Ideal Cardiovascular Health Index and Its Determinants in a Rural South African Population.

Background: The ideal cardiovascular health index (CVHI) is a measure to summarize cardiovascular (CV) health, and includes smoking, body-mass index, physical activity, blood pressure, glucose, total cholesterol, and diet. Objective: This study aimed to assess CV health using the CVHI and determinants on CV health in a rural African population, and correlate carotid intima-media thickness (CIMT), a surrogate marker for atherosclerosis, with CVHI. Methods: A cross-sectional analysis was performed on baseline data of the Ndlovu Cohort Study, located in rural South Africa. CVHI score (CVHIs) was calculated by the sum of favourable CVHI factors (range 0 to 7). Logistic regression was performed to examine the association of age, sex, HIV-status, education level, employment status, and income with good CV health (5-7 favourable health factors). Mean CIMT was displayed by poor, intermediate and good CV health. Results: The study included 1927 participants with a mean age of 38.7 years (SD ± 12.8). Of the factors contributing to the CVHI, glucose and total cholesterol scored best; diet least good. Average CVHIs for the population was 4.4 (SD ± 1.2) and 53% of the population had a good CV health. Determinants associated with good CV health were younger age, higher educational attainment, and HIV positivity. CVHIs showed good agreement with CIMT. Conclusion: CVHIs showed that more than half of the participants had a good CV health. Agreement between CVHIs and CIMT indicates potential use of CVHIs as a surrogate marker for CV risk. The study highlights the importance of education for health promotion; good CV health in HIV-positive participants may in part be attributed to more frequent health care contact and provision of chronic disease care. Highlights: Good cardiovascular health (CVH) was observed in 53% of the study population.In global comparison, rural African study participants showed a good CVH score.HIV positivity was associated with a good CVH score.CVH score showed good agreement with carotid intima-media thickness.

Ex Vivo Perfusion Treatment of Infection in Human Donor Lungs.

Ex vivo lung perfusion (EVLP) is a platform to treat infected donor lungs with antibiotic therapy before lung transplantation. Human donor lungs that were rejected for transplantation because of clinical concern regarding infection were randomly assigned to two groups. In the antibiotic group (n = 8), lungs underwent EVLP for 12 h with high-dose antibiotics (ciprofloxacin 400 mg or azithromycin 500 mg, vancomycin 15 mg/kg, and meropenem 2 g). In the control group (n = 7), lungs underwent EVLP for 12 h without antibiotics. A quantitative decrease in bacterial counts in bronchoalveolar lavage (BAL) was found in all antibiotic-treated cases but in only two control cases. Perfusate endotoxin levels at 12 h were significantly lower in the antibiotic group compared with the control group. EVLP with broad-spectrum antibiotic therapy significantly improved pulmonary oxygenation and compliance and reduced pulmonary vascular resistance. Perfusate endotoxin levels at 12 h were strongly correlated with levels of perfusates tumor necrosis factor α, IL-1ß and macrophage inflammatory proteins 1α and 1ß at 12 h. In conclusion, EVLP treatment of infected donor lungs with broad-spectrum antibiotics significantly reduced BAL bacterial counts and endotoxin levels and improved donor lung function.

The health status of a village population, 7 years after a major Q fever outbreak.

From 2007 to 2010, The Netherlands experienced a major Q fever outbreak with more than 4000 notifications. Previous studies suggested that Q fever patients could suffer long-term post-infection health impairments, especially fatigue. Our objective was to assess the Coxiella burnetii antibody prevalence and health status including fatigue, and assess their interrelationship in Herpen, a high-incidence village, 7 years after the outbreak began. In 2014, we invited all 2161 adult inhabitants for a questionnaire and a C. burnetii indirect fluorescence antibody assay (IFA). The health status was measured with the Nijmegen Clinical Screening Instrument (NCSI), consisting of eight subdomains including fatigue. Of the 70·1% (1517/2161) participants, 33·8% (513/1517) were IFA positive. Of 147 participants who were IFA positive in 2007, 25 (17%) seroreverted and were now IFA negative. Not positive IFA status, but age <50 years, smoking and co-morbidity, were independent risk factors for fatigue. Notified participants reported significantly more often fatigue (31/49, 63%) than non-notified IFA-positive participants (150/451, 33%). Although fatigue is a common sequel after acute Q fever, in this community-based survey we found no difference in fatigue levels between participants with and without C. burnetii antibodies.

Effects of low dose of tibolone on steroid receptors and Bcl-2 on the postmenopausal endometrium.

OBJECTIVE: A prospective randomized controlled trial was conducted to evaluate the effect of low dose of tibolone on the histology, expression of estrogen (ER) and progesterone receptors (PR) and Bcl-2 protein, in endometrium of postmenopausal women. METHOD: Forty postmenopausal women consented to treatment and were allocated into two groups of 20 women: Group 1 (Control) without hormone replacement therapy (HRT); Group 2 (Tibolone) treatment at the dose of 1.25 mg/day of oral tibolone administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of ER and PR were also measured. RESULTS: Tibolone group showed higher expression of ER, PR and Bcl-2 protein in glandular epithelium and stroma compared to control group. CONCLUSION: Tibolone in a daily dose of 1.25 mg during 24 weeks demonstrated endometrial action that resulted in low proliferation and was shown to lead to atrophic endometrium. It had favorable effects on the postmenopausal endometrium due to its higher immunoexpression of PR and Bcl-2 protein in endometrial glandular epithelium, thereby creating a balance between pro-apoptotic and anti-apoptotic actions.

Influence of antifouling paint on freshwater invertebrates (Mytilidae, Chironomidae and Naididae): density, richness and composition / Influência de revestimentos antiincrustantes em invertebrados aquáticos (Mytilidae, Chironomidae and Naididae): densidade, riqueza e composição

Abstract We conducted a study about invertebrates on artificial substrates with different antifouling paints in order to answer the following questions 1) is there lower accumulation of organic matter on substrates with antifouling paints, 2) is invertebrate colonization influenced by the release of biocides from antifouling paints, 3) is the colonization of aquatic invertebrates positively influenced by the material accumulated upon the substrate surface and 4) is the assemblage composition of invertebrates similar among the different antifouling paints? To answer these questions, four structures were installed in the Baía River in February 1st, 2007. Each structure was composed of 7 wood boards: 5 boards painted with each type of antifouling paints (T1, T2, T3, T4 and T5), one painted only with the primer (Pr) and the other without any paint (Cn). After 365 days, we observed a greater accumulation of organic matter in the substrates with T2 and T3 paint coatings. Limnoperna fortunei was recorded in all tested paints, with higher densities in the control, primer, T2 and T3. The colonization of Chironomidae and Naididae on the substrate was positively influenced by L. fortunei density. The non-metric multidimensional scaling (NMDS) of the invertebrate community provided evidence of the clear distinction of invertebrate assemblages among the paints. Paints T2 and T3 were the most similar to the control and primer. Our results suggest that antifouling paints applied on substrates hinder invertebrate colonization by decreasing the density and richness of invertebrates.

Resumo O estudo dos invertebrados em substrato artificial com diferentes revestimentos antiincrustantes foi realizado com o intuito de responder as seguintes questões 1) Há menor acumulação de material orgânico nos substratos com revestimentos antiincrustantes? 2) A colonização de invertebrados é afetada pela liberação de biocidas dos revestimentos antiincrustantes? 3) A colonização dos invertebrados aquáticos é facilitada por material acumulado sobre a superfície do substrato? 4) A composição da assembléia é similar entre os diferentes revestimentos? Para realização deste estudo, quatro estruturas foram instaladas em 01 de fevereiro de 2007 no rio Baía. Em cada estrutura foram colocadas sete placas de madeira: cinco placas com aplicação de um tipo de revestimentos antiincrustantes (T1, T2, T3, T4 e T5), uma placa apenas com a aplicação do primer (Pr) e a outra placa permaneceu sem aplicação de nenhum revestimento (Cn). Ao final dos 365 dias em que os substratos ficaram submersos observou-se maior acumulação de material orgânico nos substratos dos revestimentos T2 e T3. Limnoperna fortunei foi registrada em todos os revestimentos testados, com maiores densidades encontradas no controle, primer, T2 e T3. A colonização de Chironomidae e Naididae sobre os substratos foi influenciada pela densidade de L. fortunei. A ordenação (NMDS) evidenciou a separação da assembléia de invertebrados entre os revestimentos. Os revestimentos T2 e T3 foram os mais similares ao controle e ao primer. Os resultados obtidos sugerem que revestimentos antiicrustantes aplicados sobre substratos dificultam a colonização de invertebrados, reduzindo a densidade e riqueza de invertebrados.

Influence of antifouling paint on freshwater invertebrates (Mytilidae, Chironomidae and Naididae): density, richness and composition

Abstract We conducted a study about invertebrates on artificial substrates with different antifouling paints in order to answer the following questions 1) is there lower accumulation of organic matter on substrates with antifouling paints, 2) is invertebrate colonization influenced by the release of biocides from antifouling paints, 3) is the colonization of aquatic invertebrates positively influenced by the material accumulated upon the substrate surface and 4) is the assemblage composition of invertebrates similar among the different antifouling paints? To answer these questions, four structures were installed in the Baía River in February 1st, 2007. Each structure was composed of 7 wood boards: 5 boards painted with each type of antifouling paints (T1, T2, T3, T4 and T5), one painted only with the primer (Pr) and the other without any paint (Cn). After 365 days, we observed a greater accumulation of organic matter in the substrates with T2 and T3 paint coatings. Limnoperna fortunei was recorded in all tested paints, with higher densities in the control, primer, T2 and T3. The colonization of Chironomidae and Naididae on the substrate was positively influenced by L. fortunei density. The non-metric multidimensional scaling (NMDS) of the invertebrate community provided evidence of the clear distinction of invertebrate assemblages among the paints. Paints T2 and T3 were the most similar to the control and primer. Our results suggest that antifouling paints applied on substrates hinder invertebrate colonization by decreasing the density and richness of invertebrates.

Resumo O estudo dos invertebrados em substrato artificial com diferentes revestimentos antiincrustantes foi realizado com o intuito de responder as seguintes questões 1) Há menor acumulação de material orgânico nos substratos com revestimentos antiincrustantes? 2) A colonização de invertebrados é afetada pela liberação de biocidas dos revestimentos antiincrustantes? 3) A colonização dos invertebrados aquáticos é facilitada por material acumulado sobre a superfície do substrato? 4) A composição da assembléia é similar entre os diferentes revestimentos? Para realização deste estudo, quatro estruturas foram instaladas em 01 de fevereiro de 2007 no rio Baía. Em cada estrutura foram colocadas sete placas de madeira: cinco placas com aplicação de um tipo de revestimentos antiincrustantes (T1, T2, T3, T4 e T5), uma placa apenas com a aplicação do primer (Pr) e a outra placa permaneceu sem aplicação de nenhum revestimento (Cn). Ao final dos 365 dias em que os substratos ficaram submersos observou-se maior acumulação de material orgânico nos substratos dos revestimentos T2 e T3. Limnoperna fortunei foi registrada em todos os revestimentos testados, com maiores densidades encontradas no controle, primer, T2 e T3. A colonização de Chironomidae e Naididae sobre os substratos foi influenciada pela densidade de L. fortunei. A ordenação (NMDS) evidenciou a separação da assembléia de invertebrados entre os revestimentos. Os revestimentos T2 e T3 foram os mais similares ao controle e ao primer. Os resultados obtidos sugerem que revestimentos antiicrustantes aplicados sobre substratos dificultam a colonização de invertebrados, reduzindo a densidade e riqueza de invertebrados.

Life expectancy of young adults with follicular lymphoma.

BACKGROUND: This study was aimed at investigating the clinical features and outcomes of follicular lymphoma (FL) patients younger than 40 years, which have not been extensively investigated yet. PATIENTS AND METHODS: One hundred and fifty-five patients younger than 40 years were retrospectively studied from a series of 1002 FL patients diagnosed in four different European Oncology Centres (Barcelona, Spain; Bellinzona, Switzerland; London, UK; Novara, Italy) from 1985 to 2010. RESULTS: Patients younger than 40 had a lower incidence of elevated LDH, high beta2-microglobulin, and a high-risk Follicular Lymphoma International Prognostic Index (FLIPI) score, whereas bone marrow involvement and bulky and disseminated lymphadenopathy were more frequent. At a median follow-up of 10 years, younger patients, in comparison with those older than 40, had significantly better overall (OS), cause-specific survival (CSS), and progression-free survival (PFS), with 10-year OS rate of 81% versus 51% (P < 0.0001), 10-year CSS rate of 82% versus 60% (P < 0.0001), and 10-year PFS of 39% versus 24% (P = 0.0098). However, there were no significant CSS and PFS differences in comparison with the patients aged 40-60. In multivariate analysis, having the lymphoma diagnosed in the last two decades and a favourable FLIPI score were associated with a significantly longer PFS and CSS in younger patients, whereas only FLIPI retained statistical significance for OS. CONCLUSIONS: In our series, FL patients younger than 40 have a median OS of 24 years and their outcome seems to be improving over time. However, they still have a significantly shorter life expectancy than that of an age-matched general healthy population.

