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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): La Trobe University Introduction mHealth technologies have evolved rapidly in recent years and are now widely implemented for the secondary prevention of coronary artery disease (CAD). While there is increasing evidence of their effectiveness, there are significant knowledge gaps concerning their reach, adoption, implementation, and maintenance. Purpose This study evaluates internal and external validity dimensions of mHealth-enabled cardiac disease management programs (DMPs) using elements of Glasgow’s RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) Framework. It is a supplementary review to a systematic review and meta-analysis which evaluated effectiveness. Methods From the 27 studies reviewed for the previous systematic review on effectiveness, a citation search was performed to identify additional publications reporting on elements of reach, adoption, implementation, and maintenance. All eligible publications were independently coded by two team members using the 23-item RE-AIM extraction tool and analysed using mixed-methods to ascertain the reporting of these elements. Results In total, 35 publications were included in the analysis, 27 from the previous systematic review and 8 supplementary publications. The items for the Reach dimension indicated participant participation rates ranging between 18% to 67%, and used a wide range of exclusion criteria, relating to mental and cognitive impairment (37%), physical impairments (41%) and language issues (26%). Most (44%) interventions were solely home-based with nurses being the main health professionals delivering the intervention (adoption items). The implementation and maintenance items showed intervention duration of between 4-52 weeks (median 24 weeks) with intervention follow-up of between 1-48 months (median 6 months). Conclusions This review found great heterogeneity in the duration and follow-up of mHealth-enabled DMPs for patients with CAD, with low participation rates suggesting access barriers. Addressing RE-AIM dimensions in the evaluation of mHealth-enabled cardiac DMPs for patients with CAD is critically important for identifying factors affecting the reach, adoption, implementation, and maintenance of interventions in order to improve translation of research evidence into practice for patients, clinicians and health service organisations.

Background Clinicians face difficulty in positioning biologics and JAK inhibitors in anti-TNF refractory ulcerative colitis (UC) patients. Head-to-head trials comparing the efficacy of vedolizumab and tofacitinib in UC patients are lacking. We aimed to compare the effectiveness and safety of vedolizumab and tofacitinib in anti-TNF experienced UC patients in our prospective, nationwide registry using a propensity score weighted cohort. Methods UC patients who failed anti-TNF treatment (with or without thiopurine) and initiated vedolizumab or tofacitinib treatment subsequently, were identified in the observational prospective Initiative on Crohn and Colitis (ICC) Registry. We selected patients with both clinical (Simple Clinical Colitis Activity Index (SCCAI) >2) and biochemical (C-reactive protein (CRP) >5mg/L or faecal calprotectin (FC) >250 µg/g) or endoscopic disease activity (endoscopic MAYO score ≥ 1) at initiation of therapy. Patients previously treated with vedolizumab or tofacitinib were excluded. Corticosteroid-free clinical remission (SCCAI Results Overall, 83 vedolizumab and 65 tofacitinib treated patients were included (table 1). Propensity score weighted analysis showed that tofacitinib treated patients were more likely to achieve corticosteroid-free clinical remission at week 12, 24 and 52 compared to vedolizumab treated patients (OR: 5.87, 95%CI:3.55–9.70, P Conclusion In tofacitinib treated, anti-TNF experienced, UC patients, we observed that a higher proportion of patients achieved corticosteroid-free remission after 12, 24 and 52 weeks compared to vedolizumab treated patients. In addition, more tofacitinib treated patients achieved biochemical remission at week 12 and 24. There was no statistically significant difference in severe adverse events.

