A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.

PURPOSE: An optimal target for glucose control in ICU patients remains unclear. This prospective randomized controlled trial compared the effects on ICU mortality of intensive insulin therapy (IIT) with an intermediate glucose control. METHODS: Adult patients admitted to the 21 participating medico-surgical ICUs were randomized to group 1 (target BG 7.8-10.0 mmol/L) or to group 2 (target BG 4.4-6.1 mmol/L). RESULTS: While the required sample size was 1,750 per group, the trial was stopped early due to a high rate of unintended protocol violations. From 1,101 admissions, the outcomes of 542 patients assigned to group 1 and 536 of group 2 were analysed. The groups were well balanced. BG levels averaged in group 1 8.0 mmol/L (IQR 7.1-9.0) (median of all values) and 7.7 mmol/L (IQR 6.7-8.8) (median of morning BG) versus 6.5 mmol/L (IQR 6.0-7.2) and 6.1 mmol/L (IQR 5.5-6.8) for group 2 (p < 0.0001 for both comparisons). The percentage of patients treated with insulin averaged 66.2 and 96.3%, respectively. Proportion of time spent in target BG was similar, averaging 39.5% and 45.1% (median (IQR) 34.3 (18.5-50.0) and 39.3 (26.2-53.6)%) in the groups 1 and 2, respectively. The rate of hypoglycaemia was higher in the group 2 (8.7%) than in group 1 (2.7%, p < 0.0001). ICU mortality was similar in the two groups (15.3 vs. 17.2%). CONCLUSIONS: In this prematurely stopped and therefore underpowered study, there was a lack of clinical benefit of intensive insulin therapy (target 4.4-6.1 mmol/L), associated with an increased incidence of hypoglycaemia, as compared to a 7.8-10.0 mmol/L target. (ClinicalTrials.gov # NCT00107601, EUDRA-CT Number: 200400391440).

Acknowledgment and psychiatric symptoms in police officers in Switzerland

The way supervisors acknowledge specific contribution and efforts of their employees has an impact on occupational health and wellbeing. Acknowledgement is a protective factor when it is sufficiently provided. We carried out a study about occupational health in police officers with special emphasis on acknowledgment and reward. A questionnaire was sent to 1000 police officers and inspectors working for a cantonal administration in Switzerland. In total, 695 participants answered the questionnaire. We used the TST questionnaire (French version of the Langner's questionnaire on psychiatric symptoms) to identify cases characterized by potential mental health problems. Multiple choice items (5 modalities ranging from "not at all" to "tremendously") were used to measure acknowledgment. The score for psychiatric symptoms was high (TST score >or= 9) for 86 police officers and inspectors for whom health might be at risk. Compared with police officers having low or medium scores for psychiatric symptoms (TST score < 9), police officers with high TST scores were more likely to report the lack of support and attention from the supervisors (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.0 to 5.1) and the lack of acknowledgment by the hierarchy (OR 3.0, 95% CI 1.9 to 4.8). They were also more likely to mention that judicial authorities have a low consideration for police officers (OR 2.7, 95% CI 1.7 to 4.3) and that the public in general have a low appreciation of police officers (OR 1.8, 95% CI 1.2 to 2.9). Preserving mental health in occupations characterized by high emotional demand is challenging. Our results show that acknowledgment and mental health are associated. Further research should address a potential causal relation of acknowledgment on mental health in police officers and inspectors.

Uranium reserve, nuclear fuel cycle delusion, CO2 emission from the sea, and electricity supply: reflections after the fuel meltdown of Fukushima nuclear power units

The Great Tohoku-Kanto earthquake and resulting tsunami has brought considerable attention to the issue of the construction of new power plants. We argue in this paper, nuclear power is not a sustainable solution to energy problems. First, we explore the stock of uranium-235 and the different schemes developed by the nuclear power industry to exploit this resource. Second, we show that these methods, fast breeder and MOX fuel reactors, are not feasible. Third, we show that the argument that nuclear energy can be used to reduce CO2 emissions is false: the emissions from the increased water evaporation from nuclear power generation must be accounted for. In the case of Japan, water from nuclear power plants is drained into the surrounding sea, raising the water temperature which has an adverse affect on the immediate ecosystem, as well as increasing CO2 emissions from increased water evaporation from the sea. Next, a short exercise is used to show that nuclear power is not even needed to meet consumer demand in Japan. Such an exercise should be performed for any country considering the construction of additional nuclear power plants. Lastly, the paper is concluded with a discussion of the implications of our findings.

Health Technical Memorandum 04-01: Addendum & Pseudomonas Aeruginosa & Advice for augmented care units

Water Systems HTM 04-01

Registration & Inspection Units 2003 (pdf 620 kb)

Summary of Statistical Results

Registration & Inspection Units 2002 (pdf 308 kb)

Summary of Statistical Results

Registration & Inspection Units 2001 (pdf 332 kb)

Summary of Statistical Results

Registration & Inspection Units 2000 (pdf 428 kb)

Summary of Statistical Results

Hepatitis C and hepatitis B virus infection in different hemodialysis units in Belo Horizonte, Minas Gerais, Brazil

The prevalence, virological and epidemilogical aspects of the hepatitis C virus (HCV) and the hepatitis B virus (HBV) infections vary among hemodialysis patients in different countries. Aiming at analyzing these aspects of HCV and HBV infections in hemodialysis patients in Belo Horizonte, MG, Brazil, we studied three hemodialysis units including 434 patients. Serology was used to detect anti-HCV and HBsAg. Reverse trancriptase nested polymerase chain reaction (RT-nested-PCR) of the 5'-noncoding region was used to detect circulating HCV RNA and restriction fragment length polymorphism analysis for genotyping. Seroprevalence varied from 26.5% to 11.1% for hepatitis C and from 5.9% to 0% for hepatitis B. Risk factors observed for HBV and/or HCV infections were the number of patients per dialysis unit, duration of treatment, number of clinics attended, number of blood units transfused, and lower level scholarity. Alanine aminotransferase levels were altered with a higher frequency in HBV or HCV seropositive patients. Half of ten patients, negative for anti-HCV, had detectable viremia by RT-nested-PCR, indicating that this technique should be used to confirm infections in this group of patients. The HCV genotype 1 was the most frequently observed, followed by the genotype 2, but no correlation was detected between genotype and clinical or epidemiological data.

La force publique devant les caméras. Considérations sur la sous-veillance de la police par ses publics

Les médias de masse, en particulier Internet, ont profondément modifié la distribution du pouvoir dans notre société. Sous l'oeil des caméras et des citoyens-reporters, le pouvoir policier est l'objet d'une intense « sous-veillance » publique et médiatique. Pourquoi et comment sensibiliser les nouveaux entrants aux « risques médiatiques » de leur future profession ?