964 resultados para Bech, Henning: When men meet


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BACKGROUND: Peer pressure (PP) has been shown to play a major role in the development and continuation of alcohol use and misuse. To date, almost all the studies investigating the association of PP with alcohol use only considered the PP for misconduct but largely ignored other aspects of PP, such as pressure for peer involvement and peer conformity. Moreover, it is not clear whether the association of PP with alcohol use is direct or mediated by other factors. The aim of the present study was to investigate the association of different aspects of peer pressure (PP) with drinking volume (DV) and risky single-occasion drinking (RSOD), and to explore whether these associations were mediated by drinking motives (DM). METHODS: A representative sample of 5521 young Swiss men, aged around 20 years old, completed a questionnaire assessing their usual weekly DV, the frequency of RSOD, DM (i.e. enhancement, social, coping, and conformity motives), and 3 aspects of PP (i.e. misconduct, peer involvement, and peer conformity). Associations between PP and alcohol outcomes (DV and RSOD) as well as the mediation of DM were tested using structural equation models. RESULTS: Peer pressure to misconduct was associated with more alcohol use, whereas peer involvement and peer conformity were associated with less alcohol use. Associations of drinking outcomes with PP to misconduct and peer involvement were partially mediated by enhancement and coping motives, while the association with peer conformity was partially mediated by enhancement and conformity motives. CONCLUSIONS: Results suggest that PP to misconduct constitutes a risk factor, while peer conformity and peer involvement reflect protective factors with regard to alcohol use. Moreover, results from the mediation analyses suggest that part of the association of PP with alcohol use came indirectly through DM: PP was associated with DM, which in turn were associated with alcohol use.

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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.

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The Spearhead Intervention Tool has been commissioned by the Department of Health through the Association of Public Health Observatories (APHO). This version of the tool has been updated with latest data for 2005-07. The tool is designed to assist commissioners in Spearhead Primary Care Trusts (PCTs) with their Local Delivery Planning (LDP) and commissioning and to assist Spearhead Local Authorities (LAs) with the delivery of Local Area Agreements (LAAs). It highlights key issues for Spearhead PCTs and LAs to consider in order to achieve the life expectancy element of the Government̢?Ts Public Service Agreement (PSA) on health inequalities by 2010.

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This study investigated the seropositivity for hepatitis B virus (HBV), the vaccination index, and the vaccine response index in dentists from Campo Grande, MS. Blood samples from 474 dentists (63.7% women and 36.3% men), with a mean age of 38.5 ± 10.5 years were analyzed by enzyme-linked immunosorbent assay to detect the serological markers: HBsAg, anti-HBs, and anti-HBc. The HBsAg positive samples were tested for anti-HBc IgM, HBeAg, and anti-HBe. A total of 51 (10.8%) dentists showed seropositivity for HBV. Three (0.6%) were HBsAg/anti-HBc/anti-HBe positive, 43 (9.1%) were anti-HBc/anti-HBs positive, and 5 (1.1%) had only anti-HBc. Viral DNA was detected by polymerase chain reaction in 9 (17.6%) out of 51 HBV seropositive samples. A vaccination index of 96.6% (458/474) was observed, although 73.1% (335/458)completed the three-dose schedule. Excluding 46 HBV seropositive individuals from 458 that reported vaccination, 412 were analyzed for vaccine response index. It was observed that 74.5% (307/412) were anti-HBs positive; this percentage increased to 79.1% when three doses were administered. The results showed a high vaccination index and a good rate of vaccine response; however, the failure in completing the three-dose schedule and the occurrence of HBV infection reinforce the need for more effective prevention strategies.

