Guidelines for the safe administration of cytotoxic medical preparations in the treatment of patients with cancer

The Minister for Health’s Strategy for effective health care in the 1990s has emphasised quality of service as one of its key principles.  Within the medical sphere, almost no other field has developed and continues to expand as rapidly as that of cancer biology and treatment.  Cytotoxic therapies are a major part of these developments. The Cancer Strategy has highlighted the importance of these drugs in the treatment of cancers. Download the Report here

Primary Care - A New Direction

Primary Care: A New Direction acknowledges the central role of primary care in the future development of our health services and proposes the introduction of an inter-disciplinary team-based approach which will be introduced on a phased basis using existing infrastructure and encouraging the use of public-private partnerships where practical. Download the Report here

Schistosomiasis mansoni in Bananal (State of São Paulo, Brazil): IV. Study on the public awareness of its risks in the Palha District

A rather high prevalence of mansoni schistosomiasis has been observed in some localities of Bananal, State of São Paulo, during the past decade. The highest prevalence of schistosomiasis was found in the Palha District; it was thus considered adequate for an evaluation of public awareness of the risks involved in acquiring schistosomiasis, a likely outcome of certain behavior patterns. We interviewed 542 district-dwellers. The 5-to-39 age-group constituted 65.5% of the whole sample. Concerning the infection, 69.2% had hearsay information; 46.1% know the infection; 69.6% know how it is acquired; 31.5% know about the symptoms and 57.1% know what can be done to avoid infection; 17.7% declared to have acquired the infection at least once in their lifetime; 62.3% reported total or partial immersion in collections of water of Bananal, once or twice a week, 53.9% of these for bathing or fishing. Although most (91.7%) households have treated running water, are connected to the sewage network or have septic tanks, 9% of the people interviewed use to defecate on the field. It became clear that the educational messages aimed at this population had not been adequate, having failed to fulfil any expectations. The local people received only piecemeal and subjective information about their problem. The control of schistosomiasis requires an integrated practice, which includes the analysis of macro-determinant factors, such as basic sanitation, habitation, education and health care. In short, we require a multidisciplinary vision of the mechanisms of transmission of the infection, which depends upon adequate planning and well trained personnel, intent on their educational work, to attain satisfactory results.

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

Health in Ireland, Key Trends 2007

This booklet provides an overview of selected key trends in health in Ireland in recent years. Tables and graphs are presented which summarise information on demographics, on health status and on health care in order to give a quick reference guide in major areas of health and health services. The past decade has been a time of rapid change in many aspects of life in Ireland. The evidence presented in this booklet reflects this period of change with respect to health. Download document here

Isolation and identification of mycobacteria from livestock specimens and milk obtained in Brazil

The prevalence of Mycobacterium bovis and other mycobacterial species in livestock specimens and milk was evaluated. An emphasis was placed upon the distribution of these organisms in milk that is readily available to the public that was either untreated, pasteurized, or treated using ultra high temperature. Twenty-two pathologic specimens from livestock (bovine, swine and bubaline) in five Brazilian states and 128 bovine milk samples from retail markets in the State of São Paulo were examined for mycobacteria. Identification was made by classical biochemical tests, thin layer chromatography of mycolic acids and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Mycobacteria were isolated from 15 (68.2%) caseous lesions and from 23 (18%) milk samples. Eleven isolates were identified as M. bovis, and the remaining 27 nontuberculous mycobacterial isolates were represented by five species and six unidentified rapidly growing mycobacterial strains. The data demonstrate that animal products in Brazil are frequent reservoirs of mycobacteria and may pose a risk to the public.

