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Tobacco retailer licencing has been recommended as an effective tobacco control strategy. In most European countries, however, retailers do not need a licence to sell tobacco products. We aimed to stimulate a discussion on the potential for tobacco retail licencing in Europe by describing (1) potential public health benefits, (2) licencing methods and (3) barriers and success factors in adoption of licencing systems. There is limited scientific evidence, but tobacco retail licencing may reduce smoking in three ways: (1) improved enforcement of and compliance to existing point-of-sale tobacco control policies (eg, minimum age of sale), (2) a reduction in the number and/or density of tobacco retail outlets and (3) denormalisation of tobacco. Licencing systems may take diverse forms. Systems may make licences expensive, and set criteria for purchasing a licence and retaining the licence after first purchase. In Europe, licencing systems have been implemented in Finland, Hungary, France, Italy and Spain. Licencing in Finland and Hungary was adopted for public health reasons; in Finland, with strong public support. In France, Italy and Spain, tobacco sales were state-monopolised, driven by economic motives. The cases of Norway and Scotland show that adoption of retail licencing may fail when political support is insufficient and tobacco retailers organise opposition with support from the tobacco industry. In conclusion, tobacco retailer licencing is a promising method to contribute to tobacco control efforts. Placing tobacco retailer licencing in a child protection framework may help generate the strong political and public support needed to effectively adopt licencing systems.

Despite evidence for microbial endemism, an understanding of the impact of geological and paleoclimate events on the evolution of regional protist communities remains elusive. Here, we provide insights into the biogeographical history of Antarctic freshwater diatoms, using lacustrine fossils from mid-Miocene and Quaternary Antarctica, and dovetail this dataset with a global inventory of modern freshwater diatom communities. We reveal the existence of a diverse mid-Miocene diatom flora bearing similarities with several former Gondwanan landmasses. Miocene cooling and Plio-Pleistocene glaciations triggered multiple extinction waves, resulting in the selective depauperation of this flora. Although extinction dominated, in situ speciation and new colonizations ultimately shaped the species-poor, yet highly adapted and largely endemic, modern Antarctic diatom flora. Our results provide a more holistic view on the scale of biodiversity turnover in Neogene and Pleistocene Antarctica than the fragmentary perspective offered by macrofossils and underscore the sensitivity of lacustrine microbiota to large-scale climate perturbations.

Background: We estimated the annually incidence and mortality of acquired brain injury (ABI) in people aged 15-30years during 1994-2013.Methods: All Danes with a first-ever hospital diagnosis of ABI, including traumatic brain injury (TBI), encephalopathy, CNS-infection or brain tumour, were identified in the Danish National Patient Register. Incidence rates (IRs) and estimated annual percentage changes (EAPC) were estimated by Poisson regression. Mortality was estimated by the Kaplan-Meier estimator and adjusted hazard ratios (aHR) were computed using Cox regression with 1994-1998.Results: A total of 10,542 individuals were hospitalized with a first-time diagnosis of ABI. The IR for ABI decreased from 63.36 to 33.91/100,000person-years from 1994 to 2013 [EAPC: -2.78% (95% CI: -3.26 to -2.28)] mainly driven by a decreasing IR of TBI [EAPC: -6.53% (95% CI: -9.57 to -3.39)] during 2007-2013. IRs of brain tumour and CNS infections also decreased significantly. The mortality after ABI tended to be higher during 1999-2013 compared to 1994-1998. For brain tumour, the 1-year mortality decreased significantly [2009-2013 aHR: 0.41 (95% CI: 0.23-0.72)].Conclusion: Incidence of hospitalisations for ABI and in particular TBI has decreased significantly. Overall, the mortality after ABI has not improved, but the mortality after brain tumour has decreased significantly.

The members of the ACER project wish to thank the QUEST-DESIRE (UK and France) bilateral project, the INQUA International Focus Group ACER and the INTIMATE-COST action for funding a suite of workshops to compile the ACER pollen and charcoal database and the workshop on ACER chronology that allow setting the basis for harmonizing the chronologies. Josué M. Polanco-Martinez was funded by a Basque Government postdoctoral fellowship (POS_2015_1_0006) and Sandy P. Harrison by the ERC Advanced Grant GC2.0: unlocking the past for a clearer future. Quaternary records provide an opportunity to examine the nature of the vegetation and fire responses to rapid past climate changes comparable in velocity and magnitude to those expected in the 21st-century. The best documented examples of rapid climate change in the past are the warming events associated with the Dansgaard–Oeschger (D–O) cycles during the last glacial period, which were sufficiently large to have had a potential feedback through changes in albedo and greenhouse gas emissions on climate. Previous reconstructions of vegetation and fire changes during the D–O cycles used independently constructed age models, making it difficult to compare the changes between different sites and regions. Here, we present the ACER (Abrupt Climate Changes and Environmental Responses) global database, which includes 93 pollen records from the last glacial period (73–15 ka) with a temporal resolution better than 1000 years, 32 of which also provide charcoal records. A harmonized and consistent chronology based on radiometric dating (14C, 234U∕230Th, optically stimulated luminescence (OSL), 40Ar∕39Ar-dated tephra layers) has been constructed for 86 of these records, although in some cases additional information was derived using common control points based on event stratigraphy. The ACER database compiles metadata including geospatial and dating information, pollen and charcoal counts, and pollen percentages of the characteristic biomes and is archived in Microsoft AccessTM at https://doi.org/10.1594/PANGAEA.870867 Publisher PDF

The great auk was once abundant and distributed across the North Atlantic. It is now extinct, having been heavily exploited for its eggs, meat, and feathers. We investigated the impact of human hunting on its demise by integrating genetic data, GPS-based ocean current data, and analyses of population viability. We sequenced complete mitochondrial genomes of 41 individuals from across the species’ geographic range and reconstructed population structure and population dynamics throughout the Holocene. Taken together, our data do not provide any evidence that great auks were at risk of extinction prior to the onset of intensive human hunting in the early 16th century. In addition, our population viability analyses reveal that even if the great auk had not been under threat by environmental change, human hunting alone could have been sufficient to cause its extinction. Our results emphasise the vulnerability of even abundant and widespread species to intense and localised exploitation. Copyright Thomas et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited.

Neonates born very preterm (before 32 weeks’ gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

BackgroundOur knowledge of the role of parental and child-care staff behavior in the development and prevention of obesity is rapidly increasing. Potential interaction between both settings in socalled meso-systems, as hypothesized by the ecological systems perspective, is however often ignored. Specifically, inconsistency between home and child-care is hypothesized to have negative effects on child outcomes.MethodsParticipants were recruited through 23 child-care centers in the Netherlands. Data regarding 161 child-parent-child-care staff triads were available. Parenting and child care practices were assessed using validated questionnaires for parents (Child Feeding Practices Questionnaire, Preschooler Physical Activity Parenting Practices instrument) and child-care staff (Child-care Food and Activity Practices Questionnaire), using similar items in both settings. Absolute difference scores between parents and child-care staff were calculated for each triad as a measure of meso-system consistency. Child outcomes were physical activity (as assessed by accelerometry), dietary intake (from the parental questionnaire), and measured BMI z-scores. Paired t-tests were used to examine consistency between practices in both settings. Linear regression analyses were used to explore the association of parenting practices, child-care practices and difference scores on the one hand, and child outcomes on the other.ResultsSignificant differences between settings were found for almost all practices, and in most cases child-care staff scores more favorable on the practices than parents. Inconsistencies were mostly associated with unhealthy dietary intake and lower physical activity levels, but not with BMI.ConclusionThe current study showed that inconsistencies in parenting and child-care practices exist, and that these inconsistencies seem to be associated with unhealthy behavior in children. The results underline the importance of studying meso-system influences on behavior in general, and children's energy balance-related behavior specifically.

