Percevoir et Juger la « corruption politique »:Enjeux et usages des enquêtes sur les représentations des atteintes à la probité publique

Entre l’idéal démocratique d’un citoyen vertueux contrôlant la probité des gouvernants et l’image d’un électeur cynique, la perception de la « corruption politique » par les citoyens constitue un enjeu important du rapport moral à la politique au cœur des débats de sociologie et de théorie politiques. L’article présente un ensemble mal connu de travaux anglo-saxons qui étudient les représentations ordinaires des atteintes à la probité publique. Il en discute les fondements, les méthodes et les résultats pour formuler de nouvelles hypothèses. Sont analysés la variation des perceptions et des classements des transgressions politiques, la fluctuation des formes de réprobation, les ancrages sociaux et économiques de cette faculté de juger ou encore l’existence de formes de consensus normatif.The investigation of conceptions among citizens of perceived political corruption forms an important component of theoretical and empirical studies in democratic theory and political ethics. Studies have moved beyond a simple dichotomy of “ideal types”: cynical voters and virtuous citizens sanctioning political misconduct. This article surveys Anglo-Saxon scholarship on ordinary judgements towards political corruption. It discusses their epistomological foundations and methods, but also develops the existing studies’ results to propose a set of new hypotheses. Several points are stressed: divergent perceptions and classifications of political corruption; willingness to sanction, social and economic factors that influence judgement; forms of normative consensus about political behaviours

Специфіка гуманізму епохи Відродження

Objectives. B-type natriuretic peptide (BNP) levels predict prognosis and outcome in heart failure (HF) patients. To evaluate the optimal cut-off level of BNP to predict death, need for hospitalization, and worsening HF, and also to determine the optimal time to apply the chosen cut-off value. Design. In a sub-study from the Use of PeptideS in Tailoring hEart failure Project or UPSTEP study where tailoring treatment of HF by BNP level was evaluated, we assessed the change in percentage between levels of BNP at study start versus a specific week (2, 6, 10, 16, 24, 36, or 48) during the follow-up period. Results. The optimum cut-off percentage levels were obtained using a Cox proportional regression analysis of death, hospitalization, and worsening HF. A decrease in BNP by less than 40% in week 16 compared with study start and/or a BNP > 300 ng/L presented the highest hazard ratio (HR) for a non-responder to reach a combined endpoint (HR: 2.43; 95% confidence interval or CI: 1.61-3.65; p < 0.00003). This definition gave a 78% risk reduction of cardiovascular (CV) mortality (p > 0.0005) and an 89% risk reduction of HF mortality (p > 0.004), and reduced risk of CV and HF hospitalization for the responders. Conclusions. Patients with a decrease in BNP of more than 40% compared with that at study start and/or a BNP level below 300 ng/L at week 16 had a significantly reduced risk of CV and HF mortality and hospitalization

Prognostic importance of emerging cardiac, inflammatory, and renal biomarkers in chronic heart failure patients with reduced ejection fraction and anaemia: RED-HF study

Aims: To test the prognostic value of emerging biomarkers in the Reduction of Events by Darbepoetin Alfa in Heart Failure (RED-HF) trial. Methods and results: Circulating cardiac [N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT)], neurohumoral [mid-regional pro-adrenomedullin (MR-proADM) and copeptin], renal (cystatin C), and inflammatory [high-sensitivity C-reactive protein (hsCRP)] biomarkers were measured at randomization in 1853 participants with complete data. The relationship between these biomarkers and the primary composite endpoint of heart failure hospitalization or cardiovascular death over 28 months of follow-up (n = 834) was evaluated using Cox proportional hazards regression, the c-statistic and the net reclassification index (NRI). After adjustment, the hazard ratio (HR) for the composite outcome in the top tertile of the distribution compared to the lowest tertile for each biomarker was: NT-proBNP 3.96 (95% CI 3.16–4.98), hsTnT 3.09 (95% CI 2.47–3.88), MR-proADM 2.28 (95% CI 1.83–2.84), copeptin 1.66 (95% CI 1.35–2.04), cystatin C 1.92 (95% CI 1.55–2.37), and hsCRP 1.51 (95% CI 1.27–1.80). A basic clinical prediction model was improved on addition of each biomarker individually, most strongly by NT-proBNP (NRI +62.3%, P < 0.001), but thereafter was only improved marginally by addition of hsTnT (NRI +33.1%, P = 0.004). Further addition of biomarkers did not improve discrimination further. Findings were similar for all-cause mortality. Conclusion: Once NT-proBNP is included, only hsTnT moderately further improved risk stratification in this group of chronic heart failure with reduced ejection fraction patients with moderate anaemia. NT-proBNP and hsTnT far outperform other emerging biomarkers in prediction of adverse outcome

