Current genetic data do not improve the prediction of type 2 diabetes mellitus: the CoLaus study.

CONTEXT: Several genetic risk scores to identify asymptomatic subjects at high risk of developing type 2 diabetes mellitus (T2DM) have been proposed, but it is unclear whether they add extra information to risk scores based on clinical and biological data. OBJECTIVE: The objective of the study was to assess the extra clinical value of genetic risk scores in predicting the occurrence of T2DM. DESIGN: This was a prospective study, with a mean follow-up time of 5 yr. SETTING AND SUBJECTS: The study included 2824 nondiabetic participants (1548 women, 52 ± 10 yr). MAIN OUTCOME MEASURE: Six genetic risk scores for T2DM were tested. Four were derived from the literature and two were created combining all (n = 24) or shared (n = 9) single-nucleotide polymorphisms of the previous scores. A previously validated clinic + biological risk score for T2DM was used as reference. RESULTS: Two hundred seven participants (7.3%) developed T2DM during follow-up. On bivariate analysis, no differences were found for all but one genetic score between nondiabetic and diabetic participants. After adjusting for the validated clinic + biological risk score, none of the genetic scores improved discrimination, as assessed by changes in the area under the receiver-operating characteristic curve (range -0.4 to -0.1%), sensitivity (-2.9 to -1.0%), specificity (0.0-0.1%), and positive (-6.6 to +0.7%) and negative (-0.2 to 0.0%) predictive values. Similarly, no improvement in T2DM risk prediction was found: net reclassification index ranging from -5.3 to -1.6% and nonsignificant (P ≥ 0.49) integrated discrimination improvement. CONCLUSIONS: In this study, adding genetic information to a previously validated clinic + biological score does not seem to improve the prediction of T2DM.

Prediction of recanalization in acute stroke patients receiving intravenous and endovascular revascularization therapy.

BACKGROUND AND PURPOSE: The study aims to assess the recanalization rate in acute ischemic stroke patients who received no revascularization therapy, intravenous thrombolysis, and endovascular treatment, respectively, and to identify best clinical and imaging predictors of recanalization in each treatment group. METHODS: Clinical and imaging data were collected in 103 patients with acute ischemic stroke caused by anterior circulation arterial occlusion. We recorded demographics and vascular risk factors. We reviewed the noncontrast head computed tomographies to assess for hyperdense middle cerebral artery and its computed tomography density. We reviewed the computed tomography angiograms and the raw images to determine the site and degree of arterial occlusion, collateral score, clot burden score, and the density of the clot. Recanalization status was assessed on recanalization imaging using Thrombolysis in Myocardial Ischemia. Multivariate logistic regressions were utilized to determine the best predictors of outcome in each treatment group. RESULTS: Among the 103 study patients, 43 (42%) received intravenous thrombolysis, 34 (33%) received endovascular thrombolysis, and 26 (25%) did not receive any revascularization therapy. In the patients with intravenous thrombolysis or no revascularization therapy, recanalization of the vessel was more likely with intravenous thrombolysis (P = 0·046) and when M1/A1 was occluded (P = 0·001). In this subgroup of patients, clot burden score, cervical degree of stenosis (North American Symptomatic Carotid Endarterectomy Trial), and hyperlipidemia status added information to the aforementioned likelihood of recanalization at the patient level (P < 0·001). In patients with endovascular thrombolysis, recanalization of the vessel was more likely in the case of a higher computed tomography angiogram clot density (P = 0·012), and in this subgroup of patients gender added information to the likelihood of recanalization at the patient level (P = 0·044). CONCLUSION: The overall likelihood of recanalization was the highest in the endovascular group, and higher for intravenous thrombolysis compared with no revascularization therapy. However, our statistical models of recanalization for each individual patient indicate significant variability between treatment options, suggesting the need to include this prediction in the personalized treatment selection.

An evaluation of the inappropriate prescribing in older residents in long term care facilities in the greater Cork and Northern Ireland regions using the STOPP and Beers' criteria.

This work has highlighted a number of areas of prescribing concern, for example, the long term use of both benzodiazepines and hypnotics, in older residents residing in long term care facilities. Each of these individual areas should be further investigated to determine the underlying reason(s) for the prescribing concerns in these areas and strategic methods of addressing and preventing further issues should be developed on a national level.This resource was contributed by The National Documentation Centre on Drug Use.

HIV & AIDS education and prevention plan 2008-2012. Mid-term review.