Molluscicidal action of the latex of Euphorbia splendens var. hislopii N.E.B. ("Christ's Crown") (Euphorbiaceae) against Lymnaea columella (Say, 1817) (Pulmonata: Lymnaeidae), intermediate host of Fasciola hepatica Linnaeus, 1758 (Trematode: Fasciolidae): 1- test in laboratory

The latex action of Euphorbia splendens var. hislopii (Christ's Crown) against snails Lymnaea columella, intermediate host of Fasciola hepatica, derived from irrigation ditches of the Station of Pisciculture at Universidade Federal Rural do Rio de Janeiro, was studied in the laboratory. Lab bioassays, using aqueous solutions of the latex, varying between 0.1 and 10 mg/l, have proven molluscicidal activity of the product collected on the same day the tests were performed, during the four seasons of the year, finding the following lethal concentrations (LC90): 1.51 mg/l in the spring; 0.55 mg/l in the summer; 0.74 mg/l in the fall and 0.93 mg/l in winter, after 24 h exposure of the snails, showing significant differences among the seasons of the year (ANOVA test, F = 11.01, G.L.= 3/33, p < 0.05), as well as among the concentrations (ANOVA test, F = 27.38, G.L.= 11/33, p < 0.05). In the summer, mortality reached 100% from concentration at 0.6 mg/l, the same during fall and in winter as of 1 mg/l, while in spring it only reached 100% mortality as of 2 mg/l. Mortality in the controls was low, reaching 5% in the summer and winter and 10% in the fall and spring. None of the samples died. During the assay, with an aqueous solution of the latex at a concentration of 5 mg/l, in order to check the time of duration of the product effect, in the laboratory, it was observed that the molluscicidal activity remained stable up to the 15th day after the beginning of the test with 100% mortality of L. columella, gradually losing its effect until the 23rd day, when we no longer observed animal mortality. In the control group, there was a random daily variation in mortality rate ranging 0-50% after 48 h of observation for 30 days.

Simulation of amoxicillin pharmacokinetics in humans for the prevention of streptococcal endocarditis in rats.

The pharmacokinetic determinants of successful antibiotic prophylaxis of endocarditis are not precisely known. Differences in half-lives of antibiotics between animals and humans preclude extrapolation of animal results to human situations. To overcome this limitation, we have mimicked in rats the amoxicillin kinetics in humans following a 3-g oral dose (as often used for prophylaxis of endocarditis) by delivering the drug through a computerized pump. Rats with catheter-induced vegetations were challenged with either of two strains of antibiotic-tolerant viridans group streptococci. Antibiotics were given either through the pump (to simulate the whole kinetic profile during prophylaxis in humans) or as an intravenous bolus which imitated only the peak level of amoxicillin (18 mg/liter) in human serum. Prophylaxis by intravenous bolus was inoculum dependent and afforded a limited protection only in rats challenged with the minimum inoculum size infecting > or = 90% of untreated controls. In contrast, simulation of kinetics in humans significantly protected animals challenged with 10 to 100 times the inoculum of either of the test organisms infecting > or = 90% of untreated controls. Thus, simulation of the profiles of amoxicillin prophylaxis in human serum was more efficacious than mere imitation of the transient peak level in rats. This confirms previous studies suggesting that the duration for which the serum amoxicillin level remained detectable (not only the magnitude of the peak) was an important parameter in successful prophylaxis of endocarditis. The results also suggest that single-dose prophylaxis with 3 g of amoxicillin in humans might be more effective than predicted by conventional animal models in which only peak levels of antibiotic in human serum were stimulated.

Unintentional injuries among 16 to 20 year old students in Switzerland.

In our society, accidents constitute a major public health problem, especially among youth. The objective of this paper was to describe the incidence of nonfatal injuries that required medical care among 16 to 20 year-old in Switzerland, its distribution by type of injury and whether there were differences by gender or by academic track and whether these injuries had sequels (hospitalisation, physical and psychological sequels). Overall, 28.3% of the sample reported at least one accident needing medical care in the previous 12 months, with males having more accidents than females and apprentices more than students. By type of accident, sports were the most frequently reported, followed by traffic, leisure time and work accidents. Half of males and one-third of females reported more than one accident, and 16% and 8% of them, respectively, reported four or more. Both physical and psychological sequels were more frequent among females, while hospitalisation was more frequent among males. Accident prevalence rates remain high among adolescents. Safety counselling and environmental measures need to be implemented.

