European web-based platform for recording international health regulations ship sanitation certificates: results and perspectives

The purpose of this study was to report the data analysis results from the International Health Regulations (2005) Ship Sanitation Certificates (SSCs), recorded in the European Information System (EIS). International sea trade and population movements by ships can contribute to the global spread of diseases. SSCs are issued to ensure the implementation of control measures if a public health risk exists on board. EIS designed according to the World Health Organization (WHO) Handbook for Inspection of Ships and Issuance of SSC. Inspection data were recorded and SSCs issued by inspectors working at European ports were analysed. From July 2011-February 2017, 107 inspectors working at 54 ports in 11 countries inspected 5579 ships. Of these, there were 29 types under 85 flags (including 19 EU Member States flags). As per IHR (2005) 10,281 Ship Sanitation Control Exception Certificates (SSCECs) and 296 Ship Sanitation Control Certificates (SSCCs) were issued, 74 extensions to existing SSCs were given, 7565 inspection findings were recorded, and 47 inspections were recorded without issuing an SSC. The most frequent inspection findings were the lack of potable water quality monitoring reports (23%). Ships aged 12 years (odds ratio, OR = 1.77, 95% confidence intervals, CI = 1.37-2.29) with an absence of cargo at time of inspection (OR = 3.36, 95% CI = 2.51-4.50) had a higher probability of receiving an SSCC, while ships under the EU MS flag had a lower probability of having inspection findings (OR = 0.72, 95% CI = 0.66-0.79). Risk factors to prioritise the inspections according to IHR were identified by using the EIS. A global information system, or connection of national or regional information systems and data exchange, could help to better implement SSCs using common standards and procedures

7th Drug hypersensitivity meeting: part two

No abstract availabl

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees

Valoración del cumplimiento de la quimioprofilaxis antituberculosa en la población reclusa del centro penitenciario de Jaén

BACKGROUND: This study highlights the importance of anti-tubercular chemoprophylaxis with isoniazid to control and prevent tuberculosis in prisons. The relationship between compliance with the chemoprophylaxis and study factors was evaluated and we examined whether health education given in our prison motivated the prisoners to comply with this treatment. METHODS: Compliance with chemoprophylaxis using isoniazid by 52 inmates of the Jaén Penal Institution was studied for the period February to May 1995. The dose of isoniazid taken was calculated by means of the spectrophotometric determination of isoniazid metabolites in urine using the Eidus Hamilton method. Likewise, the influence of variables such as sex, HIV infection, legal situation and cultural level on compliance was studied. RESULTS: Out of 52 inmates, 23 (44.23%) were taking a daily dose of isoniazid that was considered to be effective and 29 inmates (55.77%) were taking less than the effective isoniazid dose for the chemoprophylaxis. With regard to the variables studied, greater compliance with the chemoprophylaxis was recorded among men (sex variable) and those inmates with a higher educational level (cultural level) although no significant differences were found. CONCLUSIONS: Compliance with the chemoprophylaxis among our inmates is inadequate although it matches similar studies that have been carried out on the prison population. This is not the case for the community population where compliance with chemoprophylaxis is greater. This low compliance forces us to review our current health education programme and to take steps that might increase this degree of compliance such as direct observation of treatment, a system of intermittent treatment, etc.FUNDAMENTO: El presente estudio resalta la importancia de la quimioprofilaxis antituberculosa con Isoniacida, para el control y prevención de la tuberculosis en el medio penitenciario. Se ha valorado la relación existente entre el cumplimiento de la quimioprofilaxis con factores de estudio; así como, hemos determinado si la educación sanitaria dispensada en nuestro centro, ha motivado a la población reclusa en el cumplimiento de este tratamiento. MÉTODOS: Se estudió el cumplimiento de la quimioprofilaxis con Isoniacida de 52 internos del Centro Penitenciario de Jaén, durante el periodo de febrero a mayo de 1995, calculando la dosis de Isoniacida tomada, mediante la determinación espectrofotométrica de metabolitos de Isoniacida en orina, por el método de Eidus Hamilton. Asímismo, se estudió la influencia sobre el cumplimiento de variables como sexo, infección por VIH, situación judicial y nivel cultural. RESULTADOS: De los 52 internos, 23 (44.23%) tomaban diariamente una dosis de Isoniacida considerada como efectiva; y 29 internos (55.77%) tomaban menos de la dosis de Isoniacida efectiva para la quimioprofilaxis. En cuanto a las variables estudiadas, los hombres (variable sexo) y aquellos internos con mayor grado educacional (nivel cultural) mostraron un mayor cumplimiento de la quimioprofilaxis, a pesar de no encontrar diferencias significativas. CONCLUSIONES: El cumplimiento de la quimioprofilaxis en nuestra población es deficiente, aunque se halla en consonancia con estudios similares realizados también sobre la población reclusa; no ocurre lo mismo con la población comunitaria donde encontramos un mayor cumplimiento de la quimioprofilaxis. ste bajo cumplimiento nos obliga a revisar el actual programa de educación sanitaria, así como aplicar medidas que puedan aumentar este grado de cumplimiento, como la observación directa del tratamiento, el régimen de tratamiento intermitentes, etc

A Severe Lack of Evidence Limits Effective Conservation of the World's Primates

Threats to biodiversity are well documented. However, to effectively conserve species and their habitats, we need to know which conservation interventions do (or do not) work. Evidence-based conservation evaluates interventions within a scientific framework. The Conservation Evidence project has summarized thousands of studies testing conservation interventions and compiled these as synopses for various habitats and taxa. In the present article, we analyzed the interventions assessed in the primate synopsis and compared these with other taxa. We found that despite intensive efforts to study primates and the extensive threats they face, less than 1% of primate studies evaluated conservation effectiveness. The studies often lacked quantitative data, failed to undertake postimplementation monitoring of populations or individuals, or implemented several interventions at once. Furthermore, the studies were biased toward specific taxa, geographic regions, and interventions. We describe barriers for testing primate conservation interventions and propose actions to improve the conservation evidence base to protect this endangered and globally important taxon