In 2008 a 4-year plan for HIV and AIDS Education and Prevention in Ireland was published. The plan aimed to contribute to a reduction in new infections of HIV and AIDS through education and prevention measures. It also aimed to guide and inform the development of policy and services in the statutory and non-statutory sectors with responsibility in this regard. This report is produced as a response to a letter from the Secretariat of the National AIDS Strategy Committee (NASC). The letter requested “feedback from the Education and Prevention Sub-Committee on prevention activities currently in place and on progress to date on the Education and Prevention Action Plan (2008-2012).” In addition, action 2 under Action Area 5: Monitoring and evaluation states that “a mid-term review of the implementation of this action plan should be published”. We note from the HPSC data that there has been a slight decrease in the overall number of new HIV infections however; there has been a huge concern over the large increase in new diagnoses in men who have sex with men (MSM). Although we cannot provide the evidence for the reason for this increase, it is stipulated that there has been a huge increase in the education and prevention programmes targeted at MSM and the report will show the evidence of that increase (Action Area 3: Preventing new infections: population group MSM). There is a presumption that because of increased awareness, access and confidence of MSM and improved treatment that there are more MSM being tested and more diagnoses. This report presents an update on the progress of the implementation of the actions in the HIV and AIDS Education and Prevention Plan 2008-2012.This resource was contributed by The National Documentation Centre on Drug Use.

A framework for quality in long-term residential care for older people in Ireland / National Council on Ageing and Older People

In 1999 the National Council on Ageing and Older People commissioned a postal survey of all long-term residential care facilities in the country to determie: - whether facilities had quality initiatives in operation - providers' views and aspirations for future provision of long-term care - providers' views on the introduction of a national quality monitoring policy This report is the outcome of the programme of work conducted by the Council on the quality of long-term residential care provision for older people in Ireland. The aim of the report is to provide a framework for developing quality in long-term residential care settings with a focus on the well-being, dignity and autonomy of older residents.

Palliative Care - A Five Year/Medium Term Development Framework

This document details the HSE's Palliative Care Services - Five Year Medium Term Development Framework (2009 - 2013). It has been developed using a holistic, system-wide, approach to addressing the level of need identified by both the Baseline Study on the Provision of Hospice / Specialist Palliative Care Services in Ireland (2006) as well as the HSE Audit of Palliative Care Service Provision (2007). The HSE Audit was conducted by each of the four HSE Administrative Areas, in conjunction with Area Development Committees, against the recommendations of the Report of the National Advisory Committee on Palliative Care 2001 (the NACPC Report). Therefore, this document is grounded in the recommendations of the NACPC Report, (e.g. palliative care definition, palliative care service areas, staffing and bed number ratios), and informed by the findings of the HSE Audit. The purpose of this document is not to replace the recommendations of the NACPC Report from a policy context, nor does it represent a new national strategy for palliative care. This document details the required actions and initiatives necessary to address the gaps in palliative care service provision, against the recommendations set out in the NACPC Report.

Interventions to achieve long-term weight loss in obese older people: A systematic review and meta-analysis

The prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE.

Interventions to achieve long-term weight loss in obese older people: A systematic review and meta-analysis

Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Design: systematic review and meta-analysis. Data sources: thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE. Study selection: we included studies with participants�۪ mean age 60 years and mean body mass index 30 kg/m2, with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus. Data extraction: nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis. Results: meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1���0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: ���0.36 mmol/l (95% CI ���0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50���0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study. Conclusions: although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people. ��Keywords: obesity, older, weight loss, meta-analysis, elderly, systematic review

Interventions to achieve long-term weight loss in obese older people

Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Design: systematic review and meta-analysis. Data sources: thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE. Study selection: we included studies with participants�۪ mean age 60 years and mean body mass index 30 kg/m2, with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus. Data extraction: nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis. Results: meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1���0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: ���0.36 mmol/l (95% CI ���0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50���0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study. Conclusions: although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people. ��Keywords: obesity, older, weight loss, meta-analysis, elderly, systematic review��

CARDI Research Brief: Future demand for long-term care in Ireland

With the population across the island of Ireland growing older, the issue of how to provide and pay for care in the home and in residential settings is becoming more urgent. It is important that a strategy for providing long-term care for an ageing population is put in place, and understanding what the demand for care will be is a major part of this. As a result, CARDI funded a research project led by Professor Charles Normand at Trinity College Dublin which aimed to develop a predictive model of future long-term care demand in NI and ROI.This research brief contains information collated by CARDI and a summary of the findings in the full report, Towards the Development of a Predictive Model of Long-Term Care Demand for Northern Ireland and the Republic of Ireland (Wren et al., 2012).

Long-term measurements of energy expenditure in humans using a respiration chamber.

