Obesity Weighting up the Evidence: All-Island Multisectoral Conference on Obesity

The World Health Organization reports that overweight and obesity have reached epidemic proportions globally and estimates that approximately 1.6 billion adults and at least 20 million children under the age of five are overweight or obese. It is accepted that being overweight or obese increases the risk of health conditions such as heart disease, stroke, diabetes and some cancers and has significant impacts on a wide range of other factors including education, employment and emotional wellbeing. This conference aimed to present a multisectoral audience with the latest developments in overweight and obesity prevention and management. This presentation was given by Dr. Kevin Balanda, Institute of Public Health in Ireland. The Institute of Public Health in Ireland (IPH) is leading the development of an All-Ireland obesity observatory The obesity observatory development is being undertaken in collaboration with: - HRB Centre for Health and Diet Research ﾖ UCC /UCD - Centre of Excellence for Public Health (NI) - QUB Projected outcomes: Adequate sample size Data to be sought and recorded Usefulness of a database in influencing policy Value to clinicians in management of obesity

A Tobacco-Free Future - An all-island report on tobacco, inequalities and childhood 2013

A Tobacco-Free Future - An all-island report on tobacco, inequalities and childhood 2013 reveals declines in smoking rates among both children and pregnant women over the past decade, both North and South of the border. This report published by the Institute of Public Health in Ireland (IPH) and the TobaccoFree Research Institute Ireland (TFRI), shows that while tobacco control measures are being successful, disadvantaged children are at particular risk of tobacco-related harms.

A Fitter Future for All: Consultation Document

The prevalence of people who are overweight and obese has been steadily rising in Northern Ireland, and in the western world, over the last few decades. It has been described as an “obesity time-bomb”, given the impact that obesity can have on physical and mental health and wellbeing.Evidence has shown that, while weight gain is the result of a relatively simple energy imbalance, the causes that underpin changes to energy intake and expenditure are very complex and cover issues such as social and individual psychology, physiology, food production and consumption, individual activity, and the built environment.This Framework aims to “empower the population of Northern Ireland to make healthy choices, and reduce the level of harm related to overweight and obesity, by creating an environment that supports and promotes a physically active lifestyle and a healthy diet”.In addition, the following overarching target has been set: to reduce the level of obesity in Northern Ireland to the 2005-06 level by 2021.

Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022: A Fitter Future for All (PDF 1MB)

A Framework for Preventing and Addressing Overweight and Obesity in NI 2012-2022 This Framework aims to “empower the population of Northern Ireland to make healthy choices, reduce the risk of overweight and obesity related diseases and improve health and wellbeing, by creating an environment that supports and promotes a physically active lifestyle and a healthy diet”. In addition, the following overarching targets have been set: Adults • To reduce the level of obesity by 4% and overweight and obesity by 3% by 2022. Children • A 3% reduction of obesity and 2% reduction of overweight and obesity by 2022åÊThe target is in two parts; the proportion that are obese and the proportion that are overweight and obese. Prevention is typically taken forward through action to address two main areas – improving diet and nutrition, and increasing participation in physical activity. Acknowledging this, two overarching objectives for the Framework have been set: to increase the percentage of people eating a healthy, nutritionally balanced diet; and to increase the percentage of the population meeting the CMO guidelines on physical activity.

Age-specific incidence of all neoplasms after colorectal cancer.