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SUMMARY : The traditional medical advice for pregnant women has been to reduce their physical activity (PA) levels. The advice was based on concerns that exercise could affect pregnancy outcomes by increasing core body temperature, by increasing the risk of maternal musculoskeletal injury and by altering the transplacental transport of oxygen and nutrients to maternal skeletal muscle rather than to the developing foetus. In the meantime, several studies have provided new information on adaptation of the pregnant woman and her foetus to moderate PA. New investigations have shown no adverse maternal or neonatal outcomes, abnormal foetal growth, increase in early pregnancy loss, or late pregnancy complications. Moreover, enrolment in moderate PA has proven to result in marked health benefits including improved maternal cardiovascular function, reduction of excessive weight gain and fat retention, less complicated labour, improved foetal stress tolerance and neurobehavioral maturation. In view of the beneficial effects, current recommendations encourage healthy pregnant women to engage in 30 minutes of moderate PA on most, if not all, days of the week. This thesis work addressed several questions. Firstly, it examined whether compliance with the recommended levels of PA during pregnancy results in better preparedness for the sudden physical exertion of labour and delivery. Secondly, it measured PA during pregnancy as compared to postpartum. Lastly, it assessed the influence of pre-pregnancy body mass index on gestational resting metabolic rate. Data collection was conducted on healthy women living in Switzerland during the third trimester of pregnancy and postpartum. Total and activity energy expenditure was assessed through 24-hour heart rate and accelerations recordings, and cardiovascular fitness through an individual step-test. Information related to pregnancy, labour and delivery was collected from medical records. The results indicate that a minimum 30 min of moderate PA per day during pregnancy are associated with better cardiovascular fitness and lower risk of operative delivery with no negative effects on maternal and foetal conditions (study 1). Despite these benefits, a substantial proportion of pregnant women (39%) living in Switzerland do not meet the PA recommendations. The decrease in activity related energy expenditure during pregnancy compared to postpartum was measured to be around 100 kcal/day (~13%), whereas the total energy expenditure was found to increase by 300 kcal/day (study 2). Thus, the energy cost of late pregnancy in Switzerland corresponds to 200 kca/day. These findings are based on average values of the study group. It should be noted, however, that large variations in individual energy expenditure may occur depending on the pre-pregnancy body mass index (study 3). When adjusted to body weight, gestational resting metabolic rate is significantly lower among women of high pre-pregnancy body mass index compared to women of normal or low pre-pregnancy body mass index. This can be explained by the fact that resting metabolic rate is primarily a function of fat-free mass, and when expressed per kg body weight, it decreases as the percentage of body fat increases. If energy intake is not modified appropriately in order to match lower energy cost per kg body weight in overweight and obese women it will result in positive energy balance, thus contributing to the current trend towards increasing adiposity in affluent society. The results of these studies go beyond the current state of knowledge on PA and pregnancy (study 4) and provide valid evidence to guide clinical practice. In view of the current epidemic of sedentary behaviour and obesity related pathology, the findings contribute new and reliable information to public health policies regarding the effects of PA in pregnancy, an important period of life for both mother and infant.

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Nonadherence to treatment is a common problem in the clinical management of hypercholesterolemic patients. This study was carried out with the aim of monitoring the daily compliance to a 6-month course of lipid-lowering therapy, using a microelectronic device, the Medication Event Monitoring System (MEMS), versus pill count. Forty men with primary hypercholesterolemia were prescribed fluvastatin 1 x 40 mg daily, provided in a MEMS package to record the date and time of each opening of the pillbox. Thirty-nine of 40 patients (98%) completed the study. Total cholesterol and LDL cholesterol levels decreased significantly (18% and 25%, p < 0.001) during the 6-month therapy period. A high mean rate of compliance was achieved by MEMS using the following three indexes--compliance to total prescribed dose (88.8% +/- 13.5%), compliance to prescribed days (82.4% +/- 19.5%), and compliance to prescribed time of day (81.86% +/- 19.5%)--and by pill count (93.4% +/- 9.5%). In addition, the MEMS provided some patterns of nonadherence to medication, undetectable by pill count alone, such as a drug holiday in 38% of cases, a drug omission for more than 7 consecutive days in 9% of cases, and, conversely, use of more than the one prescribed daily dose in 47% of cases. A significant correlation between the rate of compliance and the decrease in LDL cholesterol was observed only when the compliance was assessed by MEMS. The results indicate that MEMS is a useful tool for monitoring compliance in clinical practice and may possibly increase adherence to long-term lipid-lowering therapy.

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This third and final report of the CEMACH national diabetes programme comes at an important time in the national drive to improve services for women with diabetes in pregnancy. The National Service Framework (NSF) for Diabetes requires the NHS to develop, implement and monitor policies that seek to empower and support women with diabetes to optimise the outcomes of their pregnancy. The CEMACH report shows that, whilst progress has been made in improving services for women with diabetes and their babies, there is much still to be done to meet the standards recommended by the NSF. Too many women continue to be poorly prepared for pregnancy in the critical areas of glycaemic control and folic acid supplementation. The report underlines the need for an increased focus on diabetes preconception care services and the development of strategies to educate women with diabetes of childbearing age. The growing proportion of women with type 2 diabetes during pregnancy, many of whom are from minority ethnic groups, presents an additional challenge for health services in developing responsive and accessible services.This CEMACH report has identifi ed several areas of good clinical practice during pregnancy in women with pre-existing diabetes. However, there continue to be areas where there is room for improvement, including antenatal fetal surveillance, glycaemic control during labour and delivery and postnatal diabetes care. The National Institute for Health and Clinical Excellence (NICE) is currently in the fi nal stages of development of its new guideline for the management of diabetes in pregnancy. This guideline, when taken together with the CEMACH report, will provide local health services with an unprecedented wealth of material on which to base their development of improved services for women with diabetes in pregnancy.��

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A short report using the experiences of young suicidal men to inform mental health care services.�

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This leaflet is given to all men who have attended screening through the Northern Ireland Abdominal Aortic Aneurysm (AAA) Screening Programme and been diagnosed with a large AAA.The leaflet provides: background information on the AAA screening programme; details on what a large AAA is; information on the process of referral to a team of vascular specialists;details on the operation to treat a large AAA;important information on the symptoms of a ruptured AAA;lifestyle advice that may help those men diagnosed with an AAA. Men who have been diagnosed with a large AAA will be invited to meet a team of vascular specialists for further assessment within two or three weeks of their scan. Following additional medical tests, the patient may be offered surgery to treat the large AAA. Those men assessed as unsuitable for an operation will continue to be monitored within the vascular service.

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Effective safeguarding children practice depends upon information sharing, collaboration and understanding between families, agencies and professionals. Nurses are required to work in partnership with other disciplines and agencies to safeguard and promote the health and wellbeing of children and young people. This includes working in partnership with the guardian ad litem (guardian) appointed by the court when making decisions regarding the best interests of a child or young person.This guidance replaces previous regional guidance. Regional implementation will ensure that information held by nurses is shared with the guardian in a consistent, timely and appropriate manner, so that informed decisions can be made in the best interests of children and young people.

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La finalitat general d'aquest projecte és dissenyar i avaluar la facilitat d'ús del menú de l'aplicació GAT. Els objectius principals són ordenar, agrupar i classificar les opcions del menú, agrupar-les per processos i subprocessos de la UOC, disminuir l'adaptació a l'aplicació, facilitar-ne l'aprenentatge i distingir amb claredat si és una opció de tipus formulari o de tipus web.

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The Northern Ireland Abdominal Aortic Aneurysm (AAA) Screening Programme began in June 2012 and offers AAA screening to all men aged 65 and over in Northern Ireland. All men in their 65th year receive an invite in the post. All men aged over 65 who have not been screened can request an appointment. The aim of the AAA screening programme is to reduce AAA-related mortality by providing systematic, population-based screening.� This poster was sent out to all GPs, GP practice managers and pharmacies as part of a professional information pack in the run-up to the launch of the programme. The poster is also distributed to relevant voluntary organisations and charities as a means of raising awareness among the target population.

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Rapport de synthèse:Le but de cette étude était d'investiguer pour la première fois chez l'homme l'effet du sodium alimentaire et de l'hypertension artérielle sur l'oxygénation tissulaire par une technique spéciale d'imagerie à résonance magnétique nommée 'BOLD-IRM' (Blood Oxygen Level Dependent-IRM). Le BOLD-IRM est une technique nouvelle qui permet de mesurer la bio disponibilité tissulaire d'oxygène de façon non-invasive chez l'homme, en utilisant le déoxyhémoglobine comme produit de contraste endogène.Le rational de cette étude était double. Premièrement, des changements dans l'apport sodique alimentaire devraient théoriquement influencer l'oxygénation tissulaire rénale, étant donné que la réabsorption tubulaire du sodium est un transport actif nécessitant de l'énergie et de l'oxygène. Deuxièmement, des études chez l'animal suggèrent une rôle possible de l'hypoxie tissulaire dans le développement de la néphropathie hypertensive.Nous avons déterminé l'oxygénation rénale avec le BOLD-IRM chez dix hommes normo tendus (âgés de 26.5±7.4 ans) et huit hommes hypertendus non-traités (âgés de 28.8±5.7 ans) une semaine après un régime riche en sel (>200 mmol/jour), et de nouveau une semaine après un régime pauvre en sel (<100 mmol/jour). En parallèle, nous avons mesuré la clearance de l'inuline, du p- aminohippurate (PAH) et du lithium endogène, afin de déterminer respectivement la filtration glomérulaire, le flux sanguin rénal et le 'renal sodium handling', tous des paramètres ayant la capacité d'influencer la consommation et/ou la disponibilité d'oxygène tissulaire. Nous nous attendions d'une côté à une oxygénation rénale diminuée chez les sujets hypertendus par rapport aux sujets normo tendus, et d'une autre côté à une augmentation de l'oxygénation tissulaire rénale après une semaine de régime pauvre en sel par rapport à la phase d'un régime riche en sel.Nous retenons comme résultat principal une augmentation de l'oxygénation rénale médullaire suite à une restriction sodique par rapport à un régime riche en sel chez tous les participants (normo-et hypertendus). Chez les participants normotendus ces changements correlaient avec des changements dans le transport actif du sodium, et ceci indépendamment du flux sanguin rénal. Contrairement à ce qu'on attendait, l'oxygénation rénale médullaire était plus élevé chez les sujets hypertendus par rapport aux sujets normotendus.En résumé, ces observations offrent possiblement une explication pour les bénéfices rénaux liés à un régime pauvre en sel. En plus, la combinaison d'études de clearance et le BOLD- IRM comme utilisé dans cette étude se sont révélés un outil performant et prometteur qui peut stimuler la recherche dans ce domaine.