Treatment strategies in Alzheimer’s disease: a review with focus on selenium supplementation

Alzheimers disease (AD) is a neurodegenerative disorder presenting one of the biggest healthcare challenges in developed countries. No effective treatment exists. In recent years the main focus of AD research has been on the amyloid hypothesis, which postulates that extracellular precipitates of beta amyloid (A beta) derived from amyloid precursor protein (APP) are responsible for the cognitive impairment seen in AD. Treatment strategies have been to reduce A beta production through inhibition of enzymes responsible for its formation, or to promote resolution of existing cerebral A beta plaques. However, these approaches have failed to demonstrate significant cognitive improvements. Intracellular rather than extracellular events may be fundamental in AD pathogenesis. Selenate is a potent inhibitor of tau hyperphosphorylation, a critical step in the formation of neurofibrillary tangles. Some selenium (Se) compounds e.g. selenoprotein P also appear to protect APP against excessive copper and iron deposition. Selenoproteins show anti-inflammatory properties, and protect microtubules in the neuronal cytoskeleton. Optimal function of these selenoenzymes requires higher Se intake than what is common in Europe and also higher intake than traditionally recommended. Supplementary treatment with N-acetylcysteine increases levels of the antioxidative cofactor glutathione and can mediate adjuvant protection. The present review discusses the role of Se in AD treatment and suggests strategies for AD prevention by optimizing selenium intake, in accordance with the metal dysregulation hypothesis. This includes in particular secondary prevention by selenium supplementation to elderly with mild cognitive impairment

The systematic guideline review: method, rationale, and test on chronic heart failure

Background: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources-especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development-the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). Methods: A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Results: Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. Conclusion: The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines

Pesticider i frukt och grönsaker

Rekommendationer från Livsmedelsverket manar till ett ökat intag av frukt och grönsaker samtidigt som halten av bekämpningsmedel, pesticider, i dessa grödor har diskuterats myck- et. En fråga som ofta ställs i denna diskussion är ifall svenska frukter och grönsaker innehar lägre halter av dessa bekämpningsmedel och även huruvida nuvarande nivåer av bekämp- ningsmedel i frukt och grönsaker ger negativa hälsoeffekter. Syftet: Att undersöka förekomsten av pesticidrester i frukter och grönsaker och studera hur dessa skiljer sig i svenska grödor jämfört med grödor odlade i andra länder. Dessutom ämna- des undersöka hur pesticider påverkar människan. Metod: Litteraturstudie genomfördes med hjälp av artikelsökning i databaserna PubMed och Web of Knowledge. Artiklar som överensstämde med frågeställningarna och var publicerade 1999-2009 inkluderades. Detta genererade 12 artiklar och en rapport från Livsmedelsverket. Tre frukter och två grönsaker valdes ut för jämförelse av pesticidförekomst i olika studier. Artiklar som jämförde olika analysmetoder för att påvisa pesticidrester exkluderades. Resultat: Inkluderade studier visade på olika resultat av pesticidförekomst, så som i apelsin där frekvensen varierade från 4,5 % till 87,1%. Svenskodlade frukter och grönsaker hade lägst nivåer av pesticider, medan grödor odlade utanför Europeiska Unionen gav högst utfall. Fre- kvensen av prover som överskred tillåtna nivåer var 0,5% i svenskproducerat, 2,1 % i EU- producerat och 9,5% i frukt- och grönsaksprover från länder utanför EU. Majoriteten av studi- erna visade inte på nämnvärda hälsorisker kopplat till ett genomsnittligt intag av frukt och grönsaker, även om riskerna var högre för specifika grupper så som barn, personer med låg vikt och vegetarianer. Det påträffades dock ett flertal prover med halter vida överstigande re- kommenderade nivåer och även prover innehållande förbjudna bekämpningsmedel. Vid hög exponering av pesticider, vilket gäller för bland annat odlare, fanns det tydliga kopplingar till en ökad risk av sjukdomar så som mag- och blodcancer. Konklusion: Förekomsten av pesticidrester i frukt och grönsaker skiljer betydligt mellan olika studier som jämför samma pesticider och frukter respektive grönsaker. Svenskodlade grödor har en lägre frekvens av pesticider än grödor odlade i andra länder, med högst frekvens i grö- dor odlade utanför EU. Pesticider medför en risk om de konsumerades över gränsvärden, eller för de grupper som har en hög exponering, exempelvis odlare.Recommendations from National Food Administration urge to an increased intake of fruits and vegetables, concurrently as the level of pesticides has been greatly discussed. A question often proposed within this discussion, is whether Swedish fruits and vegetables contain lower rates of pesticides and also if the current amounts of pesticides in fruits and vegetables could imply negative health effects. Aim: To examine the prevalence of pesticies in fruits and vegetables and to study how these rates differentiate in Swedish crops compared to crops grown in other countries. Furthermore there was an intention to investigate how pesticides affect the human physiology. Method: A literature study was performed with the help of an article search in the databases PubMed and Web of Knowledge. Articles corresponding to the aim and publisized 1999-2009 were included in the study. This generated in 12 articles and one report from National Food Administration. Three fruits and two vegetables were selected for comparison of pesticide incidence in different studies. Articles comparing different analytical methods to determine pesticides were excluded. Result: Included studies showed different results concerning pesticide presence, for example in orange where the incidence varied from 4,5% to 87,1%. Fruits and vegetables grown in Sweden contained the lowest rate of pesticides, while crops grown outside the European Union implied the largest outcome. The frequency of samples exceeding permitted levels was 0,5% in crops grown in Sweden, 2,1% in crops grown within the European Union and 9,5% in fruit and vegetable samples from countries outside the European Union. The majority of included studies showed no significant health risks connected to a average intake of fruits and vegetables, even tough the risks were increased for secific groups such as children, lightweight people and vegetarians. However, a few samples contained levels widely exceeding recommended levels and also samples containing prohibited pesticides. When having extended exposure to pesticides, for farmer among others, there was apparent connections to increased risk of different diseases such as gastric and blood cancer. Conclusion: The incidence of pesticides in fruits and vegetables distinguish considerably between different studies, comparing the same pesticides and fruits and vegetables respective. Crops grown in Sweden have a lower frequency of pesticides compared to crops grown in other countries, with the highest rates in crops grown outside the European Union. Pesticides emitted a risk when consumed exceeding threshold limit values, or for groups with a high exposure for example farmers. Keywords: pesticides, fruit, vegetables, MRL (Maximum Residue Level

Development of a method for determination of pesticide residues in honey using liquid chromatography tandem mass spectrometry