PURPOSE: Patients diagnosed with a specific neoplasm tend to have a subsequent excess risk of the same neoplasm. The age incidence of a second neoplasm at the same site is approximately constant with age, and consequently the relative risk is greater at younger age. It is unclear whether such a line of reasoning can be extended from a specific neoplasm to the incidence of all neoplasms in subjects diagnosed with a defined neoplasm. METHODS: We considered the age-specific incidence of all non-hormone-related epithelial neoplasms after a first primary colorectal cancer (n = 9542) in the Vaud Cancer Registry data set. RESULTS: In subjects with a previous colorectal cancer, the incidence rate of all other epithelial non-hormone-related cancers was stable around 800 per 100,000 between age 30 and 60 years, and rose only about twofold to reach 1685 at age 70 to 79 years and 1826 per 100,000 at age 80 years or older. After excluding synchronous cancers, the rise was only about 1.5-fold, that is, from about 700 to 1000. In the general population, the incidence rate of all epithelial non-hormone-related cancers was 29 per 100,000 at age 30 to 39 years, and rose 30-fold to 883 per 100,000 at age 70 to 79 years. Excluding colorectal cancers, the rise of all non-hormone-related cancers was from 360 per 100,000 at age 40 to 49 years to 940 at age 70 to 79 years after colorectal cancer, and from 90 to 636 per 100,000 in the general population (i.e., 2.6- vs. 7.1-fold). CONCLUSIONS: The rise of incidence with age of all epithelial non-hormone-related second cancers after colorectal cancer is much smaller than in the general population. This can possibly be related to the occurrence of a single mutational event in a population of susceptible individuals, although alternative models are plausible within the complexity of the process of carcinogenesis.

Health for All Children : Guidelines and Principles of Practice for Professional Staff (PDF 403 KB)

Sets out a clear core programme of child health contacts that every family can expect.

tagO is involved in the synthesis of all anionic cell-wall polymers in Bacillus subtilis 168.

Sequence homologies suggest that the Bacillus subtilis 168 tagO gene encodes UDP-N-acetylglucosamine:undecaprenyl-P N-acetylglucosaminyl 1-P transferase, the enzyme responsible for catalysing the first step in the synthesis of the teichoic acid linkage unit, i.e. the formation of undecaprenyl-PP-N-acetylglucosamine. Inhibition of tagO expression mediated by an IPTG-inducible P(spac) promoter led to the development of a coccoid cell morphology, a feature characteristic of mutants blocked in teichoic acid synthesis. Indeed, analyses of the cell-wall phosphate content, as well as the incorporation of radioactively labelled precursors, revealed that the synthesis of poly(glycerol phosphate) and poly(glucosyl N-acetylgalactosamine 1-phosphate), the two strain 168 teichoic acids known to share the same linkage unit, was affected. Surprisingly, under phosphate limitation, deficiency of TagO precludes the synthesis of teichuronic acid, which is normally induced under these conditions. The regulatory region of tagO, containing two partly overlapping sigma(A)-controlled promoters, is similar to that of sigA, the gene encoding the major sigma factor responsible for growth. Here, the authors discuss the possibility that TagO may represent a pivotal element in the multi-enzyme complexes responsible for the synthesis of anionic cell-wall polymers, and that it may play one of the key roles in balanced cell growth.

EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility.

OBJECTIVE: Quality assurance (QA) in clinical trials is essential to ensure treatment is safely and effectively delivered. As QA requirements have increased in complexity in parallel with evolution of radiation therapy (RT) delivery, a need to facilitate digital data exchange emerged. Our objective is to present the platform developed for the integration and standardization of QART activities across all EORTC trials involving RT. METHODS: The following essential requirements were identified: secure and easy access without on-site software installation; integration within the existing EORTC clinical remote data capture system; and the ability to both customize the platform to specific studies and adapt to future needs. After retrospective testing within several clinical trials, the platform was introduced in phases to participating sites and QART study reviewers. RESULTS: The resulting QA platform, integrating RT analysis software installed at EORTC Headquarters, permits timely, secure, and fully digital central DICOM-RT based data review. Participating sites submit data through a standard secure upload webpage. Supplemental information is submitted in parallel through web-based forms. An internal quality check by the QART office verifies data consistency, formatting, and anonymization. QART reviewers have remote access through a terminal server. Reviewers evaluate submissions for protocol compliance through an online evaluation matrix. Comments are collected by the coordinating centre and institutions are informed of the results. CONCLUSIONS: This web-based central review platform facilitates rapid, extensive, and prospective QART review. This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes.

Development of spatial integration depends on top-down and interhemispheric connections that can be perturbed in migraine: a DCM analysis.

