Issues in blood pressure control and the potential role of single-pill combination therapies.

Hypertension (HTN) is a major risk factor for cardiovascular mortality, yet only a small proportion of hypertensive individuals receive appropriate therapy and achieve target blood pressure (BP) values. Factors influencing the success of antihypertensive therapy include physicians' acceptance of guideline BP targets, the efficacy and tolerability of the drug regimen, and patient compliance and persistence with therapy. It is now well recognised that most hypertensive patients require at least two antihypertensive agents to achieve their target BP. However, complicated treatment regimens are a major contributory factor to poor patient compliance. The use of combination therapy for HTN offers a number of advantages over the use of monotherapy, including improved efficacy, as drug combinations with a synergistic mechanism of action can be used. This additive effect means that lower doses of the individual components can be used, which may translate into a decreased likelihood of adverse events. The use of single-pill combination therapy, in which two or more agents are combined in a single dosage form, offers all the benefits of free combination therapy (improved efficacy and tolerability over monotherapy) together with the added benefit of improved patient compliance because of the simplified treatment regimen. The use of single-pill combination therapy may also be associated with cost savings compared with the use of free combinations for reasons of cheaper drug costs, fewer physician visits and fewer hospitalisations for uncontrolled HTN and cardiovascular events. Thus, the use of single-pill combination therapy for HTN should help improve BP goal attainment through improved patient compliance, leading to reduced costs for cardiovascular-related care.

Alternativas de tratamiento para el cáncer de mama : ¿qué opción prefiero? : instrumento de ayuda para la toma de decisiones

Publicado en la página web de la Consejería de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social / Ciudadanía / Nuestro Compromiso por la Calidad / Guías de información para pacientes). Documento para la ciudadanía relacionado con el Proceso Asistencial Integrado : Cáncer de mama

Peripheral eosinophilia as an indicator of meningitic angiostrongyliasis in exposed individuals

The diagnosis of meningitic angiostrongyliasis (MA) is based on clinical criteria. A lumbar puncture is used as a diagnostic tool, but it is an invasive procedure. The blood eosinophil levels are also assessed and used in the diagnosis of this disease. We enrolled 47 patients with serologically proven MA and 131 controls with intestinal parasite infections. An absolute eosinophil count model was found to be the best marker for MA. An eosinophil count of more than 798 cells led to sensitivity, specificity, positive predictive and negative predictive values of 76.6%, 80.2%, 58.1% and 90.5%, respectively. These data support the use of testing for high blood eosinophil levels as a diagnostic tool for MA in individuals that are at risk for this disease.

Officium et missa beatae Isabellae.

F. 1 « Officium b. Ysabellis, sororis s. Ludovici, regis Francie, fundatricis monasterii Longicampi » (AA. SS., Aug. VI, 798). F. 23 « Ad missam. » F. 31v et 37 Prose de Thomas de Celano sur s. François, et « Dies irae ». Cf. Chevalier, nos 6569 et 4626.

IL2RA/CD25 gene polymorphisms: uneven association with multiple sclerosis (MS) and type 1 diabetes (T1D).

BACKGROUND: IL-2 receptor (IL2R) alpha is the specific component of the high affinity IL2R system involved in the immune response and in the control of autoimmunity. METHODS AND RESULTS: Here we perform a replication and fine mapping of the IL2RA gene region analyzing 3 SNPs previously associated with multiple sclerosis (MS) and 5 SNPs associated with type 1 diabetes (T1D) in a collection of 798 MS patients and 927 matched Caucasian controls from the south of Spain. We observed association with MS in 6 of 8 SNPs. The rs1570538, at the 3'- UTR extreme of the gene, previously reported to have a weak association with MS, is replicated here (P = 0.032). The most associated T1D SNP (rs41295061) was not associated with MS in the present study. However, the rs35285258, belonging to another independent group of SNPs associated with T1D, showed the maximal association in this study but different risk allele. We replicated the association of only one (rs2104286) of the two IL2RA SNPs identified in the recently performed genome-wide association study of MS. CONCLUSIONS: These findings confirm and extend the association of this gene with MS and reveal a genetic heterogeneity of the associated polymorphisms and risk alleles between MS and T1D suggesting different immunopathological roles of IL2RA in these two diseases.

Iowa Health Focus, March 2003

Monthly newsletter for Iowa Department of Public Health

Suomen Sosialidemokraatin Päätoimittaja 18/11 1974

Kirje 18.11.1974

Competition and cost overruns in procurement

Most cases of cost overruns in public procurement are related to important changes in theinitial project design. This paper deals with the problem of design speciffication in public procurement and provides a rationale for design misspeciffication. We propose a model in which the sponsor decides how much to invest in design speciffication and awards competitively the project to a contractor. After the project has been awarded the sponsor engages in bilateral renegotiation with the contractor, in order to accommodate changes in the initial project's design that new information makes desirable. When procurement takes place in the presence of horizontally differentiated contractors, the design's speciffication level is seen to affect the resulting degree of competition. The paper highlights this interaction between market competition and design speciffication and shows that the sponsor's optimal strategy, when facing an imperfectly competitive market supply, is to underinvest in design speciffication so as to make signifficant cost overrunslikely. Since no such misspeciffication occurs in a perfectly competitive market, cost overruns are seen to arise as a consequence of lack of competition in the procurement market.