Reproductive cycle and embryonic development of the gastropod Melampus coffeus (Linnaeus, 1758) (Ellobiidae) in the Brazilian Northeast / Ciclo reprodutivo e desenvolvimento embrionário do gastrópode Melampus coffeus (Linnaeus, 1758) (Ellobiidae) no Nordeste do Brasil

Melampus coffeus belongs to a primitive group of pulmonate mollusks found mainly in the upper levels of the marine intertidal zone. They are common in the neotropical mangroves. Little is known about the biology of this species, particularly about its reproduction. The aim of this study was to 1) characterize the morphology and histology of M. coffeus' gonad; 2) describe the main gametogenesis events and link them to a range of maturity stages; 3) chronologically evaluate the frequency of the different maturity stages and their relation to environmental factors such as water, air and sediment temperatures, relative humidity, salinity and rainfall; and 4) characterize M. coffeus' spawning, eggs and newly hatched veliger larvae. Samples were collected monthly between February, 2007 and January, 2009 from the mangroves of Praia de Arpoeiras, Acaraú County, State of Ceará, northeastern Brazil. The characterization of the gonad development stages was carried out using routine histological techniques. The results of this study show that Melampus coffeus is a simultaneous hermaphrodite. The follicles have masculine and feminine elements, interleaved within the gonad. M. coffeus presents a well-defined synchronous reproductive cycle, showing successive maturation, release and resting periods. The average diameter of the oocytes was negatively correlated with salinity and positively correlated with rainfall. The results show that no reproductive activity occurs during periods of drought. After the dry season, the increasing rainfall levels and reduced salinity lead to the appearance of very dense populations, predominantly composed of small individuals.

Melampus coffeus encontra-se em um grupo primitivo de moluscos pulmonados, primordialmente marinhos, habitantes dos níveis superiores da zona entremarés, comum em manguezais do Oceano Atlântico. Pouco se sabe sobre a biologia da espécie, em especial, sobre a sua reprodução. Os objetivos deste trabalho foram: 1) caracterizar morfo-histologicamente a gônada de M. coffeus; 2) descrever os principais eventos da gametogênese e associá-los a uma escala de estágios de maturidade; 3) avaliar temporalmente a frequência dos estágios de maturidade e sua possível relação com os fatores ambientais, como a temperatura da água, do ar e do sedimento, a umidade relativa, a salinidade e a pluviosidade, e 4) caracterizar a postura, os ovos e a véliger recém-eclodida de M. coffeus. Foram realizadas coletas mensais de fevereiro de 2007 a janeiro de 2009, no manguezal da Praia de Arpoeiras, município de Acaraú-Ceará, na Região Nordeste do Brasil. A caracterização das fases de desenvolvimento da gônada foi realizada utilizando-se técnicas histológicas de rotina. Os resultados deste estudo mostram que Melampus coffeus é um hermafrodita simultâneo. Os folículos apresentam elementos masculinos e femininos, distribuindo-se na gônada intercalados radialmente. M. coffeus apresenta um ciclo reprodutivo sincrônico bem definido, evidenciando-se períodos sucessivos de amadurecimento, de liberação e de repouso. O diâmetro médio dos oócitos apresentou correlação negativa com a salinidade e positiva com a pluviosidade. Os resultados indicam que, nos períodos de estiagem, não há atividade reprodutiva. Após essa estação, quando os valores de pluviosidade aumentam e a salinidade diminui, as populações são bastante densas e predominam indivíduos pequenos.