In humans, spatial integration develops slowly, continuing through childhood into adolescence. On the assumption that this protracted course depends on the formation of networks with slowly developing top-down connections, we compared effective connectivity in the visual cortex between 13 children (age 7-13) and 14 adults (age 21-42) using a passive perceptual task. The subjects were scanned while viewing bilateral gratings, which either obeyed Gestalt grouping rules [colinear gratings (CG)] or violated them [non-colinear gratings (NG)]. The regions of interest for dynamic causal modeling were determined from activations in functional MRI contrasts stimuli > background and CG > NG. They were symmetrically located in V1 and V3v areas of both hemispheres. We studied a common model, which contained reciprocal intrinsic and modulatory connections between these regions. An analysis of effective connectivity showed that top-down modulatory effects generated at an extrastriate level and interhemispheric modulatory effects between primary visual areas (all inhibitory) are significantly weaker in children than in adults, suggesting that the formation of feedback and interhemispheric effective connections continues into adolescence. These results are consistent with a model in which spatial integration at an extrastriate level results in top-down messages to the primary visual areas, where they are supplemented by lateral (interhemispheric) messages, making perceptual encoding more efficient and less redundant. Abnormal formation of top-down inhibitory connections can lead to the reduction of habituation observed in migraine patients.

Minority quasispecies of drug-resistant HIV-1 that lead to early therapy failure in treatment-naive and -adherent patients.

BACKGROUND: Early virological failure of antiretroviral therapy associated with the selection of drug-resistant human immunodeficiency virus type 1 in treatment-naive patients is very critical, because virological failure significantly increases the risk of subsequent failures. Therefore, we evaluated the possible role of minority quasispecies of drug-resistant human immunodeficiency virus type 1, which are undetectable at baseline by population sequencing, with regard to early virological failure. METHODS: We studied 4 patients who experienced early virological failure of a first-line regimen of lamivudine, tenofovir, and either efavirenz or nevirapine and 18 control patients undergoing similar treatment without virological failure. The key mutations K65R, K103N, Y181C, M184V, and M184I in the reverse transcriptase were quantified by allele-specific real-time polymerase chain reaction performed on plasma samples before and during early virological treatment failure. RESULTS: Before treatment, none of the viruses showed any evidence of drug resistance in the standard genotype analysis. Minority quasispecies with either the M184V mutation or the M184I mutation were detected in 3 of 18 control patients. In contrast, all 4 patients whose treatment was failing had harbored drug-resistant viruses at low frequencies before treatment, with a frequency range of 0.07%-2.0%. A range of 1-4 mutations was detected in viruses from each patient. Most of the minority quasispecies were rapidly selected and represented the major virus population within weeks after the patients started antiretroviral therapy. All 4 patients showed good adherence to treatment. Nonnucleoside reverse-transcriptase inhibitor plasma concentrations were in normal ranges for all 4 patients at 2 separate assessment times. CONCLUSIONS: Minority quasispecies of drug-resistant viruses, detected at baseline, can rapidly outgrow and become the major virus population and subsequently lead to early therapy failure in treatment-naive patients who receive antiretroviral therapy regimens with a low genetic resistance barrier.

Report of the Working Group on Post Mortem Practice

The Madden Report into Post Mortem Practice and Procedure (2005)1 stated that consideration should be given to the implementation of the recommendations made in the Report to other post mortems2, namely those carried out on babies who died before or during birth, minors and adults. It was acknowledged that while many of the recommendations in the Report may apply generically to all categories of post-mortem examinations, these post mortems also raise distinct legal and ethical issues that were not within the Terms of Reference of the Madden Report. The Report advised that a Working Group be established to ensure that appropriate adaptation in relation to those issues takes place. The terms of reference were: Read the report (PDF, 117kb)

Más allá de una distinción dicotómica del apoyo a la democracia: diversos perfiles de no demócratas