Background The study of the intestinal epithelial barrier is hampered by the lack of a suitable in vitro model system. Patient-derived organoids (PDOs) recapitulate the cellular diversity and patient heterogeneity and provide a relevant platform to study the intestinal epithelium and its response to microbial or inflammatory challenges. Here, we present the characterization of an inflammatory bowel disease (IBD) organoid biobank derived from Crohn’s disease and Ulcerative Colitis patients and its application for IBD drug development efforts. Methods PDOs from different regions of the gastrointestinal tract of 14 IBD patients were established. To recapitulate the full cellular diversity, specialized medium formulations were defined that support the differentiation of distinct epithelial cell lineages as confirmed by transcriptional profiles and histology. To study the inflammation driven loss of barrier integrity observed in the mucosa of IBD patients, we employed organoid derived monolayers and mimicked the inflammatory environment by cytokine challenge (TNF, IFNγ). Results In response to differentiation media, intestinal organoids and monolayers displayed gene expression patterns consistent with maturation of epithelial cell types found in the human gut. The cytokine challenge robustly induces loss of barrier integrity across seven patient-derived monolayers. The barrier breakdown was ameliorated in all models by treatment with the IBD therapy Tofacitinib. Conclusion Intestinal PDOs were generated from IBD patients and were capable to differentiate into mature epithelial cell types. PDO-derived monolayers built trans-epithelial electrical resistance (TEER) and are a relevant model to study epithelial barrier function and inflammation mediated barrier breakdown. Proof-of-concept studies with Tofacitinib demonstrated the suitability of the assay for IBD drug development efforts.

Background Discontinuation of anti-tumour necrosis factor alpha agents (anti-TNF) in patients with inflammatory bowel disease (IBD) in remission may reduce side effects and costs, but this has to be weighed against the risk of relapse. We developed a risk-stratified protocol for anti-TNF withdrawal, and aimed to assess the risk of relapse after risk-stratified anti-TNF withdrawal. Methods This was a single arm prospective observational cohort study. Patients were recruited between September 2018–2020 in 13 hospitals in the Netherlands. Inclusion criteria were a diagnosis of IBD, age >18 years, elective anti-TNF withdrawal in a patient with quiescent disease (according to the treating physician), no current or planned use of vedolizumab, ustekinumab or tofacitinib, no hospitalization, and no active or planned pregnancy. According to the protocol, patients were recommended to withdraw anti-TNF only when in endoscopic remission either without high-risk criteria (age at diagnosis 50cm), or when trough levels were undetectable. We constructed Kaplan-Meier curves with log-rank test to compare the risk of relapse in patients who discontinued anti-TNF in accordance with, versus against, the protocol. Cox regression analysis was performed to identify predictors of relapse. Results We enrolled 115 patients (CD: n=61, 53%), with a median follow-up time of 1.9 (IQR 1.8 – 2.1) years. Baseline endoscopic remission was confirmed in 103 (89.6%) patients, and 35 (30.4%) patients continued an immunomodulator. During follow-up, 57 (49.6%) patients relapsed (Figure 1). The relapse rate was similar in patients in endoscopic remission who withdrew anti-TNF in according with, versus against, the protocol (50.7% versus 44.4%, p=0.65), and in patients with versus without an immunomodulator (hazard rate [HR] 0.89, 95%CI 0.50 – 1.59), but was lower in patients with subtherapeutic anti-TNF trough levels (adjusted HR: 0.55, 95%CI: 0.31 – 0.99), and in patients with UC/IBD-unclassified (IBDU) who were treated with mesalamine maintenance therapy (HR: 0.35, 95%CI 0.13 – 0.94). Anti-TNF was reintroduced in 41 (71.9%) patients, with remission rates of 64.5% and 81.8% at 3 and 12 months, respectively. In 6 (15.0%) patients anti-TNF therapy was discontinued again due to primary non-response or loss of response. Conclusion The risk of relapse after anti-TNF withdrawal remains high in a strictly selected group of patients with uncomplicated IBD in endoscopic remission. Therapeutic drug monitoring prior to anti-TNF withdrawal, and mesalamine therapy for patients with UC or IBDU, may reduce the risk of relapse.