Honey is a product that may contain pesticide residues due to contamination from bees pollinating various plants as well as elimination of vermin inside the hive. Different methods are needed for analysis of pesticides, since the term includes a wide range of different substances. National Food Administration lacks a validated method for determination and quantification of pesticides in honey using liquid chromatography tandem mass spectrometry, LC-MS/MS. The technique is especially important in analysis of polar and non-volatile pesticides, where gas chromatography is not functioning optimally. After investigating what pesticides could be found in honey produced in Sweden, a number of four pesticides suitable for analysis with LC-MS/MS was compiled; boscalid, impidacloprid, tau-fluvalinate and thiacloprid. A validated multi method for pesticide analysis in fruit and vegetables using LC-MS/MS was utilized as reference method, as a new method was developed. Some of the alterations in the new method included addition of water, changed order of addition of salts, centrifuge settings and shakings of samples. Performing validation experiments at three levels; 0.01 μg/g, 0.02 μg/g and 0.1 μg/g, yielded recovery in the range from 69.4% to 91.8% with relative standard deviation <19%. These figures met, with one exception, the requirements for validation of new methods at National Food Administration and also held linear correlation coefficients higher than 0.97. Three labels of honey, with different origins, were used in the experiments. One of the honey labels formed emulsion during extraction. Absence of a separate ethyl acetate phase caused difficulties when creating a suitable extract for determination and quantification by LC-MS/MS. A special extraction procedure was developed for that specific honey label enabling extraction. As successful extraction procedures were developed and recovery tests yielded satisfying results, the aim to develop an analysis method for determination of pesticide residues in honey using liquid chromatography tandem mass spectrometry was fulfilled.Honung är en produkt som kan innehålla pesticidrester på grund av kontamination av bin när de pollinerar olika växter och även från skadedjursbekämpning inne i bikupan. Olika tekniker behövs för analys av pesticidrester eftersom begreppet inkluderar en bred grupp av olika substanser. Livsmedelsverket saknar en validerad metod för bestämning och kvantifiering av pesticider i honung med hjälp av LC-MS/MS. Tekniken är speciellt viktig för analys av polära och icke-volatila pesticider, då analys med gaskromatografi inte är optimalt för dessa pesticider. Efter undersökning av vilka pesticider som kan påträffas i honung producerad i Sverige, sammanställdes en lista med fyra pesticider som kan analyseras av LC-MS/MS; boskalid, imidakloprid, tau-fluvalinat och tiakloprid. En validerad multimetod för pesticidanalys i frukt och grönsaker med användning med LC-MS/MS användes som referensmetod när en ny metod utvecklades. Några av ändringarna i den nya metoden inkluderade tillsats av vatten, ny ordningsföljd vid tillsats av salter, centrifuginställningar och skakningar av prover. Valideringsexperimenten genomfördes på tre nivåer; 0,01μg/g, 0,0

You can’t flight, you need to fight – a qualitative study of mothers’ experiences of feeding extremely preterm infants

Aim To describe mother\u27s experiences of feeding their extremely preterm infant. Background When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce. Design A qualitative method with an inductive approach. Methods Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed. Results The overall theme was “you can\u27t flight, you need to fight.” The theme reflects the mothers’ will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry and disappointment. The categories forming the theme were as follows: The wish to provide own breastmilk; For the infant\u27s best; Loss of control; and Help to reach the goals. Conclusion The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful. Relevance to clinical practice There is a need for evidence‐based support programmes for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time

Supporting premature infants’ oral feeding in the NICU—a qualitative study of nurses’ perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU

Vitamin K and Calcium Chelation in Vascular Health

The observation that the extent of artery calcification correlates with the degree of atherosclerosis was the background for the alternative treatment of cardiovascular disease with chelator ethylenediamine tetraacetate (EDTA). Recent studies have indicated that such chelation treatment has only marginal impact on the course of vascular disease. In contrast, endogenous calcium chelation with removal of calcium from the cardiovascular system paralleled by improved bone mineralization exerted, i.e., by matrix Gla protein (MGP) and osteocalcin, appears to significantly delay the development of cardiovascular diseases. After post-translational vitamin-K-dependent carboxylation of glutamic acid residues, MGP and other vitamin-K-dependent proteins (VKDPs) can chelate calcium through vicinal carboxyl groups. Dietary vitamin K is mainly provided in the form of phylloquinone from green leafy vegetables and as menaquinones from fermented foods. Here, we provide a review of clinical studies, addressing the role of vitamin K in cardiovascular diseases, and an overview of vitamin K kinetics and biological actions, including vitamin-K-dependent carboxylation and calcium chelation, as compared with the action of the exogenous (therapeutic) chelator EDTA. Consumption of vitamin-K-rich foods and/or use of vitamin K supplements appear to be a better preventive strategy than EDTA chelation for maintaining vascular health.publishedVersio