Purpose: Despite the recent Sepsis-3 consensus, the Systemic Inflammatory Response Syndrome (SIRS) criteria continue to be assessed and recommended. Such use implies equivalence and interchangeability of criteria. Thus, we aimed to test whether such criteria are indeed equivalent and interchangeable. Materials and methods: From 2000 to 2015, we identified patients with infection, organ failure, and at least one SIRS criterion in 179 Intensive Care Units in Australia and New. Zealand. We studied the association of different SIRS criteria with hospital mortality. Results: Among 131,016 patients with infection and organ failure, mortality increased from 10.6% for the respiratory rate criterion to 15.8% for the heart rate criterion (P

Several young damaged Norway spruce stands in eastern and central Finland were observed from 2013 to 2016. The damage included trees with heavy resin flow, necrotic foliage, stem and branch cankers and dead trees. Pest identification resulted in the tortricid moth Cydia pactolana whose occurrence was always associated with the presence of the ascomycete pathogen Neonectria fuckeliana. Both the insect and the disease contributed to the extent of the damage, but it is not possible to say in which order they had attacked the trees. Apparently, changed climate has affected the increased occurrence of both the fungus and the moth. However, the characteristics of the insect-fungus interaction and the factors contributing to the coincidences are unknown. Emerging coexistence or potential symbiosis of the two damaging agents is a serious threat for Norway spruce cultivation. Understanding the biology of this fungus-insect interaction is important for controlling them.

Alexandrium ostenfeldii is a toxic dinoflagellate that has recently bloomed in Ouwerkerkse Kreek, The Netherlands, and which is able to cause a serious threat to shellfish consumers and aquacultures. We used a large set of 68 strains to the aim of fully characterizing the toxin profiles of the Dutch A. ostenfeldii in consideration of recent reports of novel toxins. Alexandrium ostenfeldii is known as a causative species of paralytic shellfish poisoning, and consistently in the Dutch population we determined the presence of several paralytic shellfish toxins (PST) including saxitoxin (STX), GTX2/3 (gonyautoxins), B1 and C1/C2. We also examined the production of spiroimine toxins by the Dutch A. ostenfeldii strains. An extensive liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis revealed a high intraspecific variability of spirolides (SPX) and gymnodimines (GYM). Spirolides included 13-desMethyl-spirolide C generally as the major compound and several other mostly unknown SPX-like compounds that were detected and characterized. Besides spirolides, the presence of gymnodimine A and 12-Methyl-gymnodimine A was confirmed, together with two new gymnodimines. One of these was tentatively identified as an analogue of gymnodimine D and was the most abundant gymnodimine (calculated cell quota up to 274 pg cell(-1), expressed as GYM A equivalents). Our multi-clonal approach adds new analogues to the increasing number of compounds in these toxin classes and revealed a high strain variability in cell quota and in toxin profile of toxic compounds within a single population.

The genetic structure of bacterial populations can be related to geographical locations of isolation. In some species, there is a strong correlation between geographical distances and genetic distances, which can be caused by different evolutionary mechanisms. Patterns of ancient admixture in Helicobacter pylori can be reconstructed in concordance with past human migration, whereas in Mycobacterium tuberculosis it is the lack of recombination that causes allopatric clusters. In Campylobacter, analyses of genomic data and molecular typing have been successful in determining the reservoir host species, but not geographical origin. We investigated biogeographical variation in highly recombining genes to determine the extent of clustering between genomes from geographically distinct Campylobacter populations. Whole genome sequences from 294 Campylobacter isolates from North America and the UK were analysed. Isolates from within the same country shared more recently recombined DNA than isolates from different countries. Using 15 UK/American pairs of isolates that shared ancestors, we identify regions that have frequently and recently recombined to test their correlation with geographical origin. The seven genes that demonstrated the greatest clustering by geography were used in an attribution model to infer geographical origins and tested using a further 383 UK clinical isolates to detect signatures of recent foreign travel. Patient records indicated that in 46 cases travel abroad had occurred less than two weeks prior to sampling: genomic analysis indicated that 34 (74%) of these isolates were of a non-UK origin. Identification of biogeographical markers in Campylobacter genomes will contribute to improved source attribution of clinical Campylobacter infection and inform intervention strategies to reduce campylobacteriosis.

Campylobacter infection is the most commonly notified bacterial enteritis in Germany. We performed a large combined case-control and source attribution study (Nov 2011-Feb 2014) to identify risk factors for sporadic intestinal Campylobacter infections and to determine the relative importance of various animal sources for human infections in Germany. We conducted multivariable logistic regression analysis to identify risk factors. Source attribution analysis was performed using the asymmetric island model based on MLST data of human and animal/food isolates. As animal sources we considered chicken, pig, pet dog or cat, cattle, and poultry other than chicken. Consumption of chicken meat and eating out were the most important risk factors for Campylobacter infections. Additional risk factors were preparation of poultry meat in the household; preparation of uncooked food and raw meat at the same time; contact with poultry animals; and the use of gastric acid inhibitors. The mean probability of human C. jejuni isolates to originate from chickens was highest (74%), whereas pigs were a negligible source for C. jejuni infections. Human C. coli isolates were likely to originate from chickens (56%) or from pigs (32%). Efforts need to be intensified along the food chain to reduce Campylobacter load, especially on chicken meat.

Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case–control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22–47). VE was 51% (95% CI: 15–71) in patients without high-risk medical conditions and 30% (95% CI: 14–44) in patients with them. VE was 39% (95% CI: 20–53) in patients aged 65–79 years and 34% (95% CI: 11–51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals. This work was supported by the National Plan of I+D+I 2008–2011 and ISCIII-Subdirección General de Evaluación y Fomento de la Investigación (Project PI12/02079), and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) and the Catalan Agency for the Management of Grants for University Research (AGAUR grant number 2014/ SGR 1403).