Background Subcutaneous (SC) formulation of vedolizumab (VDZ) is available for Crohn’s disease (CD) and ulcerative colitis (UC). We assessed the efficacy, safety, and pharmacokinetic (PK) profiles of patients with inflammatory bowel diseases (IBD) who switched from intravenous (IV) to SC VDZ treatment in two prospective, real world cohorts. Methods The primary cohort is an ongoing open-label, real life, prospective single centre cohort study. As a validation cohort, we used the Initiative on Crohn and Colitis (ICC) registry, a prospective, observational, nationwide registry including patients switching from IV to SC VDZ. In both cohorts, patients receiving IV VDZ maintenance for >4 months were offered to switch treatment to SC VDZ, 108 mg every 2 weeks. In the primary cohort, assessment of clinical, biochemical and PK parameters took place at baseline, at approximately 10 weeks following the switch and at the physician’s discretion thereafter. In the ICC cohort, follow up visits were at week 12 and 24. The primary endpoint was the proportion of patients discontinuing SC VDZ at week 24. Results In total, 78 (50 CD (64%) and 28 UC (36%)) and 54 patients (29 CD (54%) and 25 UC (46%)) were included in the primary and ICC cohort respectively (table 1). During follow up, 8 (10.3%) of the primary cohort and 6 (11.1%) patients of the ICC cohort stopped VDZ SC during follow-up time till week 24, after a median treatment duration of 18 (IQR=5–19) and 10 (IQR=7–15) weeks, respectively. Treatment withdrawal was most often caused by adverse events (AE), in total for 8 out of 132 patients (6%) (table 2). Four patients had loss of response to SC VDZ. Three of these patients had biochemical disease activity at initiation of SC therapy. Reported AEs included headache and injection related reactions. The median VDZ concentration increased from 11 ug/mL (IQR=9.4–20) to 28 ug/mL (IQR=24.3–31.2, p Conclusion The present abstract reports real world experience of switching IV to SC VDZ maintenance treatment in IBD patients in two observational Dutch cohorts. VDZ concentrations were significantly higher after the switch to SC VDZ. A switch from IV to SC VDZ appears to be effective and safe. However, a proportion of patients switched back to IV VDZ due to injection related AEs.

Smart speakers provide users with a natural modality of in- teraction - voice. Voice User Interfaces (VUIs) can be natural to use and inclusive to a majority of users. Current smart speakers, however, are mostly passive and only respond to user input once they have explicitly been addressed. Lack- ing proactivity restrains the range of application scenarios of smart speakers in a number of ways: people with chronic conditions, for example, could benefit from engaging voice- based conversations and reminders. In our research, we investigate opportunities and challenges for proactive, VUI- based chronic disease management systems. We propose a method to enable existing commercial smart speakers to become proactive. We further discuss the technology and interaction challenges in implementing such proactive smart speakers.