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BACKGROUND: Major depression, although frequent in primary care, is commonly hidden behind multiple physical complaints that are often the first and only reason for patient consultation. Major depression can be screened by two validated questions that are easier to use in primary care than the full DSM-IV criteria. A third question, called the "help" question, improves the specificity without apparently decreasing the sensitivity of this screening procedure. We validated the abbreviated screening procedure for major depression with and without the "help" question in primary care patients managed for a physical complaint. METHODS: This diagnostic accuracy study used data from a cohort study called SODA (for SOmatisation Depression Anxiety ) conducted by 24 general practitioners (GPs) in western Switzerland that included patients over 18 years of age with at least one physical complaint at index consultation. Major depression was identified with the full Patient Health Questionnaire. GPs were asked to screen patients for major depression with the three screening questions one year after inclusion. RESULTS: Out of 937 patients with at least one physical complaint, 751 were eligible one year after index consultation. Major depression was diagnosed in 69/724 (9.5%) patients. The sensitivity and specificity of the two-question method alone were 91.3% (95% confidence interval 81.4-96.4%) and 65.0% (95% confidence interval 61.2-68.6%), respectively. Adding the "help" question decreased the sensitivity (59.4% ; 95% confidence interval 47.0-70.9%) but improved the specificity (88.2% ; 95% confidence interval 85.4-90.5%) of the three-question method. CONCLUSIONS: The use of two screening questions for major depression was associated with high sensitivity and low specificity in primary care patients presenting a physical complaint. Adding the "help" question improved the specificity but clearly decreased the sensitivity; when using the "help" question; four out of ten patients with depression will be missed, compared to only one out of ten with the two-question method. Therefore, the "help" question is not useful as a screening question, but may help discussing management strategies.