Paraisópolis: região sul do município de São Paulo: ampliação do acesso universal à atenção primária à saúde com implantação das unidades CAPS III 24h, AMA 24h e UBS/ESF / Paraisópolis: south region of São Paulo

Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada “Virada Social”. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da “Jornada da Saúde” propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras.

Paraisópolis - Região Sul do município de São Paulo - Ampliação do acesso universal à atenção primária à saúde com implantação das unidades CAPS III 24h, AMA 24h e UBS/ESF

Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada “Virada Social”. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da “Jornada da Saúde” propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras

Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population.

Many individuals with hepatitis C virus (HCV) infection are undiagnosed. This study evaluates a risk assessment questionnaire, developed for use online to target blood-screening for HCV. Two hundred and eighty-nine patients with known HCV status completed a written questionnaire on prominent HCV risk factors. Questionnaires generated advice to seek testing if at least one risk factor was reported. Agreement of the testing advice with the HCV status of respondents was evaluated. Subsequently, we validated our questionnaire among 985 patients of an outpatient clinic for sexually transmitted infections. The post-test-probability-of-disease (PTPD) and diagnostic gain (PTPD minus prior probability of disease) were calculated. The questionnaire's sensitivity and specificity were 84.6% and 63.8%, respectively, and higher in the STI clinic patients. The PTPD of positive testing advice was 72.5% given HCV prevalence of 53.0%, yielding a diagnostic gain of 19.5%. Applying the estimated prevalence in the general Dutch population (0.1-0.4%), and the anticipated prevalence in the online project (1.0-6.0%), yielded diagnostic gains of 0.13-0.53% and 1.3-7.0%, respectively. We conclude that our questionnaire succeeded in selecting at-risk individuals as its testing advice agreed well with the HCV status. We suggest that the questionnaire be used online as a selection tool for HCV blood-screening in the general population.

MRSA outbreak at a transplantation unit.

Methicillin-resistant Staphylococcus aureus (MRSA) infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.

Viral hepatitis among men who have sex with men, epidemiology and public health consequences.

Viral hepatitis causes major disease burden worldwide, due to the chronic hepatitis sequelae: cirrhosis and primary liver cancer. Transmission of viral hepatitis is a problem not only in low-income countries, but also in high-income ones where viral hepatitis is a frequently occurring infection among men who have sex with men (MSM). Although the transmission routes of the three main hepatitis viruses, A, B and C, differ, MSM mainly acquire viral hepatitis during sexual contact. Vaccination programmes (only available for hepatitis A and B), raising awareness, and screening can be used to prevent transmission. However, despite the introduction of such methods in many high-income countries, the spread of viral hepatitis among MSM is still ongoing. This paper provides an overview of sexually acquired hepatitis A, B, and C among MSM in high-income countries, using recent insights obtained through molecular epidemiology, with the aim to raise awareness, improve vaccination coverage, and stimulate prevention programs.

Second national serum bank for population-based seroprevalence studies in the Netherlands.

In 2006/2007 a large serum bank was established by means of a cross-sectional population-based study. This serum bank will be used to evaluate the Dutch national immunisation programme (NIP) by serosurveillance and additional immunological and epidemiological research. In this paper we describe the design of this population-based cross-sectional serosurvey and report the participation rates as well as general characteristics of the study population. A similar serum bank was collected in 1995/1996. Dutch inhabitants (aged 0-79 years, men and women) were invited from 40 municipalities throughout the country and also from eight additional municipalities known with low vaccination coverage (LVC). An oversampling of the migrant population was performed. Blood samples were obtained from all participants accompanied with extensive information on demographic and epidemiological data, such as vaccination history, risk factors and travelling. In addition, sociodemographic data are available from individuals who declined to participate (non-response survey). Overall 33% of all invitees were included in this study. The serum bank comprises 6386 sera in the nationwide sample including the extra sample of immigrants (n=646) and 1518 sera from the LVC municipalities. The sera will be analysed for antibodies against all NI P antigens but will also be used for other infectious diseases research. Results of this second serosurveillance study will contribute to the discussion whether it is needed to reconsider the schedule and/or the vaccine components of the current National Immunisation Programme.

Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic.