To estimate the number of cases of scrapie that would occur in sheep of different prion protein (PrP) genotypes if scrapie was to become established in New Zealand, and to compare the performance of two commercially available, rapid ELISA kits using ovine retro-pharyngeal lymph nodes (RLN) from non-infected and infected sheep of different PrP genotypes.Using published data on the distribution of PrP genotypes within the New Zealand sheep flock and the prevalence of cases of scrapie in these genotypes in the United Kingdom, the annual expected number of cases of scrapie per genotype was estimated, should scrapie become established in New Zealand, assuming a total population of 28 million sheep. A non-infected panel of RLN was collected from 737 sheep from New Zealand that had been culled, found in extremis or died. Brain stem samples were also collected from 131 of these sheep. A second panel of infected samples comprised 218 and 117 RLN from confirmed scrapie cases that had originated in Europe and the United States of America, respectively. All samples were screened using two commercial, rapid, transmissible spongiform encephalopathy ELISA kits: Bio-Rad TeSeE ELISA (ELISA-BR), and IDEXX HerdChek BSE-Scrapie AG Test (ELISA-ID).If scrapie became established in New Zealand, an estimated 596 cases would occur per year; of these 234 (39%) and 271 (46%) would be in sheep carrying ARQ/ARQ and ARQ/VRQ PrP genotypes, respectively. For the non-infected samples from New Zealand the diagnostic specificity of both ELISA kits was 100%. When considering all infected samples, the diagnostic sensitivity was 70.4 (95% CI=65.3-75.3)% for ELISA-BR and 91.6 (95% CI=88.2-94.4)% for ELISA-ID. For the ARQ/ARQ genotype (n=195), sensitivity was 66.2% for ELISA-BR and 90.8% for ELISA-ID, and for the ARQ/VRQ genotype (n=107), sensitivity was 81.3% for ELISA-BR and 98.1% for ELISA-ID.In this study, the ELISA-ID kit demonstrated a higher diagnostic sensitivity for detecting scrapie in samples of RLN from sheep carrying scrapie-susceptible PrP genotypes than the ELISA-BR kit at comparable diagnostic specificity.The diagnostic performance of the ELISA-ID kit using ovine RLN merits the consideration of including this assay in the national scrapie surveillance programme in New Zealand.

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.

Campylobacteriosis in humans, caused by Campylobacter jejuni and Campylobacter coli, is the most common recognized bacterial zoonosis in the European Union and the United States. The acute phase is characterized by gastrointestinal symptoms. The long-term sequelae (Guillain-Barré syndrome, reactive arthritis, and postinfectious irritable bowel syndrome) contribute considerably to the disease burden. Attribution studies identified poultry as the reservoir responsible for up to 80% of the human Campylobacter infections. In the European Union, an estimated 30% of the human infections are associated with consumption and preparation of poultry meat. Until now, interventions in the poultry meat production chain have not been effectively introduced except for targeted interventions in Iceland and New Zealand. Intervention measures (eg, biosecurity) have limited effect or are hampered by economic aspects or consumer acceptance. In the future, a multilevel approach should be followed, aiming at reducing the level of contamination of consumer products rather than complete absence of Campylobacter.

Anthelmintic resistance of parasites in small ruminants, cattle and horses is increasing worldwide as a consequence of the over usage of the currently available products. In Belgium, Cooperia oncophora is the most common cattle nematode in which resistance, especially against macrocyclic lactones, occurs. Once resistance has been diagnosed, a change to another drug with a different mode of action is advised. However, effective anthelmintics will be hardly available in the near future. Therefore, it is important that farmers and veterinarians find a balance between achieving good parasite control and the sustainability of their control strategies. In this way, anthelmintic resistance may be delayed, and the effectiveness of anthelmintic drugs may be prolonged. This requires sensitive detection tools. With a sensitive detection technique, anthelmintic resistance can be diagnosed in a very early stage. Hence, the spread of resistance alleles in the parasite population may be prevented. In this review, different diagnostic assays for the detection of anthelmintic resistance are discussed, an overview is given of the current status of anthelmintic resistance in Belgian cattle, and measures are suggested to avoid or delay the development of anthelmintic resistance.

Background: Nutrition labeling is a prominent policy to promote healthy eating. Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases. Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC). Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL (n = 459), HSR (n = 443), or NIP (n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was −0.20 (95% CI: −0.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was −0.60 (95% CI: −1.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average (n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: −1.33 (95% CI: −2.63, −0.04; P = 0.04); HSR compared with NIP: −1.70 (95% CI: −2.97, −0.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values

Purpose Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts’ definition of paediatric RSS. Methods We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality). Results From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89–0.94), and 0.956 (95 % CI 0.93–0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality. Conclusions This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock. Electronic supplementary material The online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users.

Dothistroma needle blight (DNB) caused by Dothistroma septosporum and Dothistroma pini is a damaging disease of pine in many countries. The disease led to the abandonment of planting susceptible Pinus species in parts of Africa, Asia, Australasia, Europe and North America. Although the disease can be effectively controlled using copper fungicides, this chemical is only routinely applied in forests in New Zealand and Australia. Other management tactics aimed at making conditions less favourable for disease development, such as thinning or pruning, may be effective on some, but not all, sites. Disease avoidance, by planting non-susceptible species, is the most common form of management in Europe, along with deployment of hosts with strong disease resistance. Although D. septosporum is present almost everywhere Pinus is grown, it is important that an effort is maintained to exclude introductions of new haplotypes that could increase virulence or enable host resistance to be overcome. A global strategy to exclude new introductions of Dothistroma and other damaging forest pathogens, facilitated by collaborative programmes and legislation, is needed.

Aims: Attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice are described in several studies, but the results are heterogenous. The purpose of this systematic review was to compare the attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice. Methods: PubMed, AMED and CINAHL were screened by two independent assessors to identify relevant studies. Only quantitative studies that reported the percentages of dentists' and dental hygienists' attitude towards extended scope and independent dental hygiene practice were included. The random-effects model was used to synthesise possible heterogenous influences. Results: Meta proportions with regard to a positive attitude towards extended scope of practice are 0.54 for dentists and 0.81 for dental hygienists. Meta proportions of a positive attitude towards independent practice are 0.14 for dentists and 0.59 for dental hygienists. A meta analysis with regard to negative attitudes could only be performed on extended scope of practice and did not reveal a difference between the two professions. We obtained homogeneous outcomes of the studies included regarding negative attitudes of dentists. A minority of dentists hold negative attitudes towards extended scope of dental hygiene practice. Study outcomes regarding negative attitudes of dental hygienists were heterogeneous. Conclusions: Positive attitudes are present among a majority of dentists and dental hygienists with regard to extended scope of dental hygiene practice, while for independent dental hygiene practice this holds for a minority of dentists and a majority of dental hygienists.

We have previously shown that 11 patients became naturally coinfected with seasonal H1N1 (A/H1N1) and pandemic H1N1 (pdm/H1N1) during the Southern hemisphere winter of 2009 in New Zealand. Reassortment of influenza A viruses is readily observed during coinfection of host animals and in vitro ; however, reports of reassortment occurring naturally in humans are rare. Using clinical specimen material, we show reassortment between the two coinfecting viruses occurred with high likelihood directly in one of the previously identified patients. Despite the lack of spread of these reassortants in the community, we did not find them to be attenuated in several model systems for viral replication and virus transmission: multistep growth curves in differentiated human bronchial epithelial cells revealed no growth deficiency in six recovered reassortants compared to A/H1N1 and pdm/H1N1 isolates. Two reassortant viruses were assessed in ferrets and showed transmission to aerosol contacts. This study demonstrates that influenza virus reassortants can arise in naturally coinfected patients. IMPORTANCE Reassortment of influenza A viruses is an important driver of virus evolution, but little has been done to address humans as hosts for the generation of novel influenza viruses. We show here that multiple reassortant viruses were generated during natural coinfection of a patient with pandemic H1N1 (2009) and seasonal H1N1 influenza A viruses. Though apparently fit in model systems, these reassortants did not become established in the wider population, presumably due to herd immunity against their seasonal H1 antigen.

Despite efforts to tackle folate deficiency and Neural Tube Defects (NTDs) through folic acid fortification, its implementation is still lacking where it is needed most, highlighting the need for studies that evaluate the effectiveness of folic acid fortified wheat flour in a poor, rural, high-risk, NTD region of China. One of the most affected regions, Shanxi Province, was selected as a case study. A community intervention was carried out in which 16,648 women of child-bearing age received fortified flour (eight villages) and a control group received ordinary flour (three villages). NTD birth prevalence and biological indicators were measured two years after program initiation at endline only. The effect on the NTD burden was calculated using the disability-adjusted life years (DALYs) method. In the intervention group, serum folate level was higher than in the control group. NTDs in the intervention group were 68.2% lower than in the control group (OR = 0.313, 95% CI = 0.207–0473, p < 0.001). In terms of DALYs, burden in intervention group was approximately 58.5% lower than in the control group. Flour fortification was associated with lower birth prevalence and burden of NTDs in economically developing regions with a high risk of NTDs. The positive findings confirm the potential of fortification when selecting an appropriate food vehicle and target region. As such, this study provides support for decision makers aiming for the implementation of (mandatory) folic acid fortification in China.

BACKGROUND: The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. METHODS AND FINDINGS: We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. CONCLUSIONS: For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives.

In recent decades major declines in urban house sparrow (Passer domesticus) populations have been observed in north-western European cities, whereas suburban and rural house sparrow populations have remained relatively stable or are recovering from previous declines. Differential exposure to avian pathogens known to cause epidemics in house sparrows may in part explain this spatial pattern of declines. Here we investigate the potential effect of urbanization on the development of a bacterial pathogen reservoir in free-ranging house sparrows. This was achieved by comparing the prevalence of Salmonella enterica subspecies enterica serotype Typhimurium in 364 apparently healthy house sparrows captured in urban, suburban and rural regions across Flanders, Belgium between September 2013 and March 2014. In addition 12 dead birds, received from bird rescue centers, were necropsied. The apparent absence of Salmonella Typhimurium in fecal samples of healthy birds, and the identification of only one house sparrow seropositive for Salmonella spp., suggests that during the winter of 2013–2014 these birds did not represent any considerable Salmonella Typhimurium reservoir in Belgium and thus may be considered naive hosts, susceptible to clinical infection. This susceptibility is demonstrated by the isolation of two different Salmonella Typhimurium strains from two of the deceased house sparrows: one DT99, typically associated with disease in pigeons, and one DT195, previously associated with a passerine decline. The apparent absence (prevalence

International audience; An experiment was carried out to study the possible interaction between dexamethasone (DXM) treatment and the efficacy of ivermectin (IVM) treatment in young cattle. Two groups, each of seven calves, were experimentally inoculated with an equal mixture containing 15,000 third stage larvae of Cooperia oncophora and Ostertagia ostertagi each, and with no history of being resistant to any anthelmintics. However, in this study C. oncophora was unexpectedly classified as IVM-resistant according to the outcome from the faecal egg count reduction test (FECRT). Blood parameters and faecal egg counts (FEC) were monitored from 0 to 35 days post infection (d.p.i.). The calves in one group received intramuscular injections of short and long-term acting DXM at 22 and 24 d.p.i., respectively. The other group remained as a control. Three days post patency (24 d.p.i.) both groups were injected subcutaneously with IVM (Merial) at the recommended dose (0.2 mg/kg). A significant difference (p < 0.001) in FEC patterns was observed between groups. Although both groups still excreted eggs (100-200 eggs per gram faeces) 11 days post anthelmintic treatment, the control group had a significantly higher reduction between 23 and 35 d.p.i. (p = 0.025). After 35 days, four animals per group were euthanized, and worms in the gastrointestinal tract were counted. No O. ostertagi were found in the abomasums, but low to high numbers (800-6200) of C. oncophora remained in the small intestines in both groups. Overall, these findings indicated that there was an interaction between the efficacy of IVM and DXM treatment. As significantly lower plasma levels of IVM were observed in the DXM group, we conclude that the impaired efficacy of ivermectin was most likely due to the altered pharmacokinetics. (C) 2012 Elsevier B.V. All rights reserved.

Increasing threats from anthelmintic resistant nematode populations warrant and motivate a reappraisal of chemotherapeutic strategies for nematode control in ruminant livestock and horses. The objective of this paper is to present a guideline for the evaluation of products containing two or more constituent anthelmintic actives in a single dosage form for the treatment of nematode infections in these animals. At present, regulatory policies on the approval of such products vary across jurisdictions, and this World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) guideline should enable the harmonization of the requirements. This guideline makes clear recommendations on the minimal standards needed, but stresses that registration dossiers for combination anthelmintic products submitted for approval must conform to the standards and practices already established in existing guidelines for anthelmintics.

To estimate the prevalence of claw disorders in youngstock and first parity heifers and to evaluate the effect of grazing on claw disorders, 10 Dutch dairy herds participated in a 2-year longitudinal study. Five herds were zero-grazed, while in the other five herds cows and youngstock had access to pasture during the summer. Twenty female calves1 year of age and 20 females between 1 and 2 years of age were randomly selected on each farm, and were individually monitored at 3 monthly intervals for 2 years. Data from 366 animals with at least five observations were analysed using linear mixed models with a binomial error distribution. Independent variables were grazing, age, month of observation and previous occurrence of the disorder, while herd and animal were included as random effects. Of these 366 animals, 287 had calved once and 76 twice at the end of the study. Analytic results were obtained for digital dermatitis (DD), interdigital dermatitis/heel horn erosion (IDHE) and sole haemorrhages (SH), all of which had a prevalence of15%. The prevalence of DD increased considerably around first calving on both the grazing and the zero-grazing farms. The prevalence of IDHE increased with age while SH prevalence showed a more fluctuating pattern. Digital dermatitis was less frequently observed in pastured animals than in permanently housed animals (OR=0.12-0.64 depending on month of observation; P0.05), with the strongest effect being seen during the period when the herds which grazed cattle actually had animals at pasture (May to August). Grazing was also associated with lower levels of IDHE and SH, again particularly during the grazing season.

ObjectiveTo identify patterns of perception of front-of-pack (FOP) nutrition labels and to determine social factors, nutritional knowledge and attention to packaging features related to such patterns.DesignCross-sectional. Perception was measured using indicators of understanding and acceptability of three simple FOP labels (the ‘Green Tick’, the logo of the French Nutrition and Health Programme (PNNS logo) and ‘simple traffic lights’ (STL)) and two detailed formats (‘multiple traffic lights’ (MTL) and the ‘colour range’ logo (CR)). Associations of perception patterns with individual characteristics were examined using χ2 tests.SettingData from the French NutriNet-Santé cohort study.SubjectsA total of 38 763 adults.ResultsFour perception patterns emerged. Poorly educated individuals were most often found in groups favouring simple formats. The ‘favourable to CR’ group had a high rate of men and older persons. Poor nutritional knowledge was more frequent in the ‘favourable to STL’ group, while individuals with substantial knowledge were proportionally more numerous in the ‘favourable to MTL’ group. The ‘favourable to STL’ group more frequently self-reported noting price and marketing characteristics during purchasing, while the ‘favourable to MTL’ and ‘favourable to CR’ groups declared more interest in nutritional information. The ‘favourable to Green Tick and PNNS logo’ group self-reported paying closer attention to claims and quality guarantee labels.ConclusionsThe ‘favourable to MTL’ cluster was most frequently represented in our survey. However, simple FOP formats may be most appropriate for increasing awareness of healthy eating among targeted groups with poor nutritional knowledge and little interest in the nutritional quality of packaged foods.

The purpose of this study was to determine the prevalence of Campylobacter in fresh vegetables and fruits at retail level in the Netherlands, and to estimate its implications on the importance of vegetables and fruits as risk factor for campylobacteriosis. Thirteen of the 5640 vegetable and fruit samples were Campylobacter positive, resulting in a prevalence of 0.23% (95% confidence interval (Cl): 0.12–0.39%). The prevalence of packaged products (0.36%, 95% Cl: 0.17–0.66) was significantly higher than of unpackaged products (0.07; 95% Cl: 0.01–0.27). No statistical differences were found between seasons. Combining the mean prevalence found in this study with data on the consumption of vegetables and fruits, an exposure of 0.0048 campylobacters ingested per person per day in the Netherlands by transmission via vegetables and fruits, was calculated. This exposure, as input in a Beta-Poisson dose–response model, resulted in an estimated number of 5.3 × 105 cases of infection with Campylobacter per year for the whole Dutch population. This constitutes the consumption of raw vegetables and fruits, especially when packaged, to be a risk factor for Campylobacter infections

Item does not contain fulltext BACKGROUND: The Fc receptors II and III (FcgR2a, and FcgR3a) play a crucial role in the regulation of the immune response. The FcgR2a*519GG and FcgR3a*559CC genotypes have been associated with several autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, nephritis, and possibly to type I diabetes, and celiac disease. In a large multicenter, two-stage study of 6570 people, we tested whether the FcgR2a and FcgR3a genes were also involved in inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC). METHODS: We genotyped the FcgR2a*A519G and FcgR3a*A559C functional variants in 4205 IBD patients in six well-phenotyped Caucasian IBD cohorts and 2365 ethnically matched controls recruited from the Netherlands, Spain, and New Zealand. RESULTS: In the initial Dutch study we found a significant association of FcgR2a genotypes with IBD (P-genotype = 0.02); while the FcgR2a*519GG was more common in controls (23%) than in IBD patients (18%; odds ratio [OR] = 0.75; 95% confidence interval [CI] 0.61-0.92; P = 0.004). This association was corroborated by a combined analysis across all the study populations (Mantel-Haenszel [MH] OR = 0.84; 0.74-0.95; P = 0.005) in the next stage. The Fcgr2a*GG genotype was associated with both UC (MH-OR = 0.84; 0.72-0.97; P = 0.01) and CD (MH-OR = 0.84; 0.73-0.97; P = 0.01), suggesting that this genotype confers a protective effect against IBD. There was no association of FcgR3a*A559C genotypes with IBD, CD, or UC in any of the three studied populations. CONCLUSIONS: The FcgR2a*519G functional variant was associated with IBD and reduced susceptibility to UC and to CD in Caucasians. There was no association between FcgR3a*5A559C and IBD, CD or UC. 01 december 2010

Background. Little is known about the worldwide variation in incidence of primary glomerulonephritis (GN). The objective of this review was to critically appraise studies of incidence published in 1980-2010 so that an overall view of trends of these diseases can be found. This would provide important information for determining changes in rates and understanding variations between countries. Methods. All relevant papers found through searches of Medline, Embase and ScienceDirect were critically appraised and an assessment was made of the reliability of the reported incidence data. Results. This review includes 40 studies of incidence of primary GN from Europe, North and South America, Canada, Australasia and the Middle East. Rates for the individual types of disease were found to be in adults, 0.2/100 000/year for membrano-proliferative GN, 0.2/100 000/year for mesangio-proliferative GN, 0.6/100 000/year for minimal change disease, 0.8/100 000/year for focal segmental glomerulosclerosis, 1.2/100 000/year for membranous nephropathy and 2.5/100 000/year for IgA nephropathy. Rates were lower in children at around 0.1/100 000/year with the exception of minimal change disease where incidence was reported to be 2.0/100 000/year in Caucasian children with higher rates in Arabian children (9.2/100 000/year) and Asian children (6.2-15.6/100 000/year). Conclusions. This study found that incidence rates of primary GN vary between 0.2/100 000/year and 2.5/100 000/ year. The incidence of IgA nephropathy is at least 2.5/100 000/year in adults; this disease can exist subclinically and is therefore only detected by chance in some patients. In addition, referral policies for diagnostic biopsy vary between countries. This will affect the incidence rates found.

In Australia, manufacturers can use two government-endorsed approaches to advertise product healthiness: the Health Star Rating (HSR) front-of-pack nutrition labelling system, and health claims. Related, but different, algorithms determine the star rating of a product (the HSR algorithm) and eligibility to display claims (the Nutrient Profiling Scoring Criterion (NPSC) algorithm). The objective of this study was to examine the agreement between the HSR and NPSC algorithms. Food composition information for 41,297 packaged products was extracted from The George Institute&rsquo, s FoodSwitch database. HSR and the NPSC scores were calculated, and the proportion of products in each HSR category that were eligible to display a health claim under the NPSC was examined. The highest agreement between the HSR scoring algorithm and the NPSC threshold to determine eligibility to display a health claim was at the HSR cut-off of 3.5 stars (k = 0.83). Overall, 97.3% (n = 40,167) of products with star ratings of 3.5 or higher were also eligible to display a health claim, and 94.3% (n = 38,939) of products with star ratings less than 3.5 were ineligible to display a health claim. The food group with greatest divergence was &ldquo, edible oils&rdquo, with 45% products (n = 342) with HSR &gt, 3.5, but 64% (n = 495) eligible to display a claim. Categories with large absolute numbers of products with HSR &lt, 3.5, but eligible to display a claim, were &ldquo, yoghurts and yoghurt drinks&rdquo, (335 products, 25.4%) and &ldquo, soft drinks&rdquo, (299 products, 29.7%). Categories with a large number of products with HSR &ge, 3.5, but ineligible to display a claim, were &ldquo, milk&rdquo, (260 products, 21.2%) and &ldquo, nuts and seeds&rdquo, (173 products, 19.7%). We conclude that there is good agreement between the HSR and the NPSC systems overall, but divergence in some food groups is likely to result in confusion for consumers, particularly where foods with low HSRs are eligible to display a health claim. The alignment of the NPSC and HSR scoring algorithms should be improved.

