Vom Finanz- zum Wissenschaftsbetrug : Methode, den Irrungen in der medizinischen Literatur beizukommen [From financial to scientific fraud : Methods to detect discrepancies in the medical literature].

Fraud is as old as Mankind. There are an enormous number of historical documents which show the interaction between truth and untruth; therefore it is not really surprising that the prevalence of publication discrepancies is increasing. More surprising is that new cases especially in the medical field generate such a huge astonishment. In financial mathematics a statistical tool for detection of fraud is known which uses the knowledge of Newcomb and Benford regarding the distribution of natural numbers. This distribution is not equal and lower numbers are more likely to be detected compared to higher ones. In this investigation all numbers contained in the blinded abstracts of the 2009 annual meeting of the Swiss Society of Anesthesia and Resuscitation (SGAR) were recorded and analyzed regarding the distribution. A manipulated abstract was also included in the investigation. The χ(2)-test was used to determine statistical differences between expected and observed counts of numbers. There was also a faked abstract integrated in the investigation. A p<0.05 was considered significant. The distribution of the 1,800 numbers in the 77 submitted abstracts followed Benford's law. The manipulated abstract was detected by statistical means (difference in expected versus observed p<0.05). Statistics cannot prove whether the content is true or not but can give some serious hints to look into the details in such conspicuous material. These are the first results of a test for the distribution of numbers presented in medical research.

Rôle de l'exercice dans l'approche multidisciplinaire de la lombalgie chronique

RÉSUMÉ L'exercice est utilisé dans le traitement de la lombalgie depuis plus de cent ans. La recherche dans ce domaine a commencé au milieu du XXème siècle puis s'est développée exponentiellement jusqu'à nos jours. La première étude de cette thèse a eu pour but de passer en revue cette abondante littérature scientifique. Il en est ressorti que l'exercice est un moyen efficace de prévention primaire et secondaire de la lombalgie. En tant que modalité de traitement, l'exercice permet de diminuer l'incapacité et la douleur et d'améliorer la condition physique et le statut professionnel des patients lombalgiques subaigus et chroniques. Parmi les caractéristiques de l'exercice, la supervision est essentielle. Des investigations ultérieures sont nécessaires afin d'identifier des sous-groupes de patients répondant favorablement à d'autres caractéristiques de l'exercice. L'exercice est souvent utilisé dans l'optique de maintenir les résultats obtenus à la suite d'un traitement, bien que peu d'études s'y soient penchées. La deuxième partie de cette thèse a eu pour objectifs d'évaluer l'efficacité d'un programme d'exercice (PE) suivi par des patients lombalgiques chroniques ayant complété une restauration fonctionnelle multidisciplinaire (RFM), en comparaison avec le suivi classique (SC) consistant simplement à encourager les patients à adopter un quotidien aussi actif que possible par la suite. Les résultats ont montré que les améliorations obtenues au terme de RFM étaient maintenues par les deux groupes à un an de suivi. Bien qu'aucune différence n'ait été obtenue entre les deux groupes, seul le groupe PE améliorait significativement l'incapacité et l'endurance isométrique des muscles du tronc. Une analyse économique a ensuite été réalisée afin d'évaluer la rentabilité de PE. L'évaluation de la qualité de vie des patients au terme de RFM et à un an de suivi permettait d'estimer les années de vie ajustées par leur qualité (QALYs) gagnées par chaque groupe. Les coûts directs (visites chez le médecin, spécialiste, physio, autres) et indirects (jours d'absence au travail) étaient estimés avant RFM et à un an de suivi à l'aide d'un agenda. Aucune différence significative n'était obtenue entre les groupes. Une mince différence de QALYs en faveur de PE ne se traduisait néanmoins pas en bénéfices mesurables. La recherche future devrait s'attacher à identifier un ou des sous-groupe(s) de patients pour lesquels SC ne permet pas de maintenir à long terme les améliorations obtenues au terme de RFM, et pour lesquels l'efficacité thérapeutique et la rentabilité économique de PE pourraient être accrues. ABSTRACT Exercise is used to treat low back pain for over a hundred years. Research in this area began in the mid-twentieth century and then grew exponentially until nowadays. The first study of this thesis was aimed to review this abundant scientific literature. It showed that exercise is effective in the primary and secondary prevention of low back pain. As a modality of treatment, exercise can reduce disability and pain and improve physical fitness and professional status of patients with subacute and chronic low back pain. Among different exercise characteristics, supervision is essential. Further investigations are needed to identify subgroups of patients responding positively to other characteristics of exercise. Exercise is often used as a post-treatment modality in order to maintain results over time, although only a few studies addressed this issue directly. The purpose of the second part of this thesis was to evaluate the effectiveness of an exercise program (EP) for patients with chronic low back pain who completed a functional multidisciplinary rehabilitation (FMR), compared to the routine follow-up (RF) which simply consisted of encouraging patients to adopt an active daily life thereafter. The results showed that improvements obtained at the end of FMR were maintained by both groups at one year follow-up. Although no difference was obtained between both groups, only the EP group significantly improved disability and isometric endurance of trunk muscles. An economic analysis was then carried out to assess the cost-effectiveness of EP. Based on the evaluation of patients' quality of life after FMR and at one year follow-up, an estimation of adjusted life years for their quality (QALYs) gained by each group was done. Direct costs (physician, specialist, physiotherapist, other therapists visits) and indirect costs (days off work) were measured before FMR and at one year follow-up using a cost diary. No significant difference was obtained between both groups. A slight difference in QALYs in favour of EP did yet not translate into measurable benefits. Future research should focus on identifying subgroups of patients for which RF is insufficient to reach long-term improvements after FMR, and for which the therapeutic effectiveness and cost-effectiveness of EP could be increased.

