Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern

Background: Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations. Methods: Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison. Results: A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08). Conclusions: Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community

Gevraagd: betere informatie van de overheid over dreigende ontwikkelingen in het aanbod van drugs

Om het potentieel gevaarlijk aanbod van oude en nieuwe drugs te kunnen opsporen en daarop snel te reageren, werken de lidstaten van de Europese Unie tegenwoordig met een ‘early warning system’. Zo’n systeem moet goed kunnen communiceren. Wij onderzochten de communicatieve prestaties van het Belgische systeem. Het kan beter, zowel wat algemene persberichten betreft als de interactie met specifieke doelgroepen

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Expected Waiting Times at an Intersection with a Green Extension Strategy for Freight Vehicles: An Analytical Analysis

The need for transporting commodities has led to more and more freight vehicles on urban roads. Specific operational constraints of such vehicles could induce non-homogeneities in the smooth movement of traffic, especially at intersections where acceleration/deceleration events occur frequently. This leads to unnecessary wasted time for all vehicles, even in low to moderate traffic conditions. Hence, the literature reports different proposals to enhance the continuity of traffic at intersections. Among them, the green extension strategy has attracted researchers’ attention, owing to its simplicity, flexibility and practicality. In this paper, we propose a new approximate probabilistic model for the expected waiting/wasted time of all vehicles at an intersection with green time extension in low to moderate traffic conditions. Accordingly, the optimal green extension interval that minimizes the total expected waiting time can then be determined in different conditions. The proposed analysis needs few pieces of information (as opposed to microsimulation models conventionally employed to analyze such systems) and is therefore, suitable for quickly deciding on the optimal strategy based on the current situation in a dynamic environment. We have validated our approximate analysis with simulations in the VISSIM simulation tool

Expected Waiting Times at an Intersection with a Green Extension Strategy for Freight Vehicles: An Analytical Analysis

The need for transporting commodities has led to more and more freight vehicles on urban roads. Specific operational constraints of such vehicles could induce non-homogeneities in the smooth movement of traffic, especially at intersections where acceleration/deceleration events occur frequently. This leads to unnecessary wasted time for all vehicles, even in low to moderate traffic conditions. Hence, the literature reports different proposals to enhance the continuity of traffic at intersections. Among them, the green extension strategy has attracted researchers’ attention, owing to its simplicity, flexibility and practicality. In this paper, we propose a new approximate probabilistic model for the expected waiting/wasted time of all vehicles at an intersection with green time extension in low to moderate traffic conditions. Accordingly, the optimal green extension interval that minimizes the total expected waiting time can then be determined in different conditions. The proposed analysis needs few pieces of information (as opposed to microsimulation models conventionally employed to analyze such systems) and is therefore, suitable for quickly deciding on the optimal strategy based on the current situation in a dynamic environment. We have validated our approximate analysis with simulations in the VISSIM simulation tool