Objective: To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and training for a flu pandemic. PICU facilities will be the limiting factor in healthcare provision for children but detailed analyses for needs and demands in PICU care have not been published.Design: Based on the Center for Disease Control and Prevention and World Health Organization estimates and published models of the expected evolution of pandemic flu, we modeled the pediatric surge capacity of healthcare facility and PICU requirements over time. Various scenarios with different assumptions were explored. We compared these demands with estimates of maximal PICU capacity factoring in healthcare worker absenteeism as well as reported and more realistic estimates derived from semistructured telephone interviews with key stakeholders in ICUs in the study area.Setting: All hospitals and intensive care facilities in the Northern Region in The Netherlands with near 1.7 million inhabitants, of whom approximately 25% isMeasurements and Main Results: Using well-established modeling techniques, evidence-based medicine, and incorporating estimates from the Centers for Disease Control and Prevention and World Health Organization, we show that PICU capacity may suffice during an influenza pandemic. Even during the peak of the pandemic, most children requiring PICU admission may be served, even those who have nonflu-related conditions, provided that robust indications and decision rules are maintained, both for admission, as well as continuation (or discontinuation) of life support.Conclusions: We recommend that a model, with assumptions that can be adapted with new information obtained during early stages of the pandemic that is evolving, be an integral part of a preparedness plan for a pandemic influenza with new human transmissible agent like influenza A virus. (Pediatr Crit Care Med 2010; 11: 185-198)

Background and aim: To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period.Methods: We searched for studies on the incidence of SAH published until October 2005. The overall incidences with corresponding 95% confidence intervals were calculated. We determined the relationship between the incidence of SAH and determinants by means of univariate Poisson regression.Results: We included 51 studies (33 new), describing 58 study populations in 21 countries, observing 45 821 896 person-years. Incidences per 100 000 person-years were 22.7 (95% CI 21.9 to 23.5) in Japan, 19.7 (18.1 to 21.3) in Finland, 4.2 (3.1 to 5.7) in South and Central America, and 9.1 (8.8 to 9.5) in the other regions. With age category 45-55 years as the reference, incidence ratios increased from 0.10 (0.08 to 0.14) for age groups younger than 25 years to 1.61 (1.24 to 2.07) for age groups older than 85 years. The incidence in women was 1.24 (1.09 to 1.42) times higher than in men; this gender difference started at age 55 years and increased thereafter. Between 1950 and 2005, the incidence decreased by 0.6% (1.3% decrease to 0.1% increase) per year.Conclusions: The overall incidence of SAH is approximately 9 per 100 000 person-years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in incidence of SAH over the past 45 years is relatively moderate compared with that for stroke in general.

A faecal egg count reduction test was conducted on a sheep farm with suspected avermectin resistance. Five groups of 10 sheep were formed. Group 1 was the untreated control group. Groups 2–5 were treated according to weight with the recommended dose of, respectively, levamisole, doramectin, moxidectin or albendazole. Resistance was found in the sheep treated with doramectin (15% efficacy) and albendazole (87% efficacy). Levamisole and moxidectin were 100 and 99% effective, respectively. Larval identification of the faecal cultures of the doramectin-treated sheep revealed 100% Haemonchus contortus larvae. After albendazole treatment, 77% of the cultured larvae were H. contortus and 23% Teladorsagia / Trichostrongylus . Because there is a lot of trade in sheep on the farm, it is probable that the resistant worms were introduced with livestock from other farms than being selected on the farm.

Recent studies provided evidence that the macroalga Cladopohora in lakes hosts associated Escherichia coli, with consequences on the environmental and human health. We expanded these investigations to other macroalgae (Ulva spp., Sargassum muticum and Undaria pinnatifida) widespread in the lagoon of Venice (Italy). Attached E. coli were abundant, accounting up to 3,250 CFU gram−1 of alga. Macroalgal-associated isolates belonged to all E. coli phylogroups, including pathogenic ones and to Escherichia cryptic clades. Attached E. coli showed potential to grow even at in situ temperature on macroalgal extracts as only source of carbon and nutrients and ability to produce biofilm in vitro. The genotypic diversity of the attached isolates was high, with significant differences between algae and the overlying water. Our evidences suggest that attached populations consist of both resident and transient strains, likely resulting from the heterogeneous input of fecal bacteria from the city. We report that cosmopolitan and invasive macroalgae may serve as source of E. coli, including pathogenic genotypes and that this habitat can potentially support their growth. Considering the global diffusion of the macroalgae here studied, this phenomenon is likely occurring in other coastal cities worldwide and deserves further investigations from either the sanitary and ecological perspectives.

In Fiji and other Pacific Island countries, obesity has rapidly increased in the past decade. Therefore, several obesity prevention policies have been developed. Studies show that their development has been hampered by factors within Fiji’s policy landscape such as pressure from industry. Since policymakers in the Fijian national government are primarily responsible for the development of obesity policies, it is important to understand their perspectives; we therefore interviewed 15 policymakers from nine Fijian ministries. By applying the “attractor landscape” metaphor from dynamic systems theory, we captured perceived barriers and facilitators in the policy landscape. A poor economic situation, low food self-sufficiency, power inequalities, inappropriate framing of obesity, limited policy evidence, and limited resource sharing hamper obesity policy developments in Fiji. Facilitators include policy entrepreneurs and policy brokers who were active when a window of opportunity opened and who strengthened intersectoral collaboration. Fiji’s policy landscape can become more conducive to obesity policies if power inequalities are reduced. In Fiji and other Pacific Island countries, this may be achievable through increased food self-sufficiency, strengthened intersectoral collaboration, and the establishment of an explicit functional focal unit within government to monitor and forecast the health impact of policy changes in non-health sectors.

Contains fulltext : 153727.pdf (Publisher’s version ) (Closed access) PURPOSE: To analyze the data of the national registry of all Dutch primary immune deficiency (PID) patients, according to the European Society for Immunodeficiencies (ESID) definitions. RESULTS: In the Netherlands, 745 patients had been registered between 2009 and 2012. An overall prevalence of 4.0 per 100,000 inhabitants was calculated. The most prevalent PID was 'predominantly antibody disorder (PAD)' (60.4%). In total, 118 transplantations were reported, mostly hematopoietic stem cell transplantations (HSCT). Almost 10% of the PID patients suffered from a malignancy, in particular 'lymphoma' and 'skin cancer'. Compared to the general Dutch population, the relative risk of developing any malignancy was 2.3-fold increased, with a >10-fold increase for some solid tumors (thymus, endocrine organs) and hematological disease (lymphoma, leukemia), varying per disease category. CONCLUSIONS: The incidence rate and characteristics of PID in the Netherlands are similar to those in other European countries. Compared to the general population, PID patients carry an increased risk to develop a malignancy.

Johne's disease (JD) infection, caused byMycobacterium aviumsubsp.paratuberculosis, represents a major disease problem in farmed ruminants. Although JD has been well characterized in cattle and sheep, little is known of the infection dynamics or immunological response in deer. In this study, typing ofM. aviumsubsp.paratuberculosisisolates from intestinal lymphatic tissues from 74 JD-infected animals showed that clinical isolates ofM. aviumsubsp.paratuberculosisfrom New Zealand farmed red deer were exclusively of the bovine strain genotype. The susceptibility of deer toM. aviumsubsp.paratuberculosiswas further investigated by experimental oral-route infection studies using defined isolates of virulent bovine and ovineM. aviumsubsp.paratuberculosisstrains. Oral inoculation with high (109CFU/animal) or medium (107CFU/animal) doses of the bovine strain ofM. aviumsubsp.paratuberculosisestablished 100% infection rates, compared to 69% infection following inoculation with a medium dose of the ovine strain. The high susceptibility of deer to the bovine strain ofM. aviumsubsp.paratuberculosiswas confirmed by a 50% infection rate following experimental inoculation with a low dose of bacteria (103CFU/animal). This study is the first to report experimentalM. aviumsubsp.paratuberculosisinfection in red deer, and it outlines the strong infectivity of bovine-strainM. aviumsubsp.paratuberculosisisolates for cervines.

