PHA supports World No Tobacco Day

The Public Health Agency is taking the opportunity to highlight this year's World No Tobacco Day which takes place on Tuesday 31 May.In Northern Ireland, around 340,000 people aged 16 and over smoke. Smoking contributes not only to many cancers, heart disease, bronchitis and asthma, but to other illnesses, including stroke. In fact, smoking causes around 2,700 deaths per year here, all of them avoidable.The PHA is committed to saving lives by reducing the percentage of people who smoke. The PHA:works with councils to ensure smoking-related laws are enforced; funds a range of support to smokers who want to quit; educates young people to not start smoking, through programmes like 'Teenage Kicks' and 'Smokebusters'. In January this year, the PHA also launched its smoking campaign 'Things to do before you die' to encourage smokers, particularly those aged 20-49, to stop smoking.Health Minister Edwin Poots said:"Smoking is the greatest cause of preventable illness and premature death in Northern Ireland. While good progress has been made in the last number of years to reduce the number of people who smoke, more needs to be done."I would appeal to all smokers to use the wide range of support services available to make every effort to stop smoking - it is the single best step you can take to improve your health and quality of life."Mark Mc Bride, Health Improvement Manager, PHA, said "Smoking is the single greatest preventable cause of death in the world today. Across Northern Ireland there are over 600 support services for people who wish to stop smoking. These are based in GP surgeries, community pharmacies, hospitals, community centres and workplaces."From April 2010 to end March 2011 more than 1 in 10 of all adult smokers sought help from the support services and approximately half had quit after four weeks. This is a substantial - roughly 50% increase - on previous years and shows the benefit of the PHA campaigns and the dedication of the many specialists who help smokers quit."I would encourage everyone who is either thinking about quitting or ready to log on to our Want 2 Stop website www.want2stop.info or to contacting the Smokers' Helpline on 0808 812 8008 a Quit Kit free of charge."

PHA - improving cardiovascular services

?The Public Health Agency has identified ways of delivering cardiovascular services that will help to tackle health inequalities. These are described in a new "health impact assessment" report, launched on 1 June at the Maureen Sheehan Centre, Belfast.The PHA, in partnership with a wide variety of community, voluntary and statutory bodies, leads the work to improve cardiovascular health and wellbeing, through better prevention and treatment services, delivered through a 'cardiovascular service framework'. The result of a wide consultation, this new report will help to improve the way those services are delivered by focusing on the needs of disadvantaged people.Explaining the importance of this work, Dr Adrian Mairs, Consultant in Public Health Medicine, PHA, said: "The Public Health Agency was set up to tackle health inequalities and promote better health and wellbeing across Northern Ireland. Despite many improvements in prevention and treatment, cardiovascular diseases remain the main cause of death in Northern Ireland. We know that these diseases, including heart disease, stroke, circulation problems, diabetes and renal disease have a greater and more severe impact on people living in poverty. "This work will help us to reduce the health inequalities that exist in our society by improving the way cardiovascular services are developed and delivered, eg ensuring stop smoking services meet local needs, identifying and treating high blood pressure, and helping people to take their medicines properly."The health impact assessment has been developed from other work, including a literature review, cardiovascular health and wellbeing profile, and full technical report. All of these resources are available on the PHA website, under 'Directorates', 'Service Development and Screening'. The work will also be used to help the development of service frameworks covering other disease areas. Putting a health inequalities focus on Northern Ireland cardiovascular service framework - Summary report: www.publichealth.hscni.net/publications/putting-health-inequalities-focu... health and wellbeing profile for Northern Ireland: www.publichealth.hscni.net/publications/cardiovascular-health-and-wellbe... health and wellbeing in Northern Ireland - Literature review: www.publichealth.hscni.net/publications/cardiovascular-health-and-wellbe... focus (newsletter): www.publichealth.hscni.net/publications/hia-focus

Acute coronary syndrome in the elderly

This editorial refers to the Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: In the well developed countries of the world, ischaemic heart disease is the prevailing cause of death among patients aged >65 years. In Europe, more than in other countries in the world, we will witness during the next few decades a dramatic surge of patients with ischaemic heart disease due to the progressive ageing of our population.

Deaths in Northern Ireland, 2008

The number of deaths registered in Northern Ireland in 2008 was 14,900, a small increase on the 14,600 deaths registered in 2007. Cancer continues to be the most common cause of death with nearly 4,000 cancer deaths last year.These findings are contained in provisional 2008 mortality figures released by the Northern Ireland Statistics and Research Agency (NISRA).In 2008, over half of all deaths were caused by three main diseases; cancer (4,000 deaths), ischaemic heart disease (2,400 deaths) and stroke (1,300 deaths). Whilst ischaemic heart disease deaths halved from 4,800 in 1978 to 2,400 last year; cancer deaths have risen from 2,900 in 1978 to 4,000 last year.Over the last few years we have seen marked increases in deaths recorded due to Alzheimer's and other dementia related illnesses; conditions largely associated with the elderly. In 2008, there were 290 deaths due to Alzheimer's disease and a further 520 deaths due to other forms of dementia. Deaths related to healthcare-associated infection also increased last year.