PHA supports World Hospice and Palliative Care Day

Saturday 8 October 2011 marks World Hospice and Palliative Care Day. The Public Health Agency would like to celebrate and support hospice and palliative care around the world by raising awareness and understanding of the needs - medical, social, practical and spiritual - of people living with a life-limiting illness, and their families.This year's World Hospice and Palliative Care Day theme is 'Many diseases, manylives, many voices - palliative care fornon-communicableconditions'.The theme will focus on how people living with conditions thatare notinfectious can benefit from palliative care.Non-communicable diseases (NCDs), which include cardiovascular diseases, cancers, chronic respiratory conditions and diabetes, make up60% of deaths worldwide. The majority of thesedeaths occur in low and middle income countries, where palliative care is often not available. To get involved in World Hospice and Palliative Care Day, log on to www.worldday.org/get-involved/ which gives you ideas and suggestions on what you can do on the day to support people living with life-limiting illnesses, and their families.Mary Hinds, Director of Nursing and Allied Health Professions, PHA, and Chair of the Implementation Process for End of Life Care in Northern Ireland, said: "Good quality palliative and end of life care will be important for us all. 'Living Matters, Dying Matters' is a five year strategy for palliative and end of life care in Northern Ireland, established to ensure that any person living with a life-threatening illness lives well and dies well, irrespective of their condition or care setting. "It has been encouraging to see the plans being taken forward by the Health and Social Care Trusts in partnership with local hospices and other providers, and involving local people."We aim to ensure that people receiving palliative care, their families and carers, are provided with high quality care across all settings and conditions, and are supported to enjoy a good quality of life, maximising their potential through the course of their illness."There is still some progress to be made within the context of the review of health and social services. We are looking for statutory and voluntary services to work together to make a significant difference in improving access to high quality services for those with life-limiting conditions, and to develop innovative approaches to care."

Dose reduction of epoetin-alpha in the prevention of chemotherapy-induced anaemia.

INTRODUCTION: Anaemia during chemotherapy is often left untreated. Erythropoiesis-stimulating agents are frequently used to treat overt anaemia. Their prophylactic use, however, remains controversial and raises concerns about cost-effectiveness. Therefore, we assessed the efficacy of a dose-reduction schedule in anaemia prophylaxis. MATERIALS AND METHODS: The study included patients with untreated solid tumours about to receive platinum-based chemotherapy and had haemoglobin (Hb) levels ≥11 g/dL. Epoetin-α was administered at a dose level of 3 × 10,000 U weekly as soon as Hb descended to < 13 g/dL. Dose reductions to 3 × 4,000 U and 3 × 2,000 U weekly were planned in 4-week intervals if Hb stabilised in the range of 11-13 g/dL. Upon ascending to ≥13 g/dL, epoetin was discontinued. Iron supplements of 100 mg intravenous doses were given weekly. Of 37 patients who enrolled, 33 could be evaluated. RESULTS AND DISCUSSION: Their median Hb level was 13.7 (10.9-16.2) g/dL at baseline and descended to 11.0 (7.4-13.8) g/dL by the end of chemotherapy. Anaemia (Hb < 10 g/dL) was prevented in 24 patients (73%). The mean dose requirement for epoetin-α was 3 × 5,866 U per week per patient, representing a dose reduction of 41%. Treatment failed in nine patients (27%), in part due to epoetin-α resistance in four (12%) and blood transfusion in three (9%) patients. CONCLUSION: Dose reduction was as effective as fixed doses in anaemia prophylaxis but reduced the amount of prescribed epoetin substantially.

Looked after children in Dublin and their mental health needs.

