisational interventions for secondary prevention of IHD: a systematic review and meta-analysis.

Background: Ischaemic heart disease (IHD) is the most common cause of death worldwide.

Aim: To determine the long-term impact of organisational interventions for secondary prevention of IHD.

Design and setting: Systematic review and meta-analysis of studies from CENTRAL, MEDLINE®, Embase, and CINAHL published January 2007 to January 2013.

Method: Searches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random-effects model was used and risk ratios were calculated.

Results: Five studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7–6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval [CI] = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7–6 years.

Conclusion: Cardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4–6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely.

Ultraviolet irradiation for the prevention of graft-versus-host disease and graft rejection in bone marrow transplantation

This review describes an approach to the prevention of graft-versus-host disease (GVHD) and graft rejection following allogeneic BMT that differs from conventional methods. Ultraviolet (UV) irradiation inhibits the proliferative responses of lymphoid cells to mitogens and alloantigens by inactivation of T lymphocytes and dendritic cells, and in animal models this can prevent both GVHD and graft rejection. It is important that the marrow repopulating capacity of haemopoietic stem cells is not damaged by the irradiation process. We have found that polymorphic microsatellite markers are a sensitive way of assessing the impact of UV irradiation on chimerism after BMT in rodents.