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Stress urinary incontinence (SUI) is defined as a complaint of inadvertent loss of urine occurring as a result of an increase in intraabdominal pressure, in the absence of a detrusor muscle contraction [1]. Estimates of the prevalence vary widely in the published literature, due in part to differing terminologies, diagnostic approaches, and populations studied [1–3]. It has been reported that SUI affects up to 14% of premenopausal women and up to 35% of postmenopausal women [4, 5], unfavourably affecting quality of life (QoL), sexual function, and mental health [6, 7]. Pathophysiologically, SUI is caused by urethral deficiency and impairment of supportive structures such as the levator ani muscle, endopelvic fascia, and pubourethral ligament [8]. The beneficial effect of pelvic floor muscle training (PFMT) on female urinary incontinence and pelvic organ prolapse was first described in 1948 by Arnold Kegel, who reported an astonishing success rate of 84% [9]. More recent studies have demonstrated somewhat lower success rates of PFMT than those reported by Kegel, but still in the impressive range from 56 to 75% based on improved clinical outcomes [10]. Strong evidence and grade A recommendations support the use of PFMT as the first-line conservative treatment for SUI [11]. Although alternative exercise regimens for SUI have been investigated, their clinical implementation is not yet recommended [12]. Other conservative therapeutic options for SUI include vaginal cones, bladder training, as well as electrical or magnetic stimulation. Extracorporeal magnetic stimulation (EMS) is a non-invasive, effective, acceptable, and safe therapeutic modality for SUI [6, 7]. In EMS, induction of a changing magnetic field results in a flow of electrons within the field, controlled depolarisation of the adjacent nerves, and subsequent muscular contraction [13]. Although the optimal frequency and duration of treatment are not yet established, findings of a systematic review have suggested that higher frequency and pulse duration provide an adequate modality for achieving treatment efficacy [14]. At our clinic, which is the largest Croatian urogynaecological referral centre, EMS is routinely offered as an alternative to women who are not willing to perform Kegel exercises. Considering that a direct comparison of these two common conservative methods is lacking, we decided to perform a randomized controlled trial comparing the efficacy of PFMT versus EMS for the treatment of SUI. In this paper we describe the protocol of the study.

As the SARS-CoV-2 virus (COVID-19) continues to affect people across the globe, there is limited understanding of the long term implications for infected patients1–3. While some of these patients have documented follow-ups on clinical records, or participate in longitudinal surveys, these datasets are usually designed by clinicians, and not granular enough to understand the natural history or patient experiences of ‘long COVID’. In order to get a complete picture, there is a need to use patient generated data to track the long-term impact of COVID-19 on recovered patients in real time. There is a growing need to meticulously characterize these patients’ experiences, from infection to months post-infection, and with highly granular patient generated data rather than clinician narratives. In this work, we present a longitudinal characterization of post-COVID-19 symptoms using social media data from Twitter. Using a combination of machine learning, natural language processing techniques, and clinician reviews, we mined 296,154 tweets to characterize the post-acute infection course of the disease, creating detailed timelines of symptoms and conditions, and analyzing their symptomatology during a period of over 150 days.

Author(s): Lane, Jennifer CE; Weaver, James; Kostka, Kristin; Duarte-Salles, Talita; Abrahao, Maria Tereza F; Alghoul, Heba; Alser, Osaid; Alshammari, Thamir M; Areia, Carlos; Biedermann, Patricia; Banda, Juan M; Burn, Edward; Casajust, Paula; Fister, Kristina; Hardin, Jill; Hester, Laura; Hripcsak, George; Kaas-Hansen, Benjamin Skov; Khosla, Sajan; Kolovos, Spyros; Lynch, Kristine E; Makadia, Rupa; Mehta, Paras P; Morales, Daniel R; Morgan-Stewart, Henry; Mosseveld, Mees; Newby, Danielle; Nyberg, Fredrik; Ostropolets, Anna; Woong Park, Rae; Prats-Uribe, Albert; Rao, Gowtham A; Reich, Christian; Rijnbeek, Peter; Sena, Anthony G; Shoaibi, Azza; Spotnitz, Matthew; Subbian, Vignesh; Suchard, Marc A; Vizcaya, David; Wen, Haini; Wilde, Marcel de; Xie, Junqing; You, Seng Chan; Zhang, Lin; Lovestone, Simon; Ryan, Patrick; Prieto-Alhambra, Daniel; OHDSI-COVID-19 consortium | Abstract: ObjectivesConcern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA.MethodsWe performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2 l40%.ResultsA total of 918 144 and 290 383 users of HCQ and SSZ, respectively, were included. No consistent risk of psychiatric events was observed with short-term HCQ (compared with SSZ) use, with meta-analytic HRs of 0.96 (95% CI 0.79, 1.16) for depression, 0.94 (95% CI 0.49, 1.77) for suicide/suicidal ideation and 1.03 (95% CI 0.66, 1.60) for psychosis. No consistent long-term risk was seen, with meta-analytic HRs of 0.94 (95% CI 0.71, 1.26) for depression, 0.77 (95% CI 0.56, 1.07) for suicide/suicidal ideation and 0.99 (95% CI 0.72, 1.35) for psychosis.ConclusionHCQ as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation or psychosis compared with SSZ. No effects were seen in the short or long term. Use at a higher dose or for different indications needs further investigation.Trial registrationRegistered with EU PAS (reference no. EUPAS34497; http://www.encepp.eu/encepp/viewResource.htm? id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine2.

Background Hydroxychloroquine, a drug commonly used in the treatment of rheumatoid arthritis, has received much negative publicity for adverse events associated with its authorisation for emergency use to treat patients with COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin, to determine the risk associated with its use in routine care in patients with rheumatoid arthritis. Methods In this multinational, retrospective study, new user cohort studies in patients with rheumatoid arthritis aged 18 years or older and initiating hydroxychloroquine were compared with those initiating sulfasalazine and followed up over 30 days, with 16 severe adverse events studied. Self-controlled case series were done to further establish safety in wider populations, and included all users of hydroxychloroquine regardless of rheumatoid arthritis status or indication. Separately, severe adverse events associated with hydroxychloroquine plus azithromycin (compared with hydroxychloroquine plus amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, the Netherlands, Spain, the UK, and the USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (HRs) according to drug use. Estimates were pooled where the I² value was less than 0·4. Findings The study included 956 374 users of hydroxychloroquine, 310 350 users of sulfasalazine, 323 122 users of hydroxychloroquine plus azithromycin, and 351 956 users of hydroxychloroquine plus amoxicillin. No excess risk of severe adverse events was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. Selfcontrolled case series confirmed these findings. However, long-term use of hydroxychloroquine appeared to be associated with increased cardiovascular mortality (calibrated HR 1·65 [95% CI 1·12–2·44]). Addition of azithromycin appeared to be associated with an increased risk of 30-day cardiovascular mortality (calibrated HR 2·19 [95% CI 1·22–3·95]), chest pain or angina (1·15 [1·05–1·26]), and heart failure (1·22 [1·02–1·45]). Interpretation Hydroxychloroquine treatment appears to have no increased risk in the short term among patients with rheumatoid arthritis, but in the long term it appears to be associated with excess cardiovascular mortality. The addition of azithromycin increases the risk of heart failure and cardiovascular mortality even in the short term. We call for careful consideration of the benefit–risk trade-off when counselling those on hydroxychloroquine treatment.

BackgroundHydroxychloroquine has recently received Emergency Use Authorization by the FDA and is currently prescribed in combination with azithromycin for COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin.MethodsNew user cohort studies were conducted including 16 severe adverse events (SAEs). Rheumatoid arthritis patients aged 18+ and initiating hydroxychloroquine were compared to those initiating sulfasalazine and followed up over 30 days. Self-controlled case series (SCCS) were conducted to further establish safety in wider populations. Separately, SAEs associated with hydroxychloroquine- azithromycin (compared to hydroxychloroquine-amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, Netherlands, Spain, UK, and USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (CalHRs) according to drug use. Estimates were pooled where I2ResultsOverall, 956,374 and 310,350 users of hydroxychloroquine and sulfasalazine, and 323,122 and 351,956 users of hydroxychloroquine-azithromycin and hydroxychloroquine-amoxicillin were included. No excess risk of SAEs was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. SCCS confirmed these findings. However, when azithromycin was added to hydroxychloroquine, we observed an increased risk of 30-day cardiovascular mortality (CalHR2.19 [1.22- 3.94]), chest pain/angina (CalHR 1.15 [95% CI 1.05-1.26]), and heart failure (CalHR 1.22 [95% CI 1.02- 1.45])ConclusionsShort-term hydroxychloroquine treatment is safe, but addition of azithromycin may induce heart failure and cardiovascular mortality, potentially due to synergistic effects on QT length. We call for caution if such combination is to be used in the management of Covid-19.Trial registration numberRegistered with EU PAS; Reference number EUPAS34497 (http://www.encepp.eu/encepp/viewResource.htm?id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine.Funding sourcesThis research received partial support from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) and Senior Research Fellowship (DPA), US National Institutes of Health, Janssen Research & Development, IQVIA, and by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea [grant number: HI16C0992]. Personal funding included Versus Arthritis [21605] (JL), MRC-DTP [MR/K501256/1] (JL), MRC and FAME (APU). The European Health Data & Evidence Network has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806968. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. No funders had a direct role in this study. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Clinician Scientist Award programme, NIHR, NHS or the Department of Health, England.

Background Hydroxychloroquine, a drug commonly used in the treatment of rheumatoid arthritis, has received much negative publicity for adverse events associated with its authorisation for emergency use to treat patients with COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin, to determine the risk associated with its use in routine care in patients with rheumatoid arthritis. Methods In this multinational, retrospective study, new user cohort studies in patients with rheumatoid arthritis aged 18 years or older and initiating hydroxychloroquine were compared with those initiating sulfasalazine and followed up over 30 days, with 16 severe adverse events studied. Self-controlled case series were done to further establish safety in wider populations, and included all users of hydroxychloroquine regardless of rheumatoid arthritis status or indication. Separately, severe adverse events associated with hydroxychloroquine plus azithromycin (compared with hydroxychloroquine plus amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, the Netherlands, Spain, the UK, and the USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (HRs) according to drug use. Estimates were pooled where the I2 value was less than 0·4. Findings The study included 956 374 users of hydroxychloroquine, 310 350 users of sulfasalazine, 323 122 users of hydroxychloroquine plus azithromycin, and 351 956 users of hydroxychloroquine plus amoxicillin. No excess risk of severe adverse events was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. Self-controlled case series confirmed these findings. However, long-term use of hydroxychloroquine appeared to be associated with increased cardiovascular mortality (calibrated HR 1·65 [95% CI 1·12–2·44]). Addition of azithromycin appeared to be associated with an increased risk of 30-day cardiovascular mortality (calibrated HR 2·19 [95% CI 1·22–3·95]), chest pain or angina (1·15 [1·05–1·26]), and heart failure (1·22 [1·02–1·45]). Interpretation Hydroxychloroquine treatment appears to have no increased risk in the short term among patients with rheumatoid arthritis, but in the long term it appears to be associated with excess cardiovascular mortality. The addition of azithromycin increases the risk of heart failure and cardiovascular mortality even in the short term. We call for careful consideration of the benefit–risk trade-off when counselling those on hydroxychloroquine treatment. Funding National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, NIHR Senior Research Fellowship programme, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research and Development, IQVIA, Korea Health Industry Development Institute through the Ministry of Health and Welfare Republic of Korea, Versus Arthritis, UK Medical Research Council Doctoral Training Partnership, Foundation Alfonso Martin Escudero, Innovation Fund Denmark, Novo Nordisk Foundation, Singapore Ministry of Health's National Medical Research Council Open Fund Large Collaborative Grant, VINCI, Innovative Medicines Initiative 2 Joint Undertaking, EU's Horizon 2020 research and innovation programme, and European Federation of Pharmaceutical Industries and Associations.

We report a qualitative analysis of higher education biomedical informatics (BMI) teachers' opinions on the needs for BMI workforce and employment opportunities in the Croatian health care system. Needs were perceived as considerable; however this was not coupled with adequate employment opportunities. Barriers were identified to correcting this imbalance, including the failure of the health care system planners to recognise BMI experts as an important part of the workforce and lack of adequate educational opportunities.

The objective of this paper is to show how a simple but powerful simulation model can be build up using standard spreadsheet program and used to simulate future, needs and supply of physicians in order to inform policy makers at national level when deciding on enrollment to medical schools and immigration quotas for physicians. The Republic of Croatia is facing a serious shortage of physicians in the healthcare system and simulation results have shown that the gap between needs and supply will even increase if current enrollment qoutas to medical schools would persist. Increasing enrollment quotas, adjusting immigration policy, re-directing physicians from other professions to the healthcare system, task shift and skill mix options are just some of the measures needed to be taken promptly in order to prevent a huge deficit of physicians in the future. Simulation modeling is certainly a method for predicting changes within healthcare systems with a possibility to examine multiple different scenarios and suggest interventions.

U radu se raspravlja infrastruktura za sekundarnu uporabu podataka u zdravstvenom sustavu Republike Hrvatske - kakvo je sadašnje stanje i što bi trebalo razviti kako bi bolje bio ispunjen potencijal sekundarne uporabe za razvoj znanstvenoga rada, kliničke medicine i bolje upravljanje sustavom.

The objective of this paper is to show how a simple but powerful simulation model can be build up using standard spreadsheet program and used to simulate future, needs and supply of physicians in order to inform policy makers at national level when deciding on enrollment to medical schools and immigration quotas for physicians. The Republic of Croatia is facing a serious shortage of physicians in the healthcare system and simulation results have shown that the gap between needs and supply will even increase if current enrollment qoutas to medical schools would persist. Increasing enrollment quotas, adjusting immigration policy, re- directing physicians from other professions to the healthcare system, task shift and skill mix options are just some of the measures needed to be taken promptly in order to prevent a huge deficit of physicians in the future. Simulation modeling is certainly a method for predicting changes within healthcare systems with a possibility to examine multiple different scenarios and suggest interventions.

Lack of experts with complementary competences in the field of information technology as well as medicine and health care has been recognised as an important obstacle to successful computerisation of the health care system. Using a questionnaire survey, we aimed to describe the current educational landscape of biomedical informatics in Croatia, focussing on teachers' profiles and attitudes about existing educational opportunities in the field. Our findings show that Croatian institutions of higher education should better recognise the need for education in biomedical informatics. Dedicated programs need to be established and teacher force strengthened. Joint efforts of existing teachers-institutionalised through a working group focussing on education within the Croatian Society for Medical Informatics, for which strong support exists-might contribute to recognition of the field and improvement of educational opportunities.

Lack of experts with complementary competences in the field of information technology as well as medicine and health care has been recognised as an important obstacle to successful computerisation of the health care system. Using a questionnaire survey, we aimed to describe the current educational landscape of biomedical informatics in Croatia, focussing on teachers' profiles and attitudes about existing educational opportunities in the field. Our findings show that Croatian institutions of higher education should better recognise the need for education in biomedical informatics. Dedicated programs need to be established and teacher force strengthened. Joint efforts of existing teachers—institutionalised through a working group focussing on education within the Croatian Society for Medical Informatics, for which strong support exists—might contribute to recognition of the field and improvement of educational opportunities.

Secondary use of routinely collected health care data holds promise for providing better and less costly health care. We describe the current state of the Croatian health care system from the perspective of potential for ethical and meaningful secondary use. We also attempt to delineate a way towards building research infrastructure for secondary use of health care data in Croatia.

We have identified in the literature variants in 64 genes that may be involved in gene-obesity-behaviour interactions. Personalisation of behaviourally based preventive approaches against obesity seems feasible, however obesity genomics is still in the discovery phase of translational research and abundant replication studies are needed before these largely pioneering findings can be extended to practice and population impact. Automation of search algorithms and development of more efficient tools for knowledge synthesis of genomic research into gene-obesity-behaviour interactions might facilitate the advent of widely available personalised prevention approaches. Our future efforts shall therefore concentrate on developing such tools, as well as a research repository dedicated to the use of public health genomics for obesity control.

The objective of this paper was to evaluate the 5-year incidence of obesity on a sample of 3229 adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals. The average annual rate of increase in the prevalence of obese adults between 2003 and 2008 was 10.60% for men and 11.08% for women. Analysis showed that development of obesity in 5-year period in women in Croatia is significantly positively associated with frequent consumption of »hidden« fats of animal origin and significantly negative with each higher education level. No significant predictor of obesity has been found in men. Obesity remains a serious health problem for the Croatian population ; the alarming rates of excess body weight continue to increase. Preventive measures should urgently be undertaken.

This study aimed to assess levels of stress in Croatian adult population using PSS, in a population study (Croatian Adult Cohort Health Study - CroHort). Our results show that the levels of stress were 17.46 (SD = 6.73) for men and 18.32 (SD = 6.46) for women in Croatia. The lowest levels of stress experienced men living in urban area while women living in rural area had the highest level. Men and women who had university degree had significantly lower level of stress. The lowest levels of stress experienced participants who had much better financial condition than average. In men, stress was associated to weak heart, lower back pain, poor financial condition of the household and high alcohol consumption. In women, stress was associated to poor mental health, poor social functioning, poorer financial condition of the household, higher age, lower education, low monthly income of the household and poor general health.

The Public Health Surveillance System (PHSS) is defined as the ongoing, systematic collection, analysis, interpretation and dissemination of health-related data essential to the planning, implementation, and evaluation of public health practice. It serves as an early warning system, guides public health policy and strategies, documents the impact of an intervention or progress towards specified public health targets/goals, and understands and monitors the epidemiology of a condition to set priorities and guide public health policy and strategies. For this purpose, the PHSS should: be ICT-based and comprehensive with clearly defined sources, volumes, and standards of data; include all the stakeholders with information they produce, with enough flexibility in the dynamic of constructing indicators; be safe and able to produce information on demand and on time; and be able to act as a risk management system by providing warnings/reminders/alerts to prevent unwanted events.

The objective of this paper was to evaluate the 5-year incidence of obesity on a sample of 3229 adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals. The average annual rate of increase in the prevalence of obese adults between 2003 and 2008 was 10.60% for men and 11.08% for women. Analysis showed that development of obesity in 5-year period in women in Croatia is significantly positively associated with frequent consumption of "hidden" fats of animal origin and significantly negative with each higher education level. No significant predictor of obesity has been found in men. Obesity remains a serious health problem for the Croatian population; the alarming rates of excess body weight continue to increase. Preventive measures should urgently be undertaken.

Objectives: The purpose of this paper is to describe the medical informatics program and training at the University of Zagreb, School of Medicine (Croatia). Methods: We reviewed the medical informatics program, training and research for medical students at the integrated pre-graduate and graduate level, as well as at the postgraduate education and research level. Results: We present three approaches to teaching and training medical students in medical informatics at the integrated pre-graduate and graduate level. These are (1) Basics of medical informatics taught early in the medical curriculum, (2) Medical informatics which uses students’ clinical knowledge and is taught towards the end of the medical curriculum, and (3) individualized research programs. Both Basics of medical informatics and Medical informatics are courses tailored in line with the IMIA Recommendations on Medical Informatics Education for IT users, and adjusted to students’ attitudes to medical informatics issues and the position of the courses in the medical curriculum. Postgraduate studies, as the higher level of education at the School of Medicine, also include several mostly elective medical informatics courses dealing with general medical informatics methodology and health information system management in both clinical medicine and public health. Included are also simulation modeling, methods of machine learning and knowledge discovery in medical domains, as well as medical statistics and methods oriented towards free textual data analysis. The postgraduate level includes in addition telemedicine, electrophysiological methods in research, and evidence based medicine. Conclusions: Medical students are starting to recognize the role of information in their future profession. They require medical informatics applications to support their professional work with patients, as well as their research. In particular they express interest in machine learning, simulation modeling, medical decision making, data security, e-learning, and evaluation of ICT based medical applications.

Despite numerous changes introduced by the new technologies, the role and the meaning of public health within health has remained stable and important. Public health is also expanding from the strictly population-focus to genetics and nano-technology. This means that the fundaments of public health need to be supplemented by the additional expertise in areas such as medical informatics, bioinformatics, genetic epidemiology and public health genomics. The first step in integration is to develop the means of joining these ideas and experts in the solving of multidisciplinary problems, aiming to supplement public health with the emerging new technologies, ideas and concepts.

The paper describes a visiting nurse led intervention model for the primary and secondary prevention of cardiovascular diseases (CVD) and specificities of its application. Although CVD burden is high in Croatia, the visiting nurse services have not been specifically focused on CVD prevention in the population until now. The intervention model described here is being implemented alongside the second cycle of the Croatian Adult Health Survey (2008 CAHS). The model includes an objective evaluation of respondents’ CVD risk factors through quantitative and qualitative analyses, as well as respondents’ self-evaluation of risk factors and motivation to change. At the same time, respondents are educated and intervention is evaluated. A ‘ health booklet’ was specifically designed for documentation during one year’ s follow-up, where both the user and the visiting nurse keep copies of the negotiated targets and strategies set to achieve them. This intervention model has the potential to mobilize the service towards permanent incorporation of primary and secondary CVD prevention into routine care and, due to work specificities of the visiting nurse services, to cover the entire population in an organized CVD prevention.

The aim of this study was to examine the association of obesity and selected health behaviors, based on the data from Croatian Adult Health Survey 2003. Cross-sectional study on representative random sample of 9070 Croatian adults showed that in both men and women, mean BMI varied significantly with age (p

The healing process can be viewed as a partnership between doctors and patients, nurses and physicians or, more generally, a partnership of health professionals and health care users (Anonymous, 2008, Graham, 2007). A patient-centered approach that empowers patients to participate in decisions about their treatment and health care options asks for active participation of patients themselves, specifically, in health information gathering and exchange of this information with their health or medical records (Bachman, 2007; Stolyar, Lober, Drozd, & Sibley, 2005).

Background: The contribution disclosure forms used by medical journals to assess and confirm authorship are surveys of self-reported behaviour that follow the cognitive rules of psychometric instruments. We sought to analyze how autobiographical memory, defined as memory for events and issues related to oneself, affected the reliability of contribution forms for the judging of authorship of research articles. Methods: We conducted a prospective study, which ultimately included 919 authors of 201 articles submitted to a general medical journal from July 2001 through December 2002. A authorship disclosure form with a checklist of 11 possible contribution choices for all authors was sent first to each article9s corresponding author, who was asked to fill it out for all authors. A blank form was then sent to each author individually to disclose his or her own contribution to that article. The main outcome measure was test– retest differences between the corresponding authors9 self-declarations, expressed in percent as the gross difference rate (GDR) for each article. Results: More than two-thirds of the corresponding authors (69.7%) differed in at least 1 contribution choice between the 2 disclosure statements made about their own contributions. The reliability of their answers was low to moderate (GDRs > 10%), especially for contributions on the provision of study materials or patients or final approval of the article (GDR 22.9%), guarantor of the study (GDR 20.9%) and drafting of the manuscript (GDR 20.4%). As a proxy for their coauthors9 contributions, corresponding authors also differed from them in the perception of noncorresponding authors9 contributions, disagreeing in 69.4% of cases. Of the 718 noncorresponding authors, 204 (28.4%) met all the criteria for authorship set out by the International Committee of Medical Journal Editors according to the statement given by the corresponding author. When they described their own contributions, this prevalence increased to 40.5%. Interpretation: Psychological factors such as autobiographical memory may confound contribution disclosures as an evaluation tool for authorship on scientific articles and affect responsible authorship and publication practices.

Junk food and the advertising that promotes it are a serious threat to the health of young Americans, says a new report from the US Institute of Medicine. The report summarises current evidence on the effect that advertising campaigns have on the food and beverage consumption of young people in the United States. The report was commissioned by the Congress. The diets of young Americans differ substantially from recommended diets: they are too rich in energy, fat, salt, …

In December 2004 we called for papers that would document the impact on population health and on health systems of the transition from communism in Europe and central Asia.w1 Over the past 18 months, a series of events has focused the eyes of the world on this region. May 2004 saw the historic enlargement of the European Union. In Georgia, Ukraine, and Kyrgyzstan, popular uprisings have led to the removal of autocratic regimes; in Uzbekistan, a similar uprising ended in tragedy. Yet, despite coming to the attention of the world's mass media, this vast region characterised by diversity and shared problems has generated surprisingly few publications on health and health care. We hope that this theme issue—most of it contributed by researchers and authors from the region—will fill some of these gaps and will further stimulate much needed monitoring, research, and debate. One of the key themes in this week's BMJ theme issue is the rising prevalence of HIV/AIDS in some countries of the region. For example, one paper focuses on Ukraine, which has the highest prevalence of HIV infection in Europe (estimated at 1.4% of the population) but lacks any systematic approach to prevention, treatment, or care.1 The authors report how information on the scale and nature of the problem is patchy and is not well known within Ukraine. An accompanying commentary emphasises the need for urgent international action to prevent a potential catastrophe.w2 Non-communicable diseases continue to dominate the overall burden of disease in the region.2 Yet some countries have seen marked reductions in mortality,3 and, although precise explanations for this remain a matter for discussion,w3 it is clear that much can be done to tackle the high toll from cardiovascular disease. As Marquez and Suhrcke note, however, continuing improvement will depend on much more evidence and better use of existing evidence4,5 to inform policy, as well as on the creation of systems to collect data regularly on risk factors for chronic disease.

The race is on to find the winner of science's answer to television's Pop Idol C ould you demonstrate how to make a refrigerator out of a punctured red balloon, or how to tell the temperature by the frequency of a cricket's chirping? Or would you be able to explain in lay terms how the most toxic substance on earth—Botox—can be used safely to remove wrinkles? Those who thought they could took part in an all-day competition in London last week to find the best new talent at communicating complex scientific ideas to the general public. Known as Famelab, the contest, which was held at the Science Museum's Dana Centre, is the brainchild of the Cheltenham Science Festival. More than 130 contestants had three minutes each to convince the judges that they deserved a place in the finals, later the same day. The 15 who reached that stage then had five minutes each to win a place in the national finals in Cheltenham on 11 June, where the two who made it will join up with other regional qualifiers from Manchester, Bristol, Cardiff, Glasgow, and Belfast. Whoever is …

Karol Sikora , dean elect of Britain's first private medical school, thinks the school will widen access to education. Others beg to differ. Deborah Cohen and Kristina Fister report Known for his outspoken views on NHS reform and private medicine, Karol Sikora, professor of cancer medicine and honorary consultant oncologist at Imperial College London's School of Medicine, is now grappling with medical education. After being approached by Buckingham University's vice chancellor, Terence Kealey, himself a doctor, Professor Sikora was appointed dean elect of Britain's first private medical school at Buckingham University, the only UK university not directly funded by the government. He finds the challenge of implementing a new medical course appealing. “There's going to be a shortage of doctors in 20 years' time, and according to the Wanless report it will be about 25 000 [see BMJ 2002;324: 998]. Although medical school entry has doubled over the last 10 years, it's still too small,” he said. “The trouble is that they [existing educational initiatives] all use the same system of education. We want to get away from this dreadful political correctness in medical education that exists now. The main drivers of medical education in British medical schools are not doctors; they are professional medical …

Improving children's eating and exercise habits is central to making Britain a healthier nation, health secretary John Reid said last week. He was announcing details of how the government was going to implement its public health white paper that was published last November ( BMJ 2004;329:1201). The plan gives details about who will do what and when at national, regional, and local level. The Department of Health will be publishing six monthly progress reports of developments. The bulk of the …

An Asia House and Wellcome Trust exhibition at the Brunei Gallery, School of Oriental and African Studies, London, from 13 October to 12 December 2004 (admission free) www.soas.ac.uk/gallery/bodymindspirit/home.html

Live from Brainworks at the Science Museum9s Dana Centre, London NW1 Thursday 28 October www.danacentre.org.uk/

To investigate the degree to which primary and secondary care physicians in the Herzegovina region follow the protocols recommended in the literature for treatment of patients bitten by a venomous snake. Weretrospectively examined hospital records of all patients treated at theDepartment of Infectious Diseases, Mostar University Hospital, for intoxication following a venomous snakebite in the 1997-2002 period. The data on demographic characteristics, clinical presentation, therapy protocols, and final outcome were collected for each patient. From 1997 to 2002, 43 men (60.5%) and 28 women (33.4%)were treated at our Department for a venomous snakebite. The greatest number of snakebites occurred in persons older than 60 (chi-square=12.44, df=3, p=0.006) and during the summermonths (chi-square=8.12, df=1, p=0.004). More than half of the patients (38, or 53.5%)were bitten on the hand. The commonest symptoms and signs of the local envenomation were pain (97.1%) and swelling (87.3%), whereas general symptoms were tachycardia (39.4%), nausea (33.8%), and vomiting (28.1%). Also, 56 patients (78.8%) experienced anxiety and fear. The primary care protocol recommended in the literature (antibiotics, tetanus antitoxin, snakebite antiserum, and immobilization) was given to only 2 patients (2%). However, there were no lethal outcomes. Development of a precise evidence-based protocol for prehospitalmanagement of venomous snakebite is needed in the Herzegovina region, followed by educational efforts targeted at primary care physicians.

The aim of this study was to examine the association of weight gain and life expectancy at birth in Croatia. Mean body mass index was based on the data from the Croatian Adult Health Survey 2003. Birth rate and mortality data needed for life expectancy calculation were supplied by the Central Bureau of Statistics. The results suggest that the increase in mean body mass index value (1.31 kg m(-2) for women and 1.41 kg m(-2) for men) will shorten life expectancy at birth for one year. Obesity, if unchecked, might have a negative effect on life expectancy in Croatia. Despite widespread knowledge about how to reduce the severity of the problem, observed trends in obesity in Croatia continue to worsen. These trends threaten to diminish the health and life expectancy of current and future generations.

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

Harm reduction programmes have been criticised for giving a false impression to adolescents that heroin use doesn't have to be associated with as much harm to the individual as is traditionally thought. Switzerland has had a liberal policy towards harm reduction. And a recent study shows that the incidence of heroin misuse has been falling under an extensive harm reduction programme, which includes methadone substitution with low threshold of illicit use. Credit: LANCET The researchers analysed an anonymised treatment register of almost 80% of the heroin addicts treated between 1991 and March 2005 in the canton of Zurich, which included more than 7000 people. Using the conditional lag time distribution, they estimated the proportion of addicts not yet in substitution treatment programmes and modelled the overall prevalence of heroin misuse as a function of incidence and cessation rate. Credit: ANN INT MED After its all time peak in 1990, the incidence of regular heroin use declined fourfold in the next decade, more than in any other country with data permitting such analysis. The data showed a decline, by 4% a year, in the population of problematic heroin addicts, defined as people who sought and entered treatment. However, the rates of cessation (leaving the substitution programme and not re-entering within a decade) in Switzerland are among the lowest recorded. Lancet 2006;367: 1830–4 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Children who had ventricular fibrillation or tachycardia before the onset of cardiac arrest have better prognosis than children in cardiac arrest who develop ventricular fibrillation or tachycardia during cardiopulmonary resuscitation. This finding is from a multicentre register study of more than 1000 consecutive children with cardiac arrest. It contradicts previous evidence, which was based on studies from single institutions with small sample sizes, and the traditional view that ventricular fibrillation and tachycardia are “good” cardiac arrest rhythms. Children who develop ventricular fibrillation … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DNordt%26rft.auinit1%253DC.%26rft.volume%253D367%26rft.issue%253D9525%26rft.spage%253D1830%26rft.epage%253D1834%26rft.atitle%253DIncidence%2Bof%2Bheroin%2Buse%2Bin%2BZurich%252C%2BSwitzerland%253A%2Ba%2Btreatment%2Bcase%2Bregister%2Banalysis.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252806%252968804-1%26rft_id%253Dinfo%253Apmid%252F16753485%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(06)68804-1&link_type=DOI [3]: /lookup/external-ref?access_num=16753485&link_type=MED&atom=%2Fbmj%2F332%2F7554%2F1383.atom [4]: /lookup/external-ref?access_num=000238194200028&link_type=ISI