Cardiovascular disease mortality: trends at different ages

Despite a dramatic reduction since the late 1960s, cardiovascular disease remains the largest cause of death in Australia.Cardiovascular disease mortality: trends at different ages examines recent data to determine if the observed decrease in cardiovascular disease deaths since the 1960s is shared across disease sub-types and among different population groups.This report includes information on the past and recent trends of key cardiovascular diseases such as coronary heart disease and stroke, and describes how trends vary on the basis of age group and sex. International trends are also presented for comparison.The analyses presented in this report help to better understand what is driving the observed decrease in cardiovascular disease deaths, and are a useful resource for policy makers, researchers and health professionals interested in cardiovascular diseases.

Deaths from Alzheimer's disease, dementia and senility in England: (NEoLCIN)

Care homes will face particular challenges in responding to the inevitable rise in dementia, including Alzheimer’s, according to a report published by the National End of Life Care Intelligence Network (NEoLCIN). It says commissioners and providers across adult health and social care will be faced with meeting the needs of more people dying with these conditions as the population ages. It confirms that, unlike other conditions, most people with dementia, including Alzheimer’s, die in care homes.Of those who died with one of these conditions recorded as the main underlying cause of death, some 59% died in a nursing or residential home compared to 32% in hospital. That contrasts sharply with the figure for deaths overall: nationally 58% of us die in hospital and only 16% in care homes.The report also shows that people who die from cardiovascular disease, cancer or respiratory illness are significantly more likely to die in a care home if dementia including Alzheimer’s is a contributory factor in their death.Download Deaths from Alzheimer’s disease, dementia and senility in England from the NEoLCIN website

Postmortem findings in bone cement implantation syndrome-related deaths.

Several mechanisms have been postulated as potentially involved in life-threatening complications during cemented surgery. In this study, we evaluated the role of anaphylaxis and pulmonary fat embolism in the pathophysiology of bone cement implantation syndrome in a series of fatal cases that underwent medicolegal investigations. Postmortem findings in these cases were compared with those obtained from individuals who died after other injuries and/or interventions and in which activated mast cells and pulmonary fat embolism were involved in the pathogenesis of death. Fifty subjects were selected including 6 individuals who had undergone cemented total hip arthroplasty and died intraoperatively, 32 subjects who died shortly after being involved in traffic accidents, 8 individuals who died shortly after the injection of contrast material, and 4 subjects who had undergone orthopedic surgery and died postoperatively. Massive pulmonary fat embolism was determined to be the cause of death in all the 6 subjects who died intraoperatively as well as the main cause of death in traffic-road victims with rapid respiratory function deterioration. Mast cell activation was identified exclusively in the group of subjects who died shortly after contrast material administration. Massive pulmonary fat embolism appears to be the most important factor responsible for severe cardiorespiratory function deterioration during cemented arthroplasty. Cardiac comorbidities can also significantly influence the severity of intraoperative complications, thus corroborating the hypothesis of a multifactorial model in the pathogenesis of bone cement implantation syndrome.

Assessing the associations between mental disorders, cardiovascular risk factors, and cardiovascular disease : the CoLaus/PsyCoLaus study

Background: Cardio-vascular diseases (CVD), their well established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance. However, the pathogenic mechanisms and course determinants of both CVD and mental disorders have only been partially identified.Methods/Design: Comprehensive follow-up of CVRF and CVD with a psychiatric exam in all subjects who participated in the baseline cross-sectional CoLaus study (2003-2006) (n=6'738) which also included a comprehensive genetic assessment. The somatic investigation will include a shortened questionnaire on CVRF, CV events and new CVD since baseline and measurements of the same clinical and biological variables as at baseline. In addition, pro-inflammatory markers, persistent pain and sleep patterns and disorders will be assessed. In the case of a new CV event, detailed information will be abstracted from medical records. Similarly, data on the cause of death will be collected from the Swiss National Death Registry. The comprehensive psychiatric investigation of the CoLaus/PsyCoLaus study will use contemporary epidemiological methods including semi-structured diagnostic interviews, experienced clinical interviewers, standardized diagnostic criteria including threshold according to DSM-IV and sub-threshold syndromes and supplementary information on risk and protective factors for disorders. In addition, screening for objective cognitive impairment will be performed in participants older than 65 years.Discussion: The combined CoLaus/PsyCoLaus sample provides a unique opportunity to obtain prospective data on the interplay between CVRF/CVD and mental disorders, overcoming limitations of previous research by bringing together a comprehensive investigation of both CVRF and mental disorders as well as a large number of biological variables and a genome-wide genetic assessment in participants recruited from the general population.