This study was designed to develop a customized enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of Johne’s disease (JD) in farmed deer. Two antigens were selected on the basis of their superior diagnostic readouts: denatured purified protein derivative (PPDj) and undenatured protoplasmic antigen (PpAg). ELISA development was based on the antigen reactivity of the immunoglobulin G1 (IgG1) isotype, which is a highly specific marker for mycobacterial disease seroreactivity in deer. Sensitivity estimates and test parameters were established using 102 Mycobacterium paratuberculosis-infected animals from more than 10 deer herds, and specificity estimates were determined using 508 uninfected animals from 5 known disease-free herds. A receiver-operated characteristic analysis determined that at a cut point of 50 ELISA units, there was a specificity of 99.5% and sensitivities of 84.0% with PPDj antigen, 88.0% with PpAg, and 91.0% when the antigens were used serially in a composite test. Estimated sensitivity was further improved using recombinant protein antigens unique for M. paratuberculosis, which identified infected animals that were unreactive to PPDj or PpAg. While 80% of animals that were seropositive in the IgG1 ELISA had detectable histopathology, the assay could also detect animals with subclinical disease. The test was significantly less sensitive (75%) for animals that were culture positive for M. paratuberculosis but with no detectable pathology than for those with pathological evidence of JD (>90%). When the IgG1 ELISA was used annually over a 4-year period in a deer herd with high levels of clinical JD, it eliminated clinical disease, increased production levels, and reduced JD-related mortality. Johne’s disease (JD) is a chronic enteritis found in ruminants, caused by infection with the bacterium Mycobacterium paratuberculosis, that produces major economic losses in livestock and dairy industries worldwide. Infection due to M. paratuberculosis manifests as a chronic inflammatory gastroenteritis, with epithelial thickening in the lower intestine causing malabsorption of nutrients and leading to wasting and eventual death in affected animals. In most ruminants, it can take several years for clinical symptoms of JD to present, highlighting the chronic nature of the disease. In deer, however, the process from infection to death can progress more rapidly, with animals dying from the disease as early as 8 months of age (21). This more acute presentation of pathology suggests that red deer (Cervus elaphus) may provide a more informative infection model to track immunological and etiological pathways of M. paratuberculosis infection. Outbreaks of JD have been reported in young deer (8 to 15 months), with death in 20% of animals; older animals can also sporadically present with clinical JD typical of that found in cattle and sheep, and this may be exacerbated by stress or aging (21). JD can be spread horizontally among adult animals and may also be spread pseudovertically during pregnancy. In some instances, viable

A novel, facile, high yield, and less cumbersome synthesis of riccardiphenol analogs is described. The synthesized compounds were characterized and assessed for its in vitro activity in a panel of human cancer cell lines of differing origin: HuCCT-1, BxPC3, Panc-1, Mia-Paca, A431, Hep2, and HN006. HuCCT-1 was derived from an intrahepatic cholangiocarcinoma; BxPC3, Mia-Paca, and Panc-1 were derived from pancreatic cancers; A431 was derived from a vulvar epithelial carcinoma; and Hep2 and HN006 were derived from squamous cell carcinomas of the head and neck. The cytotoxicity of a newly developed riccardiphenol analog against human cancer cell lines was assessed. The cancer cells exhibited varying sensitivities to the compound, with IC 50 values from 30 to 50 μM. This susceptibility was particularly interesting in the case of lines such as Hep2 and BxPC3 that are resistant to classic cytotoxic drugs as well as some targeted agents. These results demonstrate that the novel riccardiphenol analog has effective action against human-derived cancer cell in vitro.

Neospora caninum has been detected only sporadically in cases of ovine abortion, and it has therefore traditionally been considered as an unimportant parasite in small ruminants. This study was carried out with the aim of identifying the pathogen causing serious reproductive problems on a commercial sheep farm. Sera from all rams and ewes tested negative for antibodies against Border disease virus, Schmallenberg virus and Coxiella burnetii, and infections by these agents were therefore ruled out. Nevertheless, seropositivity to N. caninum and/or Toxoplasma gondii was detected, although the seroprevalence was higher in the case of N. caninum. The percentage of lambings and the number of lambs per dam were significantly lower in ewes that were seropositive to N. caninum while no effect on these parameters was detected in ewes that were seropositive to T. gondii. There was also no evidence of infection by T. gondii in the foetal/lamb tissues analyzed by PCR and/or immunohistopathological techniques. On the contrary, the DNA of N. caninum was detected in 13 out of 14 foetuses/lambs descendant from dams seropositive to this parasite. Characteristic lesions caused by N. caninum and/or its antigen were also detected. Genotyping of the N. caninum DNA revealed only two closely related microsatellite multilocus genotypes. The results clearly demonstrate that infection by N. caninum was the cause of the low reproductive performance of this sheep flock., The present study was supported by Xunta de Galicia (FEADER 2013/15).

BackgroundPublicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD).Methods & findingsUsing the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures.ConclusionsThere was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.

Skin and chronic wound infections caused by highly antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) are an increasing and urgent health problem worldwide, particularly with sharp increases in obesity and diabetes. New Zealand manuka honey has potent broad-spectrum antimicrobial activity, has been shown to inhibit the growth of MRSA strains, and bacteria resistant to this honey have not been obtainable in the laboratory. Combinational treatment of chronic wounds with manuka honey and common antibiotics may offer a wide range of advantages including synergistic enhancement of the antibacterial activity, reduction of the effective dose of the antibiotic, and reduction of the risk of antibiotic resistance. The aim of this study was to investigate the effect of Medihoney in combination with the widely used antibiotic rifampicin on S. aureus. Using checkerboard microdilution assays, time-kill curve experiments and agar diffusion assays, we show a synergism between Medihoney and rifampicin against MRSA and clinical isolates of S. aureus. Furthermore, the Medihoney/rifampicin combination stopped the appearance of rifampicin-resistant S. aureus in vitro. Methylglyoxal (MGO), believed to be the major antibacterial compound in manuka honey, did not act synergistically with rifampicin and is therefore not the sole factor responsible for the synergistic effect of manuka honey with rifampicin. Our findings support the idea that a combination of honey and antibiotics may be an effective new antimicrobial therapy for chronic wound infections. © 2013 Müller et al.

In this study, 1208 Campylobacter jejuni and C. coli isolates from humans and 400 isolates from chicken, collected in two separate periods over 12 years in The Netherlands, were typed using multilocus sequence typing (MLST). Statistical evidence was found for a shift of ST frequencies in human isolates over time. The human MLST data were also compared to published data from other countries to determine geographical variation. Because only MLST typed data from chicken, taken from the same time point and spatial location, were available in addition to the human data, MLST datasets for other Campylobacter reservoirs from selected countries were used. The selection was based on the degree of similarity of the human isolates between countries. The main aim of this study was to better understand the consequences of using non-local or non-recent MLST data for attributing domestically acquired human Campylobacter infections to specific sources of origin when applying the asymmetric island model for source attribution. In addition, a power-analysis was done to find the minimum number of source isolates needed to perform source attribution using an asymmetric island model. This study showed that using source data from other countries can have a significant biasing effect on the attribution results so it is important to carefully select data if the available local data lack in quality and/or quantity. Methods aimed at reducing this bias were proposed.