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Cancer is the second leading cause of mortality worldwide. Cancer progression leads to metastasis formation, which accounts for more than ninety percent of cancer-related death. Metastases are more difficult to be surgically removed because of their invasive behavior and shape. In addition, during their transformation journey, they become more and more resistant to anticancer drugs. Significant improvements have been achieved in therapy against cancer in recent years but targeting the metastatic cascade remains the Achilles heel of the cure against cancer. A First step in the metastatic process is the escape of cancer cells from the primary tumor site. This involves an increase in cell motility and the concomitant ability to clear a path through the extracellular matrix. From a therapeutic point of view, inhibition of cell migration is a logical approach to develop anti-metastatic drugs. Our lab previously developed a cell permeable peptide derived from a caspase-3-generaied fragment of the RasGAP protein called TAT-RasGAP317-326. This peptide efficiently and specifically sensitizes cancer cells to chemotherapy- and radiotherapy-induced ceil death, which allows decreasing the anticancer drug doses and eventually their associated side- effects. In the present study we discovered that TAT-RasGAP317.326 also increases cell adhesion which was associated with inhibition of cell migration and invasion into the extracellular matrix. The ability of TAT-RasGAP317.326 to increase ceil adhesion involves the dramatic depolymerization of actin cytoskekton together with redistribution of focal adhesions. We found that the inhibitory effects on migration were mediated by a RhoGAP tumor and metastasis suppressor cailed DLC1 (Deleted in Liver Cancer 1). Moreover. DEC 1 was found to be a direct RasGAP-interacting protein and this interaction requires the RasGAP tryptophan 317 residue, the very first RasGAP residue of TAT-RasGAP317.326. We then evaluated the roie of RasGAP fragments in the in vivo metastatic cascade. We found that breast cancer cells overexpressing the parental RasGAP fragment, to which the TAT-RasGAP317.326 peptide belongs, have a markedly decreased ability to form lung metastases. Unfortunately, we were not able to recapitulate these an ti-metastatic effects when TAT-RasGAP317.326 was injected. However, we later understood that this was due to the fact that TAT-RasGAP317.326 was not properly delivered to the primary tumors. Further work, aimed at better understanding of how TAT-RasGAP317.326 functions, revealed that the ten amino acid TAT-RasGAP317.326 peptide could, be narrowed down to a three amino acid TAT-RasGAP317.329 peptide while keeping its sensitizer activity. In parallel, investigations on the RasGAP-DLCl binding indicated that the arginine linger of the DLC1 GAP domain is required for this interaction, which suggests that TAT-RasGAP317.326 modulates the GAP activity of DLC1. Additional work should be performed to fully elucidate its mechanism of action and render TAT-RasGAP317.326 usable as a tool to fight cancer on two fronts, by improving chemotherapy and preventing metastatic progression. - Le cancer est la deuxième cause de mortalité dans le monde. La formation de métastases est la dernière étape de la progression cancéreuse et représente plus du nonante pour cent des morts induites par le cancer. De par leur morphologie et comportement invasifs, ii est difficile d'avoir recours à la chirurgie pour exciser des métastases. De plus, les cellules cancéreuses en progression deviennent souvent de plus en plus résistantes aux drogues anticancéreuses. Ces dernières années, des avancements significatifs ont contribué à l'amélioration de la lutte contre le cancer. Néanmoins, pouvoir cibler spécifiquement la cascade métastatique demeure cependant le talon d'Achille des thérapies anticancéreuses. Une première étape dans ie processus métastatique est l'évasion des cellules cancéreuses du site de la tumeur primaire. Ceci requiert une augmentation de la motiliié cellulaire couplée à la capacité de se frayer un chemin au sein de la matrice extracelluiaire. D'un point de vue thérapeutique, inhiber la migration cellulaire est une approche attrayante. Notre laboratoire a développé un peptide, nommé TAT-RasGAP317.326 dérivé d'un fragment qui est lui-même le résultat du clivage de la protéine RasGAP par la caspase-3. Ce peptide est capable de pénétrer les cellules cancéreuses et de les sensibiliser spécifiquement à la mort induite par la radiothérapie et la chimiothérapie. La finalité des effets de ce peptide est de pouvoir diminuer les doses des traitements anti-cancéreux et donc des effets secondaires qu'ils engendrent. Dans cette étude, nous avons découvert que TAT-RasGAP317.326 augmente l'adhésion des cellules et inhibe la migration cellulaire ainsi que l'invasion des cellules à travers une matrice extracellulaire. La capacité de TAT-RasGAP317.326 à induire l'adhésion repose sur ia dépolymérisation du cytosquelette d'actine associée à une redistribution des points d'ancrage cellulaire. Nous avons découvert que l'inhibition de ia migration par TAT-RasGAP317.326 nécessitait la présence d'un suppresseur de tumeur et de métastases appelé DLC1 (Deleted in Liver Cancer l), qui par ailleurs s'avère aussi être une protéine RhoGAP. De plus, nous avons aussi trouvé que DLC1 était un partenaire d'interaction de RasGAP et que cette interaction s'effectuait via l'acide aminé tryptophane 317 de RasGAP. qui s'avère être le premier acide aminé du peptide TAT-RasGAP317.326. Nous avons ensuite évalué le rôle joué par certains fragments de RasGAP dans le processus de métastatisation. Dans ce contexte, des cellules de cancer du sein qui sur-expriment un fragment de RasGAP contenant la séquence TAT-RasGAP317.326 ont vu leur potentiel métastatique diminuer drastiquerment. Malheureusement, aucun effet anti-métastatique n'a été obtenu après injection de TAT-RasGAP317.326 dans les souris. Cependant, nous avons réalisé rétrospectivement que TAT-RasGAP317.326 n'était pas correctement délivré à la tumeur primaire, ce qui nous empêche de tirer des conclusions sur le rôle anti-métastatique de ce peptide. La suite de cette étude visant à mieux comprendre comment TAT-RasGAP317.326 agit, a mené à la découverte que les dix acides aminés de TAT-RasGAP317.326 pouvaient être réduits à trois acides aminés, TAT-RasGAP317.329, tout en gardant l'effet sensibilisateur à la chimiothérapie. En visant à élucider le mode d'interaction entre RasGAP et DLC1, nous avons découvert qu'un acide aminé nécessaire à l'activité GAP de DLC1 était requis pour lier RasGAP, ce qui laisse présager que TAT-RasGAp317.32c, module i'activité GAP de DLC1. Des travaux supplémentaires doivent encore être effectués pour complètement élucider les mécanismes d'action de TAT-RasGAP317.326 et afin de pouvoir l'utiliser comme un outil pour combattre le cancer sur deux fronts, en améliorant les chimiothérapies et en inhibant la formation de métastases.