El apoyo ciudadano a la democracia constituye un requisito fundamental de los modernos regímenes democráticos, tanto respecto de su estabilidad y consolidación como de la calidad de su funcionamiento. En este marco, la legitimidad democrática pertenece a la dimensión de creencias ciudadanas respecto de que la democracia y sus instituciones son las más apropiadas (de hecho, las únicas aceptables) como régimen de gobierno. Sin perjuicio de lo anterior, no todos los ciudadanos expresan este conjunto de actitudes positivas hacia el régimen democrático. En gran parte de las nuevas democracias un número considerable de personas o bien no entregan un apoyo abierto a la democracia o, expresan actitudes contradictorias hacia los regímenes democráticos. Este grupo de individuos ha sido normalmente tratado por la literatura como un solo grupo homogéneo, que responde sin más consideraciones a la etiqueta de “no demócratas”. Sin embargo, tal como esta investigación pretende demostrar, existen razones teóricas y empíricas para esperar que no haya un único perfil de ciudadanos que no apoya la democracia. Por el contrario, sería posible encontrar y analizar diversos perfiles de “no demócratas”, que explican sus diferencias de acuerdo a distintas objeciones hacia la democracia. Esto es, las razones que se tienen para no entregar un apoyo difuso a la democracia no serían las mismas en todos los casos. De esta forma se derivan las siguientes preguntas de investigación: ¿Cuáles son los argumentos teóricos y empíricos que permiten distinguir diversos tipos de “no demócratas”? ¿Cuáles son las distintas objeciones hacia la democracia (razones) que configuran estos perfiles diversos? Sin embargo, no basta con responder sólo a estas preguntas. Es necesario avanzar en esta línea argumental, preguntándose respecto de la relevancia de distinguir distintos perfiles de “no demócratas”. Así, surge una tercera pregunta: ¿Bajo qué circunstancias tiene relevancia efectuar una distinción entre quienes no apoyan la democracia?

Communally breeding Bechstein's bats have a stable social system that is independent from the postglacial history and location of the populations.

Investigating macro-geographical genetic structures of animal populations is crucial to reconstruct population histories and to identify significant units for conservation. This approach may also provide information about the intraspecific flexibility of social systems. We investigated the history and current structure of a large number of populations in the communally breeding Bechstein's bat (Myotis bechsteinii). Our aim was to understand which factors shape the species' social system over a large ecological and geographical range. Using sequence data from one coding and one noncoding mitochondrial DNA region, we identified the Balkan Peninsula as the main and probably only glacial refugium of the species in Europe. Sequence data also suggest the presence of a cryptic taxon in the Caucasus and Anatolia. In a second step, we used seven autosomal and two mitochondrial microsatellite loci to compare population structures inside and outside of the Balkan glacial refugium. Central European and Balkan populations both were more strongly differentiated for mitochondrial DNA than for nuclear DNA, had higher genetic diversities and lower levels of relatedness at swarming (mating) sites than in maternity (breeding) colonies, and showed more differentiation between colonies than between swarming sites. All these suggest that populations are shaped by strong female philopatry, male dispersal, and outbreeding throughout their European range. We conclude that Bechstein's bats have a stable social system that is independent from the postglacial history and location of the populations. Our findings have implications for the understanding of the benefits of sociality in female Bechstein's bats and for the conservation of this endangered species.