Children in care in Ireland have increased by 27% in the last decade. This population is recognized to be among the most vulnerable. This study aims to describe their placement histories, service use and mental health needs. Data was obtained on 174 children (56.5% of eligible sample) with a mean age of 10.83 (SD = 5.04). 114 (65.5%) were in care for three years or more. 29 (16.7%) did not have a SW and 49 (37.7%) had no GP. 50 (28.7%) were attending CAMHS. Long term care, frequent placement changes and residential setting were significantly related with poorer outcomes and increased MH contact. Given the increase in numbers in care and the overall decrease in resource allocation to health and social care, individual care planning and prioritizing of resources are essential.This resource was contributed by The National Documentation Centre on Drug Use.

Dementia Care Services UK Market Briefing 2009

This brand new market briefing adds to the growing national debate on the future of dementia care services, making use of a unique and extensive L&B survey (2008) of over 6,000 care homes in the UK which provide care for people with dementia. It builds on the findings of the Alzheimer’s Society’s Dementia UK report (2007) and the national strategy for dementia Living Well with Dementia (2009) to identify market opportunities and provide essential guidance and information with regard to planning and developing new and existing services.Key issues, facts and figures highlighted in the report include:Dementia care is a multi-billion pound market in the UK and this market is set to grow considerably.��Dementia care in care homes dominates the sector in terms of current market value.��The use of dementia home care – though significantly smaller than the equivalent market in care homes – is set to rise markedly in the future.A significant proportion of residents for whom dementia is a known cause of admission are receiving care in settings which are not dedicated to dementia care.The new national dementia strategy for England, Living Well with Dementia should provide the strongest impetus yet for growth in the market for specialist dementia care.Growing awareness surrounding inappropriate use of anti-psychotic drugs on people with dementia in care homes may have a major operational impact on some homes if controls are increased and could substantially increase costs.Despite evidence of increasing dementia specialisation, there are, as yet, no organisations to emerge with full service dementia expertise and integrated care pathways.The supply of dedicated dementia services varies dramatically by region and locality, reflecting local and regional priorities and commissioning strategies.The design and layout of care homes for people with dementia is key and there is an increasing consensus around what constitutes best practice and ‘dementia friendly design’ .Care home fees for dementia are generally higher than fees for frail elderly residents.The report is essential reading for senior executives and managers within any organisation committed to, or considering involvement in, the dementia care sector, including for-profit, 'third sector' and public sector agencies.For further information, please contact:��Market ReportsTel.��020 7833 9123 orEmail��info@laingbuisson.co.uk��Download Full Brochure including Order Form��Download Contents and Tables�� Featured item on home page:��no��

Cancer inequalities in South Central Strategic Health Authority

This is the second in a series of reports describing cancer inequalities across South Central Strategic Health Authority. Focusing on the four most common cancers (lung, colorectal, breast and prostate), it examines inequalities in access to and quality of care, in relation to age, sex, deprivation and area of residence.

Autochthonous horizontal transmission of a CRF02_AG strain revealed by a human immunodeficiency virus type 1 diversity survey in a small city in inner state of Rio de Janeiro, Southeast Brazil

As part of an ongoing study on the features of AIDS spread towards small cities and rural areas, we present a molecular survey of human immunodeficiency virus type 1 (HIV-1) polymerase sequences recovered between 2004 and 2006 from 71 patients receiving care in the city of Saquarema, inner state of Rio de Janeiro. Phylogenetic reconstructions found the two prevalent lineages in the state (subtypes B [59 strains, 83.1%], F1 [6 strains; 8.4%], and BF1 recombinants [four strains; 5.6%]), as well as two (2.8%) CRF02_AG strains, which seems to be an emerging lineage in the capital. These CRF02_AG sequences were recovered from a married heterosexual couple who never traveled abroad, thus providing the first molecular evidence of autochthonous horizontal transmission of this lineage of major global importance. Also, three phylogenetic clusters of strains recovered from a total of 18.3% of the cohort were uncovered. Their close genetic relatedness suggests they were recovered from patients who probably took part in the same chain of viral spread. In conjunction with our previous surveys from inner Rio de Janeiro, these results suggest that although small cities harbor unique molecular features of HIV-1 infection, they also clearly reflect and may rapidly absorb the diversity recorded in large urban centers.