Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

BACKGROUND: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. METHODS: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. RESULTS: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). CONCLUSIONS: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level.

BACKGROUND: Overweight and obesity prevalence has risen dramatically in recent decades. While it is known that overweight and obesity is associated with a wide range of chronic diseases, the cumulative burden of chronic disease in the population associated with overweight and obesity is not well quantified. The aims of this paper were to examine the associations between BMI and chronic disease prevalence; to calculate Population Attributable Fractions (PAFs) associated with overweight and obesity; and to estimate the impact of a one unit reduction in BMI on the population prevalence of chronic disease. METHODS: A cross-sectional analysis of 10,364 adults aged ≥18 years from the Republic of Ireland National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007) was performed. Using binary regression, we examined the relationship between BMI and the selected chronic diseases. In further analyses, we calculated PAFs of selected chronic diseases attributable to overweight and obesity and we assessed the impact of a one unit reduction in BMI on the overall burden of chronic disease. RESULTS: Overweight and obesity prevalence was higher in men (43.0% and 16.1%) compared to women (29.2% and 13.4%), respectively. The most prevalent chronic conditions were lower back pain, hypertension, and raised cholesterol. Prevalence of chronic disease generally increased with increasing BMI. Compared to normal weight persons, the strongest associations were found in obese women for diabetes (RR 3.9, 95% CI 2.5-6.3), followed by hypertension (RR 2.9, 95% CI 2.3-3.6); and in obese men for hypertension (RR 2.1, 95% CI 1.6-2.7), followed by osteoarthritis (RR 2.0, 95% CI 1.2-3.2). Calculated PAFs indicated that a large proportion of chronic disease is attributable to increased BMI, most noticeably for diabetes in women (42%) and for hypertension in men (30%). Overall, a one unit decrease in BMI results in 26 and 28 fewer cases of chronic disease per 1,000 men and women, respectively. CONCLUSIONS: Overweight and obesity are major contributors to the burden of chronic disease in the population. The achievement of a relatively modest reduction in average BMI in the population has the potential to make a significant impact on the burden of chronic disease.

Comparison of the anesthetic effects of oral transmucosal versus injectable medetomidine in combination with tiletamine-zolazepam for immobilization of chimpanzees (Pan troglodytes).

Seventeen adult chimpanzees (Pan troglodytes) with an average age of 37 yr were immobilized with a combination of tiletamine-zolazepam (TZ) and medetomidine (MED) by one of two modes of delivery. Group A animals received the drug combination intramuscularly at 3 mg/kg and 0.05 mg/kg, respectively. Animals in group B received MED by oral transmucosal administration, meaning oral delivery with presumptive transmucosal absorption. MED at 0.1 mg/kg was mixