Association of urinary calcium excretion with serum calcium and vitamin D levels.

BACKGROUND AND OBJECTIVES: Population-based data on urinary calcium excretion are scarce. The association of serum calcium and circulating levels of vitamin D [25(OH)D2 or D3] with urinary calcium excretion in men and women from a population-based study was explored. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: Multivariable linear regression was used to explore factors associated with square root-transformed 24-hour urinary calcium excretion (milligrams per 24 hours) taken as the dependent variable with a focus on month-specific vitamin D tertiles and serum calcium in the Swiss Survey on Salt Study. RESULTS: In total, 624 men and 669 women were studied with mean ages of 49.2 and 47.0 years, respectively (age range=15-95 years). Mean urinary calcium excretion was higher in men than in women (183.05 versus 144.60 mg/24 h; P<0.001). In adjusted models, the association (95% confidence interval) of square root urinary calcium excretion with protein-corrected serum calcium was 1.78 (95% confidence interval, 1.21 to 2.34) mg/24 h per milligram per deciliter in women and 0.59 (95% confidence interval, -0.11 to 1.29) mg/24 h per milligram per deciliter in men. Men in the third 25(OH)D3 tertile had higher square root urinary calcium excretion than men in the first tertile (0.99; 95% confidence interval, 0.36 to 1.63 mg/24 h per nanogram per milliliter), and the corresponding association was 0.32 (95% confidence interval, -0.22 to 0.85) mg/24 h per nanogram per milliliter in women. These sex differences were more marked under conditions of high urinary sodium or urea excretions. CONCLUSIONS: There was a positive association of serum calcium with urinary calcium excretion in women but not men. Vitamin 25(OH)D3 was associated with urinary calcium excretion in men but not women. These results suggest important sex differences in the hormonal and dietary control of urinary calcium excretion.

PhunkyFoods Programme (PFP)

The PhunkyFoods Programme (PFP) aids schools in meeting healthy lifestyles curriculum requirements by delivering key, consistent health messages in-line with current Government recommendations. The aim is to help schools deliver a whole-school approach to healthy lifestyles and to engage with all pupils, and their families, in promoting tangible health behaviour changes in a fun, lively and positive manner. The short-term objectives (6-months) of the PFP are; 1. To improve school staff competence, confidence and in delivering healthy lifestyles messaging in school. 2. To improve the health-related knowledge of pupils taking part in the PFP. The medium-term objectives (12-18 months) of the PFP are; 3. To improve the dietary behaviours of children taking part in the PFP (increase fruit and veg intake, increase breakfast consumption, decrease HFSS foods, decrease fizzy drink consumption). 4. To increase the levels of habitual phsyical activity undertaken by the children participating in the PFP. The longer-term objectives (+18=months) of the PFP are; 5. To reduce the prevalence of childhood overweight and obesity in participating children 6. To develop the schools to become the community hub for healthy eating and physical activity initiatives based on local needs assessment and partnership workin

A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

Therapeutic drug monitoring of imatinib: Bayesian and alternative methods to predict trough levels

Background: The imatinib trough plasma concentration (C(min)) correlates with clinical response in cancer patients. Therapeutic drug monitoring (TDM) of plasma C(min) is therefore suggested. In practice, however, blood sampling for TDM is often not performed at trough. The corresponding measurement is thus only remotely informative about C(min) exposure. Objectives: The objectives of this study were to improve the interpretation of randomly measured concentrations by using a Bayesian approach for the prediction of C(min), incorporating correlation between pharmacokinetic parameters, and to compare the predictive performance of this method with alternative approaches, by comparing predictions with actual measured trough levels, and with predictions obtained by a reference method, respectively. Methods: A Bayesian maximum a posteriori (MAP) estimation method accounting for correlation (MAP-ρ) between pharmacokinetic parameters was developed on the basis of a population pharmacokinetic model, which was validated on external data. Thirty-one paired random and trough levels, observed in gastrointestinal stromal tumour patients, were then used for the evaluation of the Bayesian MAP-ρ method: individual C(min) predictions, derived from single random observations, were compared with actual measured trough levels for assessment of predictive performance (accuracy and precision). The method was also compared with alternative approaches: classical Bayesian MAP estimation assuming uncorrelated pharmacokinetic parameters, linear extrapolation along the typical elimination constant of imatinib, and non-linear mixed-effects modelling (NONMEM) first-order conditional estimation (FOCE) with interaction. Predictions of all methods were finally compared with 'best-possible' predictions obtained by a reference method (NONMEM FOCE, using both random and trough observations for individual C(min) prediction). Results: The developed Bayesian MAP-ρ method accounting for correlation between pharmacokinetic parameters allowed non-biased prediction of imatinib C(min) with a precision of ±30.7%. This predictive performance was similar for the alternative methods that were applied. The range of relative prediction errors was, however, smallest for the Bayesian MAP-ρ method and largest for the linear extrapolation method. When compared with the reference method, predictive performance was comparable for all methods. The time interval between random and trough sampling did not influence the precision of Bayesian MAP-ρ predictions. Conclusion: Clinical interpretation of randomly measured imatinib plasma concentrations can be assisted by Bayesian TDM. Classical Bayesian MAP estimation can be applied even without consideration of the correlation between pharmacokinetic parameters. Individual C(min) predictions are expected to vary less through Bayesian TDM than linear extrapolation. Bayesian TDM could be developed in the future for other targeted anticancer drugs and for the prediction of other pharmacokinetic parameters that have been correlated with clinical outcomes.

HIV behavioural surveillance in Switzerland: trends in drug consumption, injection and syringe distribution, 1993-2011

Background: As part of the second generation surveillance system for HIV/Aids in Switzerland, repeated cross-sectional surveys were conducted in 1993, 1994, 1996, 2000, 2006 and 2011 among attenders of all low threshold facilities (LTFs) with needle exchange programmes and/or supervised drug consumption rooms for injection or inhalation. The number of syringes distributed to the injectors has also been measured annually since 2000. Distribution in other settings, such as pharmacies, is also monitored nationally. Methods: Periodic surveys of LTFs have been conducted using an interviewer/self-administered questionnaire structured along four themes: socio-demographic characteristics, drug consumption, risk/preventive behaviour and health. Analysis is restricted to attenders who had injected drugs during their lifetime (IDU´s). Pearson's chi-square test and trend analysis were conducted on annual aggregated data. Trend significance was assessed using Stata's non parametric test nptrend. Results: Median age of IDU´s increased from 26 years in 1993 to 40 in 2011; most are men (78%). Total yearly number of syringes distributed by LTFs has decreased by 44% in 10 years. Use of cocaine has increased (Table 1). Injection, regular use of heroin and borrowing of syringes/needles have decreased, while sharing of other material remains stable. There are fewer new injectors; more IDU´s report substitution treatment. Most attenders had ever been tested for HIV (90% in 1993, 94% in 2011). Reported prevalence of HIV remained stable around 10%; that of HCV decreased from 62% in 2000 to 42% in 2011. Conclusions: Overall, findings indicate a decrease in injection as a means of drug consumption in that population. This interpretation is supported by data from other sources, such as a national decrease in distribution from other delivery points. Switzerland's behavioural surveillance system is sustainable and allows the HIV epidemic to be monitored among this hard-to-reach population, providing information for planning and evaluation.

A Study of Tobacco, Alcohol and Drug Use among Irish Female Prisoners

The female prisoner population are a very specific group with very different needs to that of the general population. The study sets out to profile these women and to examine their use of tobacco, alcohol and other substances. A census sample of female prisoners was frequency matched for age with male prisoners and also the female general population. Response rate was 74.6%. Results illustrated that female prisoners are, in the majority from a lower social group, from deprived backgrounds and from families where unemployment is high and education is low. Female prisoners smoke more, take more drugs (including heroin and injection drugs) and drink considerably more when compared to the above groups. They have more alcohol related difficulties as a result of another persons drinking, illustrating high rates of verbal, physical and sexual assault. The prison setting may be the first and possibly the only opportunity for health education and promotion for this particular group. Therefore, with such high reported levels of smoking, alcohol and other substance use, the prison provides a good setting for health promotion interventions.This resource was contributed by The National Documentation Centre on Drug Use.

A Study on Health Behaviours and Young People

Numerous reports have documented the health status of young people, concluding that the main threats to their health are predominantly the health risk behaviours and choices they make. Focussing on four of these, alcohol consumption, tobacco smoking, illicit drug use and sexual activity, this study seeks to assess their levels among a group of young people in Galway City with the aim of helping with the development of Health Education in these areas. In order to develop appropriate interventions, it is first of all necessary that accurate information on the extent of the problem, if any, be available. In 1989, studies on risk taking were carried out in the Muirhouse and Easterhouse areas of Glasgow and Edinburgh in Scotland. These areas were seen as underprivileged and had high and low rates of HIV infection respectively. In 1993, a similar study was carried out in the Westside area of Galway, an area which is also seen as under-privileged with high rates of unemployment. In 1996, a follow-up to the 1993 survey was carried out. This study also attempted to determine if there was a relationship between the behaviours reported and socio-economic class. This study is a follow-up to the previous two, with the addition that it attempts to investigate whether any relationship exists between the provision of health education in schools and subsequent health behaviour patternsThis resource was contributed by The National Documentation Centre on Drug Use.

Coping and anxiety: an examination of different drinking patterns in an Irish population.

The primary aim of this study was to investigate the effect of different drinking patterns in an Irish population on ability to cope with stress. Coping ability comprised approach coping responses, avoidance coping responses and trait anxiety levels. Coping responses were measured by the coping responses inventory (CRI, Moos, 1993) and trait anxiety by the state-trait anxiety inventory (STAI, Spielberger, 1983). A total of 128 participants took part in the study and were recruited from alcohol treatment centres and the general population.This resource was contributed by The National Documentation Centre on Drug Use.

National Alcohol Policy Ireland

The National Alcohol Policy is directed at reducing the prevalence of alcohol-related problems through an emphasis on moderation in alcohol consumption. The importance of a comprehensive alcohol policy was highlighted when Ireland endorsed the European Charter on Alcohol in December 1995 along with 48 other Member States of the WHO European Region. The alcohol-related problems are multidimensional, therefore the solutions most be multi-sectoral. This means that commitment to the National Alcohol Policy must be on the agenda of policy makers in all sectors and at all levels. An Alcohol Policy requires both environmental and individual strategies. There is strong evidence that policies which influence access to alcohol, control pricing through taxation and other public health measures, can have a positive impact on curtailing the health and social burden resulting from drinking (Edwards et al. 1994). However, a key to the effectiveness of such strategies is public support, enforcement and maintenance of the policies. In examining the rationale for a National Alcohol Policy a number of elements have been identified. Research is urgently required to identify attitudes and patterns of alcohol consumption across the population and within sub-groups of the population. Based on sound research, a sensible drinking message of Less is Better should form an educational empowerment programme with regional and local initiatives as a required and integral part of such a campaign. A health education programme in all schools should be part of the core curriculum. The availability and effectiveness of treatment services need to be established. Action to contain the availability of alcohol could be achieved by reducing the number of special exemptions for longer opening hours and controlling access to underage drinking by ID schemes nation-wide. The enforcement of drink driving legislation including random breath testing needs to be continued to reduce alcohol-related traffic accidents. All levels of the Drinks Industry should recognise that people have the right to be safeguarded from pressures to drink. Finally, a National Alcohol Policy could be co-ordinated by a wider National Substance Use Surveillance Unit.This resource was contributed by The National Documentation Centre on Drug Use.

Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies.

Alcohol is responsible for a significant portion of the global burden of disease. There is widespread concern reported in the media and other sources about drinking trends among young people, particularly heavy episodic or “binge” drinking. Prominent among policy responses, in the UK and elsewhere, have been attempts to manage antisocial behaviour related to intoxication in public spaces. Much less attention has been given to the longer term effects of excessive drinking in adolescence on later adult health and well-being. Some studies suggest that individuals “mature out” of late adolescent drinking behaviour, whilst others identify enduring effects on drinking and broader health and social outcomes in adulthood. If adolescent drinking does not cause later difficulties in adulthood then intervention approaches aimed at addressing the acute consequences of alcohol, such as unintentional injuries and anti-social behaviour, may be the most appropriate solution. If causal relationships do exist, however, this approach will not address the cumulative harms produced by alcohol, unless such intervention successfully modifies the long-term relationship with alcohol, which seems unlikely. To address this issue a systematic review of cohort studies was conducted, as this approach provides the strongest observational study design to evaluate evidence for causal inference.This resource was contributed by The National Documentation Centre on Drug Use.

Behaviour change at population, community and individual levels: NICE Public Health Guidance 6

This guidance is aimed at those responsible for helping people to change their behaviour to improve their health. This includes policy makers and those working in local authorities and the community and voluntary sectors. It gives advice on how to plan and run relevant initiatives. The recommendations include the following advice: base interventions on a proper assessment of the target group, where they are located and the behaviour which is to be changed: careful planning is the cornerstone of success  work with other organisations and the community itself to decide on and develop initiatives build on the skills and knowledge that already exists in the community, for example, by encouraging networks of people who can support each other take account of and resolve problems that prevent people changing their behaviour (for example, the costs involved in taking part in exercise programmes or buying fresh fruit and vegetables, or lack of knowledge about how to make changes) base all interventions on evidence of what works train staff to help people change their behaviour evaluate all interventions.This resource was contributed by The National Documentation Centre on Drug Use.

First record of human trichinosis in Chile associated with consumption of wild boar (Sus scrofa)

The first South American case of human trichinosis, resulting from the consumption of roast wild boar (Sus scrofa) is reported in Chile. The patient presented fever, diarrhea, myalgias, facial edema, sub-conjunctival reddening, photophobia, eosinophilia, and elevated glutamic oxalacetic transaminase. The diagnosis was confirmed by two immunoenzymatic tests (ELISA) using somatic and excretion-secretion antigens.

Trends in overweight and obesity levels in Geneva: time for optimism?

Background/Introduction: ln Switzerland, most trends in overweight and obesity levels have been assessed using reported data, a methodology which is prone to reporting bias. ln this study, we aimed at assessing trends in overweight and obesity levels using objectively measured data. Methods: We used independent cross-sectional data collected between 2005 and 2011 by the Bus Santé study on representative samples of the Geneva population. Trends were assessed overall and according to different characteristics of the participants. Overweight and obesity were defined as a body mass index (BMI) between 25 and 29.9 kg/m2 and >=30 kg/m2, respectively. Results: Data from 4093 participants (2012 men) was assessed. Mean BMI was 25.2 ± 4.3 kg/m2 (mean ±standard deviation) in 2005 and 25.4 ± 4.3 in 2011 (p for trend using linear regression=0.98). For men, mean BMI was 26.3 ± 3.8 kg/m2 in 2005 and 26.1 ± 3.7 in 2011 (p for trend=0.37); for women, the corresponding values were 24.3 ± 4.6 and 24.7 ± 4.7 kg/m2 (p for trend=0.42). Overall prevalence of overweight and obesity was 32.2% and 13.3%, respectively, in 2005 and 33.6% and 13.7% in 2011 (p for trend using polytomous logistic regression adjusting for gender, age and smoking=0.49 and 0.94 for overweight and obesity, respectively). For men, prevalence of overweight and obesity was 45.9% and 12.2% in 2005 and 42.1 % and 14.6% in 2011 (P for trend=0.03 for overweight and 0.81 for obesity); for women, the corresponding values were 20.4% and 14.2% in 2005 and 25.4% and 12.9% in 2011 (p for trend=0.13 for overweight and 0.99 for obesity). Conclusion: Overweight and obesity levels appear to have levelled in Geneva, with a possible decrease in overweight levels in men. These favorable findings should be replicated in other geographical locations.

Statistics on Obesity, Physical Activity and Diet, England 2006

This is a statistical bulletin from the Information Centre which presents a range of information on obesity, physical activity and diet, drawn together from a variety of sources. The topics covered include: overweight and obesity prevalence among adults and children physical activity levels among adults and children trends in purchases and consumption of food and drink, and energy intake health outcomes of being obese hospital admissions and prescriptions dispensed related to obesity. The bulletin also summarises government plans and targets in this area, as well as providing sources of further information and links to relevant documents.