Preparing Ireland's Doctors to meet the Health Needs of the 21st Century (Buttimer Report)

The Postgraduate Medical Education and Training Group's vision is that Ireland's postgraduate education and trainingenvironment will be attractive to all medical graduates and deliver high-quality programmes that will result in a sufficient number of fully-trained, highly competent doctors to deliver a patientcentred, high-performance health service for this country.â?Âù Click here to download the document View Factors affecting Career Choices and Retention of Irish Medical Graduates, commissioned by the Group and undertaken by the Department of Public Health Medicine and Epidemiology, UCD

Female Genital Mutilation/Cutting - A Literature Review

This report represents the result of two different strands of work by the Women's Health Council. At the beginning of 2006, due to the recent significant inward migration experienced in Ireland, the Council's board identified the promotion of the health of ethnic minority women as a key area of work in its strategic plan for the period 2007-2009. At the same time, it was also decided that the problem of gender-based violence would also be addressed through a number of research and policy initiatives. This report focuses on a health issuethat marries these two concerns, Female Genital Mutilation/Cutting (FGM/C – see below for definition) and serves as an accompanying document to the recently published Violence Against Women and Health (2007) and the forthcoming study on Ethnic Minority Women and Gender-Based Violence. Download document here

La representació de la dona en les pintures de Goya : Reflexe d'una realitat social?

Treball de recerca que pretén respondre les següents preguntes: La visió de Goya sobre l'univers femení, i que plasma en les seves pintures, correspon amb la realitat social de les dones de la seva època? Es diu que el segle XVIII va ésser el segle de les dones, però és això realment cert? Va ser el segle de les dones o bé el segle d'algunes dones? A través de dos itineraris paral·lels: la literatura d'una banda i les arts plàstiques de l'altra, s'explorarà la naturalesa d'aquest segle. La comparació de l'anàlisi documental i de dades iconogràfiques potser ens podran donar una resposta.

Macrophage migration inhibitory factor: a regulator of innate immunity.

For more than a quarter of a century, macrophage migration inhibitory factor (MIF) has been a mysterious cytokine. In recent years, MIF has assumed an important role as a pivotal regulator of innate immunity. MIF is an integral component of the host antimicrobial alarm system and stress response that promotes the pro-inflammatory functions of immune cells. A rapidly increasing amount of literature indicates that MIF is implicated in the pathogenesis of sepsis, and inflammatory and autoimmune diseases, suggesting that MIF-directed therapies might offer new treatment opportunities for human diseases in the future.

Prehistoric tuberculosis in America: adding comments to a literature review

Tuberculosis is a prehistoric American human disease. This paper reviews the literature and discusses hypotheses for origins and epidemiological patterns of prehistoric tuberculosis. From the last decades, 24 papers about prehistoric tuberculosis were published and 133 cases were reviewed. In South America most are isolated case studies, contrary to North America where more skeletal series were analyzed. Disease was usually located at the deserts of Chile and Peru, Central Plains in USA, and Lake Ontario in Canada. Skeletal remains represent most of the cases, but 16 mummies have also been described. Thirty individuals had lung disease, 19 of them diagnosed by the ribs. More then 100 individuals had osseous tuberculosis and 26 also had it in other organs. As today, transmission of the infection and establishment of the disease were favored by cultural and life-style changes such as sedentarization, crowding, undernutrition, use of dark and insulated houses, and by the frequency of interpersonal contacts. The papers confirm that despite previous perceptions, tuberculosis seems to have occured in America for millennia. It only had epidemiological expression when special conditions favored its expansion. Occurring as epidemic bursts or low endemic disease, it had differential impact on groups or social segments in America for at least two millennia.

Cardiovascular health and wellbeing in Northern Ireland - Literature review

The PHA, supported by the Institute of Public Health in Ireland (IPH) and other agencies and individuals, has completed a health impact assessment (HIA) on the Cardiovascular Service Framework (CVSFW) for Northern Ireland.The CVSFW is the first in a series of service frameworks developed in Northern Ireland to guide HSC provision from prevention and health improvement over early intervention in communities and general practice into hospital and other institutional settings towards rehabilitation, palliative care and end of life.The CVSFW is relevant to everyone who has a part in HSC services for health improvement, hypertension, hyperlipidaemia, diabetes, heart disease, cerebrovascular disease (stroke), peripheral vascular disease and renal disease. This includes patients, carers, families, communities, voluntary and statutory service providers, policy makers and researchers.