Background Thiopurines including azathioprine [AZA], mercaptopurine [MP] and tioguanine [TG] are cornerstone therapies in the maintenance treatment of inflammatory bowel diseases (IBD). Withdrawal in patients in stable remission may reduce the risk of infections and malignancies, but little is known about the subsequent risk of relapse. This study aimed to assess the relapse rate after discontinuation of thiopurines in IBD patients in stable remission. Methods Patients with IBD discontinuing thiopurine therapy were prospectively included in, 14 Dutch hospitals if they used a thiopurine for at least one year, and were in steroid-free clinical remission for one year or longer. Clinical, biochemical, endoscopic and radiological data were collected at baseline (thiopurine cessation), and at, 3, 6, 12 and, 24 months thereafter. The primary endpoint was disease relapse, defined as: induction or escalation of therapy, or, if available, endoscopic activity, indicated by simple endoscopic score (SES-CD) >, 4 for Crohn’s disease (CD) or endoscopic Mayo >, 1 for ulcerative colitis and IBD unclassified (UC/IBDU). Cox regression analysis was used to determine predictors of relapse. Results We enrolled, 134 patients (94 CD [70%]; AZA, 56%, MP, 20%, TG, 25%) with a median age of, 44.0 years (IQR, 30.8–59.0). Fifty-three (40%) patients received concomitant anti-tumour necrosis factor alpha (anti-TNF) at baseline. The median therapy duration before cessation was, 61.5 months (IQR, 40.0–111.0), median time of clinical remission before cessation was, 43.5 months (IQR, 27.8–65.5). During the median follow-up time of, 14.0 (IQR, 11.9–19.7) months after cessation, 37 (28%) patients relapsed (Figure, 1). Relapse rates at, 12 and, 24 months were, 28% and, 40%, respectively. Median time to relapse was, 10.9 (IQR, 5.5–16.5) months. UC/IBDU patients had a higher risk of relapse (HR, 2.603 [95% CI, 1.364 -4.965], p=0.004). Relapse free survival probability in patients with and without concomitant anti-TNF was not significantly different (anti-TNF, 82%, no anti-TNF, 87%, log rank=0.494, Figure, 2). Type of thiopurine, concomitant, 5-ASA, remission duration, therapy duration before cessation, baseline mucosal healing, and baseline faecal calprotectin were not predictive of relapse. After relapse, 27 patients received steroids (18 budesonide, 9 prednisone), 15 (re)started thiopurines, 8 initiated anti-TNF, and, 8 intensified concomitant anti-TNF. Figure 1 Figure 2 Conclusion This prospective study showed relapse rates of, 28% and, 40% at, 12 and, 24 months, respectively, after cessation of thiopurines for stable remission. UC/IBDU patients had a higher risk of relapse. Type of thiopurine, remission duration, concomitant, 5-ASA or anti-TNF were not predictive of continuing remission.

Background The most commonly recognized clinical feature of hypogammaglobulinemia is recurrent infections with high prevalence of gastrointestinal manifestations. In some cases, clinical and endoscopic features are indistinguishable from those of inflammatory bowel disease (IBD). Methods This was a multicenter case series performed as a part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. Results This report includes 25 patients with primary hypogammaglobinemia and IBD-like features [20 males and 5 females, mean age 50 years (±21.7 SD)]. Crohn’s disease-like features were noted in 22 patients, three patients had ulcerative colitis-like features. The diagnosis of hypogammaglobulinemia preceded IBD-like features diagnosis in 20 patients (mean of 7.7 years prior, range 0.3–35 years), and followed IBD-like features appearance in 5 cases (mean of one year after, 0.4- 9.1 years). Hypogammaglobinemia etiologies were common variable immunodeficiency (72%), Agammaglobulinemia (8%), selective IgA-deficiency (8%), Goods syndrome (8%), IgG subclass deficiency with IgA deficiency (4%). In addition to antibiotics and intravenous immunoglobulin (IVIG) as a treatment for hypogammaglobinemia, fifteen patients received IBD treatment during the follow-up period, of whom two were on 5-aminosalicylic acid, five on corticosteroids, three on immunomodulatory, four on anti-tumor necrosis factor, and one on vedolizumab. By the end of the follow-up [35.5 months (Interquartile range 18–75)], 20 of 25 (80%) patients were in clinical remission. Conclusion This case series illustrates a strong male and CD-like features predilection. The diagnosis of IBD-like features mainly occurs after that of hypogammaglobulinemia, the majority of cases successfully recovered after appropriate treatment.

Diabetes Self-care behaviours: Changes over 12 months between intervention and usual care groups in Diabetes Self-care behaviours. This table details the mean baseline and 12 month measures of diabetes self-care behaviour [35, 55] for the intervention and usual care groups and compares the change overtime between the intervention and usual care group. Table S2. MDS – support and satisfaction of support friends/ health care team: Changes over 12 months between intervention and usual care groups in perception of support received. This table details the mean baseline and 12 month measures of perceived support from family and health care team [36] in the intervention and usual care groups and compares the change overtime between the intervention and usual care group. (DOCX 23 kb)

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at ∈ European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better fu treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine ‘sections’ in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. © 2016 Ferrata Storti Foundation.

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Background The Stent-In 2 trial randomized patients with malignant colonic obstruction to emergency surgery or stent placement as a bridge to elective surgery. The aim of this study was to compare the oncological outcomes. Methods Disease recurrence, and disease-free, disease-specific and overall survival were evaluated, including a subgroup analysis of patients with a stent- or guidewire-related perforation. Results Of 98 patients included in the original Stent-In 2 trial, patients with benign (16) or incurable (23) disease were excluded from this study, along with a patient who had withdrawn from the trial. Of the remaining 58 patients, 32 were randomized to emergency surgery (31 resection, 1 stoma only) and 26 to stenting. Unsuccessful stenting required emergency surgery in six patients owing to wire or stent perforation. Locoregional or distant disease recurrence developed in nine of 32 patients in the emergency surgery group and 13 of 26 in the stent group. Disease-free survival was worse in the subgroup with stent- or guidewire-related perforation. Five of six patients in this subgroup developed a recurrence, compared with nine of 32 in the emergency surgery group and eight of 20 who had unperforated stenting. Conclusion Stent placement for malignant colonic obstruction was associated with a risk of recurrence in this trial, but the numbers are small. There is not enough evidence to refute the approach strongly. Registration number: ISRCTN46462267 (http://www.controlled-trials.com).

Gastrointestinal symptoms are common in patients with common variable immunodeficiency disorders (CVID) and less frequent in X-linked agammaglobulinemia (XLA) although the exact prevalence is not well established. In this study, endoscopic screening was performed in 30 patients with CVID and four patients with XLA. Endoscopic and/or histological abnormalities were detected in 25 of 30 patients with CVID (83 %), regardless of symptoms, and in nine of these patients the results prompted medical treatment. Helicobacter pylori-associated gastritis, adenomatous polyps, and lymphoid hyperplasia were most frequently encountered; no malignancies were detected. Adenomatous polyps were found in two of the four patients with XLA at a relative young age. In conclusion, gastrointestinal pathology is frequent in patients with CVID regardless of symptoms. Patients with XLA seem to be at risk for colorectal adenomas at a young age.

To determine how many cases of inflammatory bowel disease (IBD)-related colorectal cancer (CRC) occur before recommended colonoscopy screening commences.Descriptive.A nationwide automated histological and cytopathological archive (PALGA) was used to identify patients with IBD and CRC in the period January 1990-June 2006 at the University Medical Center Utrecht, The Netherlands. The interval between the diagnosis of IBD or IBD-related symptoms and the diagnosis of CRC was calculated. The observed interval was compared with the recommended starting point for surveillance according to the British Society of Gastroenterology (BSG) and the American Gastroenterological Association (AGA), i.e. after 8-10 years for pancolitis or after 15-20 years for left-sided colitis.33 colorectal cancers were found in 29 patients with IBD. The median age at the time of diagnosis was 29 years (range: 11-82) for IBD and 47 years (range: 23-82) for CRC. 7 of the 29 patients (24%) developed CRC before the minimum recommended time to initiate screening (8 years for pancolitis, 15 years for left-sided colitis), and 9 patients (31%) developed CRC within the maximum recommended time to initiate screening (10 years for pancolitis, 20 years for left-sided colitis). If the onset of IBD-related symptoms was considered the starting point of the disease (rather than the diagnosis of IBD), 17-24% of patients developed a CRC before surveillance would have commenced.These results suggest that, by following the British and American guidelines for screening for IBD-related CRC, a substantial portion of cases (17-31%) would not be diagnosed in a timely manner.

Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of Crohn's disease, such as pyoderma gangrenosum, uveitis and arthropathy. Maintenance treatment with infliximab is effective and is regarded as safe as long as the necessary safety measures are heeded. Infusion reactions occur in 3 to 17% of the patients and are associated with the formation of antibodies to infliximab. A reduction in infusion reactions is possible by the concurrent administration of steroids and the use of immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate). Furthermore, immunosuppressants increase the duration of the response to infliximab. For these reasons, the concomitant use of immunosuppressants with infliximab is recommended. Infections and most specifically tuberculosis need to be ruled out before infliximab is administered. Up to now, there are no indications for a connection between an increased risk for malignancies and treatment with infliximab.

Psychosocial risk factors like low socio-economic status, lack of social support and social isolation, chronic work or family stress, as well as negative emotions, e. g. depression and hostility, contribute significantly to the development and adverse outcome of coronary heart disease (CHD). Negative effects of psychosocial risk factors are conveyed via behavioural pathways including unhealthy lifestyle, e. g. food choice, smoking, sedentary life, inadequate utilisation of medical resources, and psychobiological mechanisms like disturbed autonomic and hormonal regulation: all these factors contribute to metabolic dysfunction and inflammatory and haemostatic processes, which are directly involved in the pathogenesis of CHD. Interventions to improve pychosocial factors are available and have demonstrated positive effects on risk factors and - at least in part - on CHD morbidity and mortality. The prevention of CHD should therefore include screening for psychosocial risk factors and adequate interventions. Recommedations for the screening of risk factors, behavioural change and further management of psychosocial risk factors in clinical practice are pointed out.

The success of a population-based screening for colorectal cancer (CRC) is determined to a large extent by general practitioner (GP) attitudes, beliefs and support. The extent to which GPs support population-based CRC screening remains unclear.To assess the knowledge, attitudes and practices of GPs in relation to CRC screening, and to identify the determinants of GP support for population-based faecal-occult blood testing (FOBT).A cross-sectional postal survey was conducted with a random sample of 692 GPs in Queensland, -Australia. We assessed GP knowledge, attitudes and practices concerning CRC screening in relation to their stance on population-based FOBT screening.Although the response rate was low (41%), participants were representative of Queensland GPs in general. Of 284 participating GPs, 143 (50.5%) indicated that they would support a population-based FOBT screening programme, 42 (14.8%) would not and 98 (34.6%) were unsure. Belief in FOBT test efficacy (P0.001), possession of CRC guidelines (P0.05) and belief in earlier stage detection (P0.05) were major determinants of support for population-based FOBT screening. No significant association was observed for doctor's sex, location of practice, age, year completed medical training, membership of a Division of General Practice, number of weekly consultations, number of patients investigated for CRC per month, size of practice, own family history of CRC, interest in further information on CRC screening or treatment, and current use of FOBT with asymptomatic patients agedor =40 years.GP support for FOBT population-based screening appears to have increased over recent years. The knowledge and attitudes/beliefs of GPs are key determinants of their support.

In this 2-yr randomized controlled trial, we examined the effect of bone mineral density feedback and two different educational interventions (an osteoporosis information leaflet and group-based behavioral education [OPSMC]) on osteoporosis knowledge and self-efficacy in 470 women aged 25-44 yr. Osteoporosis knowledge increased across all intervention groups. Women receiving the OPSMC had a greater increase in both short (beta = +1.33, 95% confidence interval [CI] = 0.72-1.94) and long-term (beta = +0.64, 95% CI = 0.0034-1.25) osteoporosis knowledge, compared to those receiving the leaflet. In contrast, a low T-score was associated with a significant increase in long-term (beta = +0.66, 95% CI = 0.0034-1.25) but not short-term (beta = +0.57, 95% CI = -0.036 to 1.17) osteoporosis knowledge, compared to a normal T-score. Changes in osteoporosis self-efficacy were not associated with either low bone mineral density or receiving the OPSMC but were negatively associated with number of children (beta = -0.9, 95% CI = - 1.4 to -0.3) and working more than 20 h per week (beta = -2.7, 95% CI = -4.6 to -0.8). In conclusion, both the OPSMC and bone density feedback increased osteoporosis knowledge but not self-efficacy over 2 yr. Women with children or who worked full time have decreased osteoporosis self-efficacy, suggesting that this group should be a specific target for future interventional strategies.

Both anaemia of iron deficiency and anaemia of chronic disease are frequently encountered in inflammatory bowel disease. Anaemia of iron deficiency is mostly due to inadequate intake or loss of iron. Anaemia of chronic disease probably results from decreased erythropoiesis, secondary to increased levels of proinflammatory cytokines, reactive oxygen metabolites and nitric oxide. Assessment of the iron status in a condition associated with inflammation, such as inflammatory bowel disease, is difficult. The combination of serum transferrin receptor with ferritin concentrations, however, allows a reliable assessment of the iron deficit. The best treatment for anaemia of chronic disease is the cure of the underlying disease. Erythropoietin reportedly may increase haemoglobin levels in some of these patients. The anaemia of iron deficiency is usually treated with oral iron supplements. Iron supplementation may lead to an increased inflammatory activity through the generation of reactive oxygen species. To date, data from studies in animal models of inflammatory bowel disease support the theoretical disadvantage of iron supplementation in this respect. The results, however, cannot easily be extrapolated to the human situation, because the amount of supplemented iron in these experiments was much higher than the dose used in patients with iron deficiency.

This article focuses on the extent to which behavioral and social science research and theories are relevant to the challenge of promoting health and preventing disease in the whole population. An overview is provided of the major health challenges confronting developed and developing countries, including a discussion of the contribution made by social and behavioral factors to these health problems. Of particular importance is the difference between the clinical approach to health problems vs. the whole-of-community or population approach to public health issues. The clinical approach, that has been used to develop efficacious, intensive, practitioner-delivered lifestyle-change interventions, needs to be integrated within a broader public health approach. The latter approach involves consideration of the whole spectrum of sociobehavioral and environmental factors that are relevant as determinants of health to promote health and prevent disease. The importance of appropriate dissemination and diffusion of interventions towards change at an institutional or policy level is also discussed. Social and behavioral theories and models can be applied very beneficially in public health.

Iron supplements may increase disease activity in inflammatory bowel disease through the production of the hydroxyl radical because of its catalytic activity in the Fenton reaction. The purpose of this study was to assess the effect of dietary and locally administered iron in the IL-10 knock-out (-/-) mouse, a model of chronic inflammatory bowel disease.IL10-/- and wild-type mice received a standard or a high-iron diet (35 mg kg(-1) ferrosulphate vs. 500 mg kg(-1) ferrosulphate) after weaning. After 4 weeks the mice were sacrificed. Furthermore, a group of adult IL-10 knock-out mice was given three iron-containing enema's (0.2 mL of 1 mM ferrous-ammonium sulphate) or phosphate buffered saline. These mice were sacrificed after 1 week. Production of pro-inflammatory cytokines by colon tissue cultures, haematological parameters and histology was determined to assess inflammatory activity.Oral as well as rectal administration of iron resulted in increased pro-inflammatory cytokine production in IL-10-/- mice. Neutrophil counts in IL10-/- on a high iron diet increased as well. No enhanced colonic inflammation was noted on histology after iron supplementation.We conclude that dietary or topical administered iron increases pro-inflammatory cytokine production in the colon of IL10-/- mice. No significant increase of histological intestinal inflammation was observed.

At routine determination of serum activities of transaminases (aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) increased levels are frequently found. An algorithm may be used in the analysis of elevated transaminase levels: after elimination of the most frequent causes of hepatitis (alcoholic hepatitis, chronic hepatitis B and C) and some rare conditions (autoimmune hepatitis, alpha 1-antitrypsin deficiency, haemochromatosis and Wilson's disease), the diagnosis will often be nonalcoholic steatohepatitis. Although nonalcoholic steatohepatitis is considered a stable disease, recent literature shows a progression to cirrhosis in 8-17%. So far, no effective therapeutic strategies are available for nonalcoholic steatohepatitis.

A 40-year-old woman who had been treated for mesangiocapillary glomerulonephritis by renal transplantation, and who still used furosemide, azathioprine, cyclosporine and prednisone, was admitted with multiple erythematous nodes on the lower legs. Pancreatogenic panniculitis caused by pancreatitis was diagnosed. The patient died with a haemorrhagic and necrotic pancreas one month after admission. Pancreatogenic panniculitis occurs in 2-3% of patients with pancreatitis or pancreatic carcinoma. It can be a first manifestation of an undetected pancreatic disease.