ASIST suicide prevention training - all-island evaluation report

The findings of a Public Health Agency evaluation report on a suicide prevention training programme were today presented at the North South Ministerial Council Health Sector meeting.ASIST, The Applied Suicide Intervention Skills Training programme, has to date been delivered to more than 20,000 people in the Republic of Ireland and more than 11,000 people in Northern Ireland. This two day course, delivered by a wide range of organisations including those from the voluntary/community sector, for professionals and the public helps individuals provide emergency help to people at risk of suicidal behaviour. It also develops a cooperative network among participants, since often many people have to work together to prevent suicide.Talking about the findings of this work, Dr Eddie Rooney, Chief Executive, PHA, said: "Both the PHA and the National Office for Suicide Prevention (NOSP), based in the Republic of Ireland, are concerned for any loss of life through suicide and we send our condolences to all families who have been bereaved. We know ASIST training brings a positive element to suicide prevention. Those who have been trained said that the two biggest advantages are that they know when, how and have the confidence to help people who are under pressure and that it helps to build positive links between community and voluntary organisations and the health service. I am pleased that this has been borne out in the evaluation and we hope ASIST will continue to be of enormous benefit and will contribute to a reduction in suicidal behaviour and the tragedy that this brings to our community".This evaluation found that within organisations where staff had participated in ASIST training, there were improvements in service development; staff attitudes, confidence and skills in relation to suicide and suicide intervention and in policies and procedures. At a community level, ASIST was found to have contributed to a sense of empowerment through an increased confidence in being able to deal with suicide and suicidal behaviour.The report also shows that the ASIST model offers a common language, helping communication between the community or voluntary organisations and those from a health background. In fact this training helped to cancel out any differences between those with mental health qualifications and those without, in terms of knowledge, skills, attitude and willingness to intervene. The study also confirmed that ASIST training was most relevant to those who were likely to be in contact with a person 'at risk'.In welcoming the publication of the report Geoff Day, Director of the NOSP, said: "This report is an independent evaluation of the ASIST programme, it has allowed us to demonstrate the effectiveness of the programme in increasing community participants confidence and ability to respond to individuals in suicidal crisis.He added: "The fact the evaluation was completed on an all-island basis allows the NOSP and the PHA to avoid duplication of resources, improve coordination of suicide prevention training programmes across both jurisdictions and allows us to learn from different approaches used in suicide prevention across the island of Ireland."He reiterated the Health Service Executive commitment to the continued implementation of quality assured training programmes as part of Reach out: the National Strategy for Action on Suicide Prevention.ASIST training is being rolled out in Northern Ireland as part of the implementation of the 'Protect Life' suicide prevention strategy, which was published by the Department of Health, Social Services and Public Safety in 2006.A copy of the evaluation report can be found below and in the publications section of this website, by clicking here

PHA urges parents to get 'at risk' children vaccinated against seasonal flu

The Public Health Agency is urging Northern Ireland parents to make sure children in 'at risk' groups get their flu vaccine early.The message has been issued to parents and carers of children as the PHA's seasonal flu vaccination programme gets underway for 2011/12.It is very important that children with any condition that puts them more at risk of the complications of flu get the vaccine.These 'at risk' conditions include:chronic lung conditions such as asthma;chest infections that have required hospital admission;chronic heart conditions;chronic liver disease;chronic kidney disease;diabetes;lowered immunity due to disease or treatment such as steroids or cancer therapy;chronic neurological conditions such as stroke, multiple sclerosis or a condition that affects the nervous system, such as cerebral palsy;hereditary and degenerative diseases of the central nervous system or muscles.Children who attend special schools for severe learning or physical disabilities are considered to be particularly at risk, as well as those with other complex health needs.The PHA has written to principals of local special schools, as well as parents of children at these schools, to raise awareness of the importance of getting vaccinated early.Dr Richard Smithson, PHA Flu Vaccination Lead, said: "For many people, flu is a short, unpleasant illness, but it does not usually cause any serious problems. However, for others, it can have very serious complications including, in rare cases, being fatal."We have been particularly reminded over the last two winters that children with chronic neurological problems and other complex health needs are very vulnerable to these complications. We have seen children become very seriously ill and, tragically, there have even been a few deaths in children who attend special schools."For this reason, we recommend that all children who attend special schools for severe learning disability, and special schools for physical disability, are offered the flu vaccine early in the autumn, before the flu viruses start circulating."The vaccine is now available from GP surgeries and the PHA recommends that parents check arrangements with their own GP's surgery so that their child can get the jab.The earlier you get vaccinated the better, as it takes the body about 10-14 days after the jab to develop antibodies. These will then protect you against the same or similar viruses if the body is exposed to them. The vaccine contains three strains of the flu virus, which are considered the most likely to be circulating this winter, including the H1N1 (swine flu) virus."Your child needs to get the flu jab every year - the protection it gives only lasts for one winter, so even if they got it last year, they still need to get it this year," added Dr Smithson."Also, if your child has been diagnosed with flu or swine flu in the past couple of years, they will still need the jab this year as there are different types of flu that the jab will protect against. Getting the flu jab is the best way to protect your child against flu and we would strongly recommend that you arrange for them to have it."Although the vaccine gives good protection, no vaccine gives total protection, so if your child develops flu-like symptoms (such as fever, cough, aches and pains, and sore throat) you should contact your GP for advice. If your child has any of these symptoms, they should be kept at home until they feel better."For more information on seasonal flu, go to www.fluawareni.info and follow us on Facebook and Twitter.