Estimating attributable mortality due to nosocomial infections acquired in intensive care units.

BACKGROUND: The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. OBJECTIVE: To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. SETTING: Eleven ICUs of a French university hospital. DESIGN: We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. RESULTS: Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. CONCLUSIONS: ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.

Managing tobacco use: the neglected cardiovascular disease risk factor.

Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and the leading avoidable cause of death worldwide. Exposure to secondhand smoke (SHS) increases the risk of CVD among non-smokers. Smoking cessation benefits all smokers, regardless of age or amount smoked. The excess risk of CVD is rapidly reversible, and stopping smoking after a myocardial infarction reduces an individual's risk of CVD mortality by 36% over 2 years. Smoking cessation is a key component of primary and secondary CVD prevention strategies, but tobacco use often receives less attention from cardiologists than other risk factors, despite the availability of proven treatments that improve smoking cessation rates. Both psychosocial counselling and pharmacotherapy are effective methods to help smokers quit, but they are most effective when used together. The first-line medications licensed to aid smoking cessation, nicotine replacement therapy, bupropion and varenicline, are effective in and appropriate for patients with CVD. An evidence-based approach for physicians is to routinely ask all patients about smoking status and SHS exposure, advise all smokers to quit and all patients to adopt smoke-free policies for their home and car, and offer all smokers in the office or hospital brief counselling, smoking cessation pharmacotherapy, and referral to local programmes where psychosocial support can be sustained in person or by telephone. Like other chronic diseases, tobacco use requires a long-term management strategy. It deserves to be managed as intensively as other CVD risk factors.

Antimycobacterial neolignans isolated from Aristolochia taliscana

Tuberculosis (TB - Mycobacterium tuberculosis) is an ancient infectious disease that has appeared once again as a serious worldwide health problem and now comprises the second leading cause of death resulting from a single infection. The prevalence of multidrug resistance (MDR) TB is increasing and therapeutic options for treatment are not always accessible; in fact, some patients do not respond to the available drugs. Therefore, there is an urgent need to develop novel anti-TB agents. The aim of the present study was to screen extracts of Aristolochia taliscana, a plant used in traditional Mexican medicine to treat cough and snake bites, for antimycobacterial activity. The hexanic extract of A. taliscana was tested by microdilution alamar blue assay against Mycobacterium strains and bioguided fractionation led to the isolation of the neolignans licarin A, licarin B and eupomatenoid-7, all of which had antimycobacterial activity. Licarin A was the most active compound, with minimum inhibitory concentrations of 3.12-12.5 μg/mL against the following M. tuberculosis strains: H37Rv, four mono-resistant H37Rv variants and 12 clinical MDR isolates, as well as against five non-tuberculous mycobacteria (NTM) strains. In conclusion, licarin A represents a potentially active anti-TB agent to treat MDR M. tuberculosis and NTM strains.

The andalusian comprehensive cancer plan 2002-2006 : Andalusian Public Health System

Cancer is a major health problem in our Autonomous Community and is the second cause of death in both males and females. The incidence, mortality, potential years of life lost and resource consumption alongside the suffering endured by patients and families call for a commitment to be made by the Health Administration, healthcare professionals, patients and caregivers. This Plan is based on updated analyses of the mortality, incidence and survival of Cancer in Andalusia, of the situation of Cancer care and the resources available and of the expectations of patients and main caregivers, and on the conclusions of different Work Groups on the Management of Processes related to Cancer. The Andalusian Comprehensive Cancer Plan establishes an action programme that involves organisational and functional changes, new proposals for the training of professionals and a specific funding base.

Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry.

BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients. METHODS COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)). RESULTS Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7). CONCLUSIONS COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.

Estudio de los exitus con diagnóstico secundario de desnutrición en un hospital de tercer nivel.

BACKGROUND: Malnutrition is a major public health problems, according to WHO, is the leading cause of death, when it affects the group of hospitalized patients, making denominating separate entity "hospital malnutrition". OBJECTIVES: The overall objective is to quantify the main diagnoses frequently high, causing exitus, with secondary diagnosis of malnutrition. METHODS: This is a descriptive study, which included all hospital discharges in 2011 and first half of 2012, which have been exitus and whose secondary diagnosis of malnutrition, with the total of 33. We performed a descriptive analysis, effected the Mann-Whitney nonparametric test (p < 0.05). RESULTS: The most frequent main diagnoses among 33 analyzed are high sepsis (12.1%), liver metastases (9.1%), pneumonia (6.1%), acute respiratory failure (6.1%) and renal acute renal (6.1%). CONCLUSIONS: Although the most frequent primary diagnosis of sepsis, by grouping the diagnoses, the most frequent DRG is respiratory disease, so it has to make comprehensive and quality coding to adjust the relative weight of the same reality. It is essential to specify the source of clinical information used for coding, the degree of malnutrition, for greater specificity in the data.