PCV62 Annual Medication Cost Attributed To Each Kind Of Treatment Of Patients Subjected To Crmds Implantation

Le gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le rninistere de l'Agriculture organise des Sessions de formation destinées aux agriculteurs et portant sur 1utilisation de ces produits. En outre, ure programme d'analyse régulière des sols a été mis en place pour détecter la présence de résidus de pesticides. Comme la rnajorité des pays ACP, la Dominique dépend de l’agriculture pour nourrir sa population et générer des devises à l'ëxportation. Dans cette agriculture, la banane est un des piliers de L’économie agriccolle nationale; il est indéniable que La cornpétiton sur le marché européen va s'accroitre lurs de la creation effective-du rnarché unique en I992-. Pour' assurer leur avenir, les agriculteurs de la Dominique souhaitent maintenir to quantité et la qualité de la production de bananes mais aussi diversifier leurs exportations grâce au développement de la production de fruits, de légumes et de fleurs. Dans cette optique, 1utilisation croissante de pesticides est inévitable et suppose donc une grande, vigilance quant à leur utilisation. Dans la Dominique, le relief est escarpé, les pluies abondantes, les sols volcaniques : tous ces facteurs fàvorisent le ruissellement et le lessivage des sols.'Le risque de pollution des nappes phréatiques est donc potëntiellement important , notamment dans les:régions bananières 'ou les paysans ont recours aux nematicidés. Pour minimiser ces- risques, seuls les produits agrochimiques testés sort autorisés à l’importation et Ieur utilisation est contrôlée par le ministère de 1Agriculture. Ce dernier incite par ailleurs les groupements paysans à suivre des sessions régulières de formation ou ure enseignement est dispensé portant sur le mélange et l’epandagé des produits chimiques, sur 1utilisation de vêtements de protection et sur le stockage des denrées selon les normes de sécurité. Parallèlement, un programme de détection des, résidus de pesticides a été lancé dernièrement, grâce à 1appui de la FAO qui fournit des -équipements de chromatographie par gaz liquide. Les agriculteurs de la Dominique ont compris 1importance de ces formations et la majorité d'entre, eux sont aujourd’hui conscients de la nécessite d’exporter des produit de qualité,et de 1importance d'une utilisation maîtrisée des pesticides .Les épandages «excessifs» (en particulier, surdosage et mélanges inadéquats), fréquents dans de nombreux pays, sont extrêmement rares à la Dominique .Dans ce pays, on utilise les pesticides avec prudence et économie : alors, le risque est minime pour les agriculteurs les consommateurs et 'l'environnement. Pour plus de détails : Colin Bulley Chief Technical Officer Ministry of Agriculture Roseau DOMINIQUELe gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le..

Changes in heart rate variability and QT variability during the first trimester of pregnancy

The risk of new-onset arrhythmia during pregnancy is high, presumably relating to changes in both haemodynamic and cardiac autonomic function. The ability to non-invasively assess an individual's risk of developing arrhythmia during pregnancy would therefore be clinically significant. We aimed to quantify electrocardiographic temporal characteristics during the first trimester of pregnancy and to compare these with non-pregnant controls.Ninety-nine pregnant women and sixty-three non-pregnant women underwent non-invasive cardiovascular and haemodynamic assessment during a protocol consisting of various physiological states (postural manoeurvres, light exercise and metronomic breathing). Variables measured included stroke volume, cardiac output, heart rate, heart rate variability, QT and QT variability and QTVI (a measure of the variability of QT relative to that of RR).Heart rate (p < 0.0005, p < 0.0005, p < 0.0005) and cardiac output (p = 0.043, p < 0.0005, p < 0.0005) were greater in pregnant women in all physiological states (respectively for the supine position, light exercise and metronomic breathing state), whilst stroke volume was lower in pregnancy only during the supine position (p < 0.0005). QTe (Q wave onset to T wave end) and QTa (T wave apex) were significantly shortened (p < 0.05) and QTeVI and QTaVI were increased in pregnancy in all physiological states (p < 0.0005). QT variability (p < 0.002) was greater in pregnant women during the supine position, whilst heart rate variability was reduced in pregnancy in all states (p < 0.0005).Early pregnancy is associated with substantial changes in heart rate variability, reflecting a reduction in parasympathetic tone and an increase in sympathetic activity. QTVI shifted to a less favourable value, reflecting a greater than normal amount of QT variability. QTVI appears to be a useful method for quantifying changes in QT variability relative to RR (or heart rate) variability, being sensitive not only to physiological state but also to gestational age. We support the use of non-invasive markers of cardiac electrical variability to evaluate the risk of arrhythmic events in pregnancy, and we recommend the use of multiple physiological states during the assessment protocol

Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training

Background There is a growing consensus that bariatric surgery is currently the most efficacious and long-term treatment for clinically severe obesity. However, it remains to be determined whether poor physical fitness, an important characteristic of these patients, improves as well. The purpose of this pilot study is to investigate the effect of gastric bypass surgery on physical fitness and to determine if an exercise program in the first 4 months is beneficial. Methods Fifteen morbidly obese patients (BMI 43.0 kg/m(2)) were tested before and 4 months after gastric bypass surgery. Eight of them followed a combined endurance and strength training program. Before and after 4 months the operation, anthropometrical characteristics were measured, and an extensive assessment of physical fitness (strength, aerobic, and functional capacity) was performed. Results Large-scale weight loss through gastric bypass surgery results in a decrease in dynamic and static muscle strength and no improvement of aerobic capacity. In contrast, an intensive exercise program could prevent the decrease and even induced an increase in strength of most muscle groups. Together with an improvement in aerobic capacity, functional capacity increased significantly. Both groups evolved equally with regard to body composition (decrease in fat mass and fat-free mass). Conclusions An exercise training program in the first 4 months after bariatric surgery is effective and should be promoted, considering the fact that physical fitness does not improve by weight loss only

A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013