We have developed the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) which measures distress experienced by women undergoing follow-up investigation after an abnormal Pap smear result. A thorough literature review and qualitative research resulted in the development of a questionnaire which was tested on 350 women attending a Family Planning New South Wales (FPNSW) clinic. This sample included women at different stages of management after detection of a cervical abnormality: 93 first colposcopy clients and 257 follow-up colposcopy clients. Factor analysis identified four dimensions of distress: experience of medical procedures, beliefs/feelings about cervical abnormality and changes in perception of oneself, worry about infectivity and effect on sexual relationships. Repeatability of the PEAPS-Q was indicated by intra-class correlations of 0.88 overall and at least 0.60 for each scale. Internal consistency was shown by Cronbach's alpha of 0.84 overall and at least 0.72 for each scale. Validity was demonstrated by the correlation of scale scores with the 12-item General Health Questionnaire (GHQ) score of 0.32 (95% CI 0.22-0.41). The PEAPS-Q is a valid, reliable and multidimensional instrument for quantifying distress experienced by women with abnormal Pap smears.

Changes in patients' lifestyles can be approached in a practical fashion by working through the relevant 'stages of change'. Helping patients to change their lifestyles does not have to be a very time-consuming process for the clinician, but it does require planning, and attention to those factors that are important at each stage of the process. Although this paper has a focus on lifestyle change for the reduction of CVD risk factors, the same principles can apply to lifestyle change and disease prevention for other disorders.

Lifestyle change is an area in which the medical practitioner has a great deal to offer: to high-risk patients and to individuals generally. The evidence supporting the cardiovascular health benefits of lifestyle change comes from a variety of scientific sources. While the recent large-scale intervention studies have not always had unequivocal outcomes, on balance, the epidemiological evidence points to the central importance of lifestyle change in reducing CVD risk. Recently the United States Preventive Services Task Force22 has published guidelines on lifestyle change and other interventions for CVD risk and for a range of other preventable health problems. The United States Task Force's recommendations have been favourably reviewed by the National Health and Medical Research Council in Australia, and are considered to be relevant to medical practice in this country.

A large amount of observational and experimental research has demonstrated that lifestyle factors are important determinants of cardiovascular disease. In particular, epidemiological evidence from large, controlled multiple risk factor intervention trials and research examining the effects of secular changes in lifestyle on changing morbidity and mortality rates indicate that changes in lifestyle can reduce the risk of coronary heart disease (CHD). This paper provides an overview of the lifestyle change process and provides guidelines for increasing the efficacy of lifestyle change interventions in clinical settings.

Pterygia induce irregular corneal astigmatism that sometimes necessitates surgical removal before the lesion has advanced close to the visual axis. This astigmatism may occur either due to traction generated by the pterygium mechanically pulling on and distorting the cornea, or by the pooling of tears in advance of the pterygium, or both. To evaluate the effect of localized tear pooling on pterygium-induced astigmatism, corneoscope photographs were obtained before and after absorbing excess tears at the pterygium-corneal interface with a cellulose sponge. Pterygia from these patients were then excised and examined with transmission electron microscopy for the presence of myofibroblasts. The absence of myofibroblasts in these lesions as well as the alterations in corneoscopy induced by localized removal of tears at the advancing edge of the pterygia suggest that corneal distortion in the presence of pterygia is caused in part by local changes in the tear film.

A simple experimental set for the production and investigation of bacterially contaminated solid-state aerosols with constant concentration is described. The experimental set consists mainly of a fluidized bed-particle generator within a modified chamber for formaldehyde desinfection. The special conditions for the production of a defined concentration of particles and microorganisms are to be found out empirically. In a first application aerosol-sizing of an Andersen sampler is investigated. The findings of Andersen (1) are confirmed with respect to our experimental conditions.