Goblet Cell Carcinoids of the Appendix

Goblet cell carcinoid (GCC) tumors are a rare subgroup of neuroendocrine tumors almost exclusively originating in the appendix. The tumor most often presents in the fifth or sixth decade with a clinical picture of appendicitis or in advanced cases an abdominal mass associated with abdominal pain. Histologically tumors are most often positive for chromogranin A and synaptophysin, however, less homogenous than for classic appendix carcinoids. The malignant potential is higher than that for the classic appendix carcinoids due to local spread and distant metastases at diagnosis and the proliferation markers (Ki67 index) may determine prognosis. Octreotide receptor scintigraphy is usually negative while CT/MRI scans may be useful. Chromogranin A is usually negative and other biomarkers related to the mucinous component or the tumor (CEA, CA-19-9, and CA-125) may be used. Surgery is the main treatment with appendectomy and right hemicolectomy while patients with disseminated disease should be treated with chemotherapy. Overall 5-year survival is approximately 75%. The diagnosis and treatment of GCC tumorss should be restricted to high volume NET centers in order to accumulate knowledge and improve survival in GCC NET patients. The aim of this paper is to update on epidemiology, clinical presentation, and diagnostic markers including Ki67 index, treatment, and survival

How Do We Evaluate Health in All Policies? Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

Abstract It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed. Lawless and colleagues present an evaluation framework for HiAP in their article: “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia.” This work is an important endeavor in addressing this problem (of uncertainty as to whether HiAP is effective) and represents an essential contribution to the HiAP literature. Nonetheless, in the spirit of encouraging ongoing reflection on this topic, we wish to highlight some challenges in the presented framework, which may pose difficulties in operationalization. We find that the evaluation framework faces two main limitations: its unclear causal logic and its level of complexity. We argue that in order to function as a tool for evaluation, the framework should be explicit about the mechanisms of change and enable us to trace whether the assumed causal relations resulted in changes in practice. Developing manageable evaluation frameworks, albeit simplified, may then be an important part of cumulating the theoretical insights aspired in theory-based evaluation. On this basis, we highlight how HiAP processes and healthy public policies respectively involve different mechanisms, and thus argue that different program theories are needed

Goblet Cell Carcinoid in a Patient with Neurofibromatosis Type 1: A Rare Combination

Neuroendocrine tumors are rare tumors primarily located in the gastrointestinal tract. Goblet cell carcinoid is a rare subgroup of neuroendocrine tumors located in the appendix. Neurofibromatosis type 1 is an autosomal dominant disorder caused by a mutation in the NF1 gene. Patients with neurofibromatosis type 1 have an increased incidence of typical neuroendocrine tumors, but it is unknown if this is the case with goblet cell carcinoids. We describe a patient with both neurofibromatosis type 1 and goblet cell carcinoid, that according to literature would occur in 0.00017 per million per year. This may suggest a previously unknown association between neurofibromatosis type 1 and goblet cell carcinoids

Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study

Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweigh

Nikotinposer - indhold og miljøkonsekvenser

Posemateriale og indhold. Nikotinposer er typisk fremstillet af en form for semi-syntetisk cellulose (såsom viskose fleece) hvortil der er tilsat et bindemiddel i form af en (bionedbrydelig) polymer, som smelter ved opvarmning og dermed forsegler posens kanter. Indholdet i poserne består ifølge produkternes varedeklarationer af nikotin, stabilisatorer og fortykningsmidler, pH regulerende midler, fugtmidler, smagsstoffer, sødemidler og konserveringsmidler. Ifølge studier beskrevet i litteraturen er der desuden påvist indhold af formaldehyd og ammonium i nogle nikotinposer.Nikotinposer som mulig del af plastforurening. Nikotinposernes semi-syntetiske cellulose-baserede materiale har FTIR-spektre som er sammenlignelige med vådservietter, engangskarklude og cigaretfiltre, som består af henholdsvis viskose og celluloseacetat. Den største grad af lighed mellem spektre blev observeret for cigaretfiltre. På trods af, at cellulose er et naturligt og forholdsvis nedbrydeligt materiale, så vil modifikationer af denne grad påvirke materialets egenskaber og miljøskæbne herunder nedbrydelighed. Af samme grund kan nikotinposer, ligesom cigaretfiltre, potentielt anses som værende en form for semi-syntetisk polymer og dermed ’plast’. Dog er der en flydende overgang fra naturlige til syntetiske polymerer, hvilket udfordrer en entydig kategorisering af forskellige semi-syntetiske materialer, herunder brugte nikotinposer, som værende plastaffald. Nikotinposers miljøskæbne under miljørelevante forhold bør undersøges yderligere og bortskaffelse i naturen bør uanset minimeres.Risiko for mennesker og miljø. Generelle helbredsrisici ved påtænkt brug af nikotinposer indgår ikke i denne rapport, men referencer til relevante kilder fremgår af teksten. I stedet diskuteres potentielle effekter i miljøet. Nikotinposer udgør en potentiel risiko for dyr ved indtagelse. Der findes eksempler på nikotinforgiftning af hunde som har ædt henkastede brugte nikotinposer. Grundet forventet langsom nedbrydning under miljørealistiske forhold kan der over tid ske en akkumulering af nikotinposer i miljøet. Langsigtede konsekvenser af dette, samt risiko for nikotinforgiftning af dyr i naturen, bør undersøges nærmere.Nikotinposer i kontekst af genanvendelse og cirkulær økonomi. Bortskaffelse af tomme nikotinpose dåser med brugte nikotinposer udgør et potentielt problem i forhold til genanvendelse. Dåsen er ofte fremstillet af polypropylen og kan genanvendes. Dog skal de brugte nikotinposer, som opsamles i låget, bortskaffes separat. Dvs. at dåserne skal tømmes inden de sorteres som plastaffald. Det er dog plausibelt at dette ikke altid sker, og at 1) dåserne ikke tømmes inden de sorteres som plastaffald eller 2) dåserne bortskaffes i restaffald. Forbrugsvaner i forhold til bortskaffelse bør undersøges nærmere og behovet for yderligere oplysning af forbrugere kan overvejes på denne baggrund.Fremtidige undersøgelser. Henkastede nikotinposer er et stigende problem grundet stigende forbrug kombineret med uhensigtsmæssig forbrugeradfærd. På trods af at de fleste nikotinposer bliver opsamlet og bortskaffet korrekt, ender en fraktion stadig i miljøet. Fremtidige undersøgelser af brugen af nikotinposer blandt den danske befolkning kan med fordel inkludere spørgsmål om adfærd i forhold til bortskaffelse, for på denne måde at få et estimat af omfanget af henkastede nikotinposer i naturen og i det offentlige rum. Dette kan også give et forbedret grundlag for vurdering af eventuelle miljøkonsekvenser – både af posemateriale men også posernes indhold herunder nikotin

Fokus på sammenhæng mellem klima, sundhed og økonomi er nødvendigt for et bæredygtigt sundhedsvæsen

Source at https://ugeskriftet.dk/debat/fokus-pa-sammenhaeng-mellem-klima-sundhed-og-okonomi-er-nodvendigt-et-baeredygtigt.Bæredygtighed indebærer at tænke langsigtet og i netværk af forbindelser, som i sidste ende har global effekt. Det skal inkluderes i de sundhedsvidenskabelige uddannelser