Intérêt des faibles doses de rt-PA dans les syndromes inflammatoires et hémorragiques du segment antérieur: étude clinique et revue de la littérature [Treatment of anterior segment fibrinous reactions and hemorrhage with intracameral low dose rt-PA: clinical study and review of the literature].

PURPOSE: to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane. METHODS: Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae. RESULTS: Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred. CONCLUSION: Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.

A Review of Harm Reduction Approaches in Ireland and Evidence from the International Literature

This report examines international literature on harm reduction and also presents primary research in health services in Ireland on approaches to harm reduction. The aim of harm reduction efforts is to minimise the risks stemming from shared use of drug-use paraphernalia, such as needle exchange programmes. One of the criticisms of Irish drug services is that the restricted opening hours and limited number of exchange services may contribute to continued sharing of needles among drug users. The report points out that other non-injecting paraphernalia such as spoons are also associated with the risk of contracting diseases, yet services do not as yet focus on them. The report notes that specific risk factors that contribute to risky drug practices include youth, a shorter injecting history, confinement to prison, homelessness and being involved in a sexual relationship with another intravenous drug user. The report suggests that harm reduction practices can be introduced into a prison population without a subsequent increase in drug consumption rates. The provision of consumption rooms and the prescription of heroin are also discussed, with the report noting that legislation would have to altered to implement these new strategies.This resource was contributed by The National Documentation Centre on Drug Use.

Reverse transcription quantitative real-time polymerase chain reaction reference genes in the spared nerve injury model of neuropathic pain : validation and literature search

La douleur neuropathique est définie comme une douleur causée par une lésion du système nerveux somato-sensoriel. Elle se caractérise par des douleurs exagérées, spontanées, ou déclenchées par des stimuli normalement non douloureux (allodynie) ou douloureux (hyperalgésie). Bien qu'elle concerne 7% de la population, ses mécanismes biologiques ne sont pas encore élucidés. L'étude des variations d'expressions géniques dans les tissus-clés des voies sensorielles (notamment le ganglion spinal et la corne dorsale de la moelle épinière) à différents moments après une lésion nerveuse périphérique permettrait de mettre en évidence de nouvelles cibles thérapeutiques. Elles se détectent de manière sensible par reverse transcription quantitative real-time polymerase chain reaction (RT- qPCR). Pour garantir des résultats fiables, des guidelines ont récemment recommandé la validation des gènes de référence utilisés pour la normalisation des données ("Minimum information for publication of quantitative real-time PCR experiments", Bustin et al 2009). Après recherche dans la littérature des gènes de référence fréquemment utilisés dans notre modèle de douleur neuropathique périphérique SNI (spared nerve injury) et dans le tissu nerveux en général, nous avons établi une liste de potentiels bons candidats: Actin beta (Actb), Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), ribosomal proteins 18S (18S), L13a (RPL13a) et L29 (RPL29), hypoxanthine phosphoribosyltransferase 1 (HPRT1) et hydroxymethyl-bilane synthase (HMBS). Nous avons évalué la stabilité d'expression de ces gènes dans le ganglion spinal et dans la corne dorsale à différents moments après la lésion nerveuse (SNI) en calculant des coefficients de variation et utilisant l'algorithme geNorm qui compare les niveaux d'expression entre les différents candidats et détermine la paire de gènes restante la plus stable. Il a aussi été possible de classer les gènes selon leur stabilité et d'identifier le nombre de gènes nécessaires pour une normalisation la plus précise. Les gènes les plus cités comme référence dans le modèle SNI ont été GAPDH, HMBS, Actb, HPRT1 et 18S. Seuls HPRT1 and 18S ont été précédemment validés dans des arrays de RT-qPCR. Dans notre étude, tous les gènes testés dans le ganglion spinal et dans la corne dorsale satisfont au critère de stabilité exprimé par une M-value inférieure à 1. Par contre avec un coefficient de variation (CV) supérieur à 50% dans le ganglion spinal, 18S ne peut être retenu. La paire de gènes la plus stable dans le ganglion spinal est HPRT1 et Actb et dans la corne dorsale il s'agit de RPL29 et RPL13a. L'utilisation de 2 gènes de référence stables suffit pour une normalisation fiable. Nous avons donc classé et validé Actb, RPL29, RPL13a, HMBS, GAPDH, HPRT1 et 18S comme gènes de référence utilisables dans la corne dorsale pour le modèle SNI chez le rat. Dans le ganglion spinal 18S n'a pas rempli nos critères. Nous avons aussi déterminé que la combinaison de deux gènes de référence stables suffit pour une normalisation précise. Les variations d'expression génique de potentiels gènes d'intérêts dans des conditions expérimentales identiques (SNI, tissu et timepoints post SNI) vont pouvoir se mesurer sur la base d'une normalisation fiable. Non seulement il sera possible d'identifier des régulations potentiellement importantes dans la genèse de la douleur neuropathique mais aussi d'observer les différents phénotypes évoluant au cours du temps après lésion nerveuse.