Made available in DSpace on 2019-09-12T16:53:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2013 Risk factors for development of multiple sclerosis (MS) are still a matter of debate. Latitude gradient, vitamin D deficiency and season of birth are among the most investigated environmental factors associated with the disease. Several international studies suggest that birth in spring is a substantial risk factor for MS. We investigated the season of birth as a potential risk for MS in different geographical regions of Brazil. We conducted a cross-sectional retrospective study with 2257 clinically definite MS patients enrolled in 13 Brazilian MS clinics in the south, southeast, and northeast regions of Brazil. Demographic and clinical data relating to date of birth and clinical features of the disease were collected and analysed, and subsequently compared with birth date among the general Brazilian population. The distribution of date of birth of MS patients showed an increase in spring and a decrease in autumn, with no difference being observed in the other seasons. In conclusion, season of birth is a probable risk factor for MS in most parts of Brazil. These findings may be related to the role that vitamin D plays in MS pathogenesis. (C) 2013 Elsevier B.V. All rights reserved. [Becker, Jefferson; Hauck, Laura; Gomes, Irenio] Hosp Sao Lucas PUCRS, BR-90610000 Porto Alegre, RS, Brazil [Callegaro, Dagoberto; Lino, Angelina] Hosp Clin USP, Sao Paulo, Brazil [Lana-Peixoto, Marco Aurelio] CIEM Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil [Ferreira, Maria Lucia B.] Hosp Restauracao, Recife, PE, Brazil [Melo, Ailton] Hosp Univ Prof Edgard Santos UFBA, Salvador, BA, Brazil [da Gama, Paulo Diniz] Conjunto Hosp Sorocaba PUCSP, Sorocaba, SP, Brazil [Souza, Doralina G. B.; Barreira, Amilton Antunes] Hosp Clin FMRP USP, Ribeirao Preto, SP, Brazil [Souza, Doralina G. B.] Univ Estadual Paulista, UNESP, Botucatu, SP, Brazil [Teixeira, Carlos A. C.] Univ Fed Ceara, Fortaleza, CE, Brazil [Kaimen-Maciel, Damacio Ramon] Univ Estadual Londrina, Londrina, PR, Brazil [Goncalves, Marcus Vinicius] Clin Neurol Joinville, Joinville, SC, Brazil [Matta, Andre P. C.] Univ Fed Fluminense, Niteroi, RJ, Brazil [Abraham, Ronaldo] Universidade de Taubaté (Unitau), Dept Med [Furtado, Luis Edmundo T. A.] Univ Fed Ceara, Sobral, CE, Brazil

Background: Māori and Pacific Island people have significantly higher smoking rates compared to the rest of the New Zealand population. The main aim of this paper is to describe how knowledge of Indigenous people’s practices and principles can be combined with proven effective smoking cessation support into a cessation intervention appropriate for Indigenous people. Methods/Design: A literature review was conducted to identify what cultural principles and practices could be used to increase salience, and what competition elements could have an impact on efficacy of smoking cessation. The identified elements were incorporated into the design of a cessation intervention. Discussion: Cultural practices incorporated into the intervention include having a holistic family or group-centred focus, inter-group competitiveness, fundraising and ritual pledging. Competition elements included are social support, pharmacotherapy use, cash pri ze incentives and the use of ad edicated website and iPad application. Ap re-test post-test will be combined with process evaluation to evaluate if the competition results in triggering mass-quitting, utilisation of pharmacotherapy and in increasing sustained smoking cessation and to get a comprehensive understanding of the way in which they contribute to the effect. The present study is the first to describe how knowledge about cultural practices and principles can be combined with proven cessation support into a smoking cessation contest. The findings from this study are promising and further more rigorous testing is warranted.

Objective To assess the epidemiology of gout and hyperuricaemia in the Italian general population during the years 2005–2009. Methods Using the Italian primary care database (Health Search/CSD Longitudinal Patient Database), the prevalence, incidence and recurrence rates of gout and/or hyperuricaemia (serum urate level >360 mmol/l (6 mg/dl)) in outpatients aged ≥18 years during the years 2005–2009 were estimated. Rates together with 95% CI were measured overall and stratified by age, gender and calendar year. The characteristics of patients with newly diagnosed gout and hyperuricaemia were investigated and compared with the general population. Results The prevalence of gout increased from 6.7 per 1000 inhabitants in 2005 to 9.1 per 1000 inhabitants in 2009. It increased with advancing age and was fourfold higher in men. A similar trend was observed for asymptomatic hyperuricaemia (85.4 per 1000 inhabitants in 2005 vs 119.3 per 1000 inhabitants in 2009). The incidence of gout remained stable during the observation years (0.93 per 1000 person years in 2005 vs 0.95 in 2009). Recurrent episode rate was 19.1% during the first year following the first gout attack and 31.6% during the following 5 years. Advanced age, increased levels of uric acid, nephrolithiasis and concomitant use of ciclosporin were the main predictors of recurrence of gout attacks. Conclusion The prevalence of gout and hyperuricaemia increased in Italy from 2005 to 2009. A high recurrence rate for gout attack was observed during the first year following the first episode. Early management of hyperuricaemia in patients at higher risk of recurrent gout attack should be considered in primary care.

Plant pathogens and insect herbivores are prone to share hosts under natural conditions. Consequently, pathogen-induced changes in the host plant can affect herbivory, and vice versa. Even though plant viruses are ubiquitous in the field, little is known about plant-mediated interactions between viruses and non-vectoring herbivores. We investigated the effects of virus infection on subsequent infestation by a non-vectoring herbivore in a natural genotype of Trifolium repens (white clover). We tested whether infection with White clover mosaic virus (WClMV) alters (1) the effects of fungus gnat feeding on plant growth, (2) the attractiveness of white clover for adult fungus gnat females, and (3) the volatile emission of white clover plants. We observed only marginal effects of WClMV infection on the interaction between fungus gnat larvae and white clover. However, adult fungus gnat females clearly preferred non-infected over WClMV-infected plants. Non-infected and virus-infected plants could easily be discriminated based on their volatile blends, suggesting that the preference of fungus gnats for non-infected plants may be mediated by virus-induced changes in volatile emissions. The compound β-caryophyllene was exclusively detected in the headspace of virus-infected plants and may hence be particularly important for the preference of fungus gnat females. Our results demonstrate that WClMV infection can decrease the attractiveness of white clover plants for fungus gnat females. This suggests that virus infections may contribute to protecting their hosts by decreasing herbivore infestation rates. Consequently, it is conceivable that viruses play a more beneficial role in plant–herbivore interactions than generally thought. Electronic supplementary material The online version of this article (doi:10.1007/s00442-012-2322-z) contains supplementary material, which is available to authorized users.