There is a need to measure energy expenditure in man for a period of 24 h or even several days. The respiration chamber offers a unique opportunity to reach this goal. It allows the study of energy and nutrient balance; from the latter, acute changes in body composition can be obtained. The respiration chamber built in Lausanne is an air-tight room (5 m long, 2.5 m wide, and 2.5 m high) which forms an open circuit ventilated indirect calorimeter. The physical activity of the subject inside the chamber is continuously measured using a radar system based on the Doppler effect. Energy expenditure of obese and lean women was continuously measured over 24 h and diet-induced thermogenesis was assessed by using an approach which allows one to subtract the energy expended for physical activity from the total energy expenditure. Expressed in absolute terms, total energy expenditure was more elevated in the obese than in the lean controls. Basal metabolic rate was also higher in the obese than in the controls, but diet-induced thermogenesis was found to be blunted in the obese. In a second study, the effect of changing the carbohydrate/lipid content of the diet on fuel utilization was assessed in young healthy subjects with the respiration chamber. After a 7-day adaptation to a high-carbohydrate low-fat diet, the fuel mixture oxidized matched the change in nutrient intake. A last example of the use of the respiration chamber is the thermogenic response and changes in body composition due to a 7-day overfeeding of carbohydrate. Diet-induced thermogenesis was found to be 27%; on the last day of overfeeding, carbohydrate balance was reached by oxidation of 50% of the carbohydrate intake, the remaining 50% being converted into lipid.

The prediction of cardiovascular events is improved by combination of Framingham risk score and subclinical atherosclerosis imaging

Purpose: In primary prevention of cardiovascular disease (CVD), it is accepted that the intensity of risk factor treatment should be guided by the magnitude of absolute risk. Risk factors tools like Framingham risk score (FHS) or noninvasive atherosclerosis imaging tests are available to detect high risk subjects. However, these methods are imperfect and may misclassify a large number of individuals. The purpose of this prospective study was to evaluate whether the prediction of future cardiovascular events (CVE) can be improved when subclinical imaging atherosclerosis (SCATS) is combined with the FRS in asymptomatic subjects. Methods: Overall, 1038 asymptomatic subjects (413 women, 625 men, mean age 49.1±12.8 years) were assessed for their cardiovascular risk using the FRS. B-mode ultrasonography on carotid and femoral arteries was performed by two investigators to detect atherosclerotic plaques (focal thickening of intima-media > 1.2 mm) and to measure carotid intima-media thickness (C-IMT). The severity of SCATS was expressed by an ATS-burden Score (ABS) reflecting the number of the arterial sites with >1 plaques (range 0-4). CVE were defined as fatal or non fatal acute coronary syndrome, stroke, or angioplasty for peripheral artery disease. Results: during a mean follow-up of 4.9±3.1 years, 61 CVE were recorded. Event rates the rate of CVE increased significantly from 2.7% to 39.1% according to the ABS (p<0.001) and from 4% to 24.6% according to the quartiles of C-IMT. Similarly, FRS predicted CVE (p<0.001). When computing the angiographic markers of SCATS in addition of FRS, we observed an improvement of net reclassification rate of 16.6% (p< 0.04) for ABS as compared to 5.5% (p = 0.26) for C-IMT. Conclusion: these results indicate that the detection of subjects requiring more attention to prevent CVE can be significantly improved when using both FRS and SCATS imaging.

Effect of embryo culture media on birthweight and length in singleton term infants after IVF-ICSI.

QUESTIONS UNDER STUDY: To investigate if two distinct, commercially available embryo culture media have a different effect on birthweight and length of singleton term infants conceived after IVF-ICSI. METHODS: University hospital based cohort study. Between 1 January 2000 and 31 December 2004, patients conceiving through IVF-ICSI at the University Hospital, Lausanne have been allocated to two distinct embryo culture media. Only term singleton pregnancies were analysed (n = 525). Data analysis was performed according to two commercially available culture media: Vitrolife (n = 352) versus Cook (n = 173). Analysis was performed through linear regression adjusted for confounders. Media were considered equivalent if the 95% confidence interval lay between -150 g/+150 g. RESULTS: Length, gestational age and distribution of birthweight percentiles did not differ between groups (for both genders). Analysis of the whole cohort, adjusted for a subset of confounders, resulted in a statistically not different mean birthweight between the two groups (Vitrolife +37 g vs Cook, 95%CI: -46 g to 119 g) suggesting equivalence. Adjustment for an enlarged number of confounders in a subsample of patients (n = 258) also revealed no relevant mean birthweight difference of +71 g (95%CI: -45 g to 187 g) in favour of Vitrolife; however, lacking power to prove equivalence. CONCLUSIONS: Our data suggest that significant differences in birthweight due to these two distinct, commercially available embryo culture media are unlikely.

Northern Ireland Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Long Term Care Facilities

The Northern Ireland Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Long Term Care Facilities, also known as the 'HALT' survey was conducted as part of the 2013 European Centre for Disease Prevention and Control (ECDC) European HALT survey.In May 2013, 42 Northern Ireland long-term care facilities (nursing and residential homes) participated in a European point prevalence survey of healthcare-associated infections and antimicrobial use. Thirty-one privately owned nursing homes and 11 HSC Trust-controlled residential homes took part.The report and results have highlighted priority areas for future interventions to prevent and control HCAI, antimicrobial stewardship and future local and national prevalence surveys in long-term care facilities. The 2013 European report was published on 5th May 2014.