OBJECTIVES: In January 2007, opt-out HIV testing replaced provider-initiated testing at the sexually transmitted infections (STI) outpatient clinic in Amsterdam, The Netherlands. The effect of the opt-out strategy on the uptake of HIV testing was studied and factors associated with refusal of HIV testing were identified. STUDY DESIGN: Data routinely collected at the STI clinic were analysed separately for men who have sex with men (MSM) and heterosexuals. Logistic regression analysis was used to identify factors associated with opting out. RESULTS: In 2007, 12% of MSM and 4% of heterosexuals with (presumed) negative or unknown HIV serostatus declined HIV testing. Refusals gradually decreased to 7% and 2% by the year end. In 2006, before the introduction of opt-out, 38% of MSM and 27% of heterosexuals declined testing. The proportion of HIV-positive results remained stable among MSM, 3.4% in 2007 versus 3.7% in 2006, and among heterosexuals, 0.2% in 2007 versus 0.3% in 2006. In both groups factors associated with opting out were: age >or=30 years, no previous HIV test, the presence of STI-related complaints and no risky anal/vaginal intercourse. Among heterosexuals, men and non-Dutch visitors refused more often; among MSM, those warned of STI exposure by sexual partners and those diagnosed with gonorrhoea or syphilis refused more often. CONCLUSIONS: An opt-out strategy increased the uptake of HIV testing. A sharp increase in testing preceeded a more gradual increase, suggesting time must pass to optimise the new strategy. A small group of visitors, especially MSM, still opt out. Counselling will focus on barriers such as fear and low risk perception among high-risk visitors considering opting out.

Doença cardiovascular no diabetes melito tipo 1: [revisão] / Cardiovascular disease in type 1 diabetes mellitus: [review]

O risco de doença arterial coronariana (DAC) nos pacientes com diabetes melito tipo 1 (DM1) é conhecido desde o final dos anos 1970, sendo atualmente a principal causa de mortalidade na população adulta com diabetes tipo 1 de longa duração. A patogênese do processo aterosclerótico nesta doença ainda é obscura, acreditando-se que a hiperglicemia desenvolva aí um papel importante, entretanto vários estudos epidemiológicos mostraram que a associação entre doença coronariana e glicemia, em pacientes com DM1 seja fraca. Dados recentes do estudo DCCT/EDIC mostram que o grupo que recebeu tratamento insulínico intensificado durante o DCCT desenvolveu graus menores de aterosclerose, relacionado aos valores reduzidos de HbA1c durante a fase ativa do estudo, com melhor proteção nos pacientes mais jovens e com menor duração da doença. Há também evidências de que os benefícios são maiores nos pacientes sem nefropatia quando comparados aos com doença renal. Outros fatores de risco importante para o desenvolvimento de DAC em pacientes com DM1 são os mesmos descritos para DM2, incluindo os componentes da síndrome metabólica e marcadores de resistência insulínica. Sugere-se que pacientes com DM1 devam ter o melhor controle glicêmico possível, desde o início da sua doença acrescido de vigilância e tratamento rígido dos fatores de riscos clássicos para DAC, principalmente naqueles com história familiar de DM2.

The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.

[Hepatitis C in the Netherlands: sparse data on the current prevalence and the necessity for epidemiological studies and innovative methods for detecting infected individuals]. / Hepatitis C in Nederland: schaarse gegevens over actuele prevalentie en de noodzaak van epidemiologisch onderzoek en innovatieve opsporingsmethoden.

Hepatitis C is a blood-borne virus infection with an estimated 180 million infected individuals worldwide. Hepatitis C virus (HCV) infection may lead to liver failure and cancer of the liver. In 2004, in view of the improved treatment options, the Dutch Health Council again recommended that the groups at risk of HCV infection should be tracked down and informed, and that epidemiological studies should be conducted. Currently, there are few data on the prevalence of HCV infection in the Netherlands. HCV risk groups are (former) injecting drug users, haemodialysis patients and haemophiliacs, people treated with blood or blood products before 1992, people who have undergone certain invasive or medical procedures with insufficiently sterilised instruments, household contacts and partners of HCV-infected individuals and children born to HCV-infected mothers. Insight into the epidemiology of HCV infection in the Netherlands is necessary so that reliable estimates of the magnitude of hepatitis C as a public health problem can be made. Several projects for the detection of HCV infected individuals and epidemiological studies have started in 2007.