ANSA - Relatório Estatistico

Cereais: Da análise realizada nos dados do 4º trimestre de 2012, o abastecimento no conjunto dos cereais, aponta um ligeiro declíneo no stock final e stock médio, e aumentos na importação, e a disponibilidade média. ■ Neste mesmo periodo a disponibilidade total do conjunto dos cereais é de 32.296 tons, sendo 16.241 tons referente ao stock inicial, e 16.055 tons referente as importações do mesmo conjunto. A disponibilidade média mensal no trimestre é de 20.803 tons e cobre largamente as necessidades previstas do consumo médio mensal aparente que é de 7.056 tons por mês. Relativamente ao trimestre anterior registou-se um decréscimo das disponibilidades médias mensais do conjunto dos cereais da ordem do 18,8%. Este decréscimo teve maior destaque no arroz pela grande descida num valor de 32,7% no trimestre ■ O conjunto dos cereais, no final do 4º trimestre de 2012, totalizaram um stock de 16.241 tons, que vai coresponder um prazo de cobertura de 4,6 meses. Regista-se uma variação absoluta negativa entre o stock inicial e final no 4º trimestre de 2012 na ordem de 760 tons, no conjunto dos cereais, esta descida registou, no milho e no trigo, que apresentaram uma redução 4.412 tons e 1.352 tons respectivamente. ■ No 4º trimestre de 2012, a importação dos grandes operadores no conjunto dos cereais é de 16.055 tons, sendo no milho com 8.686 tons que representa a maior quantidade importada no ano 2012. Em relação ao trimestre anterior houve um aumento de 6.008 tons no conjunto dos cereais. ■ O consumo aparente do conjunto dos cereais neste periodo totalizou-se 21.168 tons, o arroz contribui com 7.171 tons para o total (33,9%) seguido do trigo com 5.842 tons do total (27,6%). Comparado com o trimestre anterior, registou-se uma queda de 1,0% no consumo dos cereais. O grau de utilização média mensal do trimestre das disponibilidades dos grandes operadores é de 33,9% contra o valor médio mensal de 28,2% verificado no trimestre anterior. ■ A distribuição inter-ilhas do conjunto dos cereais totalizou num valor de 7.927 tons, no qual 1.118 tons de milho, 1.798 tons do arroz e 5.012 tons da farinha de trigo ■ Neste trimestre, o preço do conjunto dos cereais teve ligeiros declíneos, com uma baixa no milho de 5,1% e no arroz de 1,7%. Na farinha de trigo registou-se um aumento de 3,2%. Açúcar: Com base nos dados do 4º trimestre de 2012, considera-se que o abastecimento do açúcar segue uma tendência favorável, com aumentos dos stoks, da importação e das disponibilidades médias . ■ Neste trimestre a disponibilidade total do açúcar é de 5.071 tons, sendo 2.618 tons do stock inicial e 2.453 tons da importação e cobre largamente às necessidades do consumo aparente que é de 2.095 tons. A disponibilidade média mensal do açúcar no trimestre é de 3.378 tons e em relação ao trimestre anterior verifica-se uma baixa de 4,5%. ■ No final do trimestre o stock do açúcar é de 2.976 tons e o prazo de cobertura é de 3,4 meses. A variação entre o stock inicial e final é de 358 tons. ■ O grau de utilização média mensal do trimestre das disponibilidades do açúcar dos grandes operadores é de 43,9%, estima-se que o consumo aparente médio é de 698 tons mensal. ■ Neste trimestre, a distribuição inter-ilhas total do açúcar é de 484 tons. Esta quantidade foi distribuida para todas as ilhas. ■ O preço de açúcar teve redução de 1,7% em relação ao trimestre anterior, e continua apontar uma diminuição para o próximo trimestre.

Recommandations de vaccination pour les patients atteints de maladie chronique [Immunization guidelines regarding patients with a chronic disease].

Some chronic diseases--like renal failure, liver insufficiency, chronic lung disease, cardiac involvement, diabetes mellitus, asplenia--present limited defects of the immune system and/or a higher risk of infection; therefore, patients with such pathologies should get selective vaccinations. The efficacy of immunization decreases with disease progression; for this reason, these patients should be immunized as soon as possible. At the beginning of their disease, these patients do not need a specialized treatment and are followed by the general practitioner alone who is in charge of immunizing them as well as contact people of any immunocompromised patient. OFSP's regular vaccinations programme is recommended, as well as selective vaccinations against influenza, pneumococci and viral hepatitis, depending on the underlying chronic disease.

Estudio de otolitos de Odonthestes regia r., Pejerrey: determinación de edad

El estudio de los incrementos marginales de crecimiento mensual de otolitos de pejerrey , sugiere: Un inicio de formación de anillo para el mes de julio y otra formación para enero; ambos se encuentran relacionados al ápice y secundario del desove. La regresión que relaciona la longitud del pez (cm) con la longitud del otolito (mm) corresponde a: Y=2 .302 + 7.72163 X, R=0. 99, N=427 especímenes . La distribución mensual de longitudes del total de pe­ces N=798, sugiere que hay una reducción del tamaño modal después de abril con una alta proporción de peces menores de 15 cm y ésto alcanza su máximo más o menos entre julio y setiembre. Este cambio puede significar que el reclutamiento tomaría lugar entre mayo y octubre con el ápice en agosto. La madurez sexual , estudio de la distribución porcentual por estadios a lo largo de todos los meses del año 1975, Sugiere: considerando los estadíos V, VI, VII juntos y el VI separadamente, que el ápice del desove es en julio con un rango entre mayo y octubre y con un ápice secundario en enero. El contaje de anillos anuales en la estructura de los otolitos nos dice que esta especie es de vida corta no más de tres años. La ecuación de crecimiento de von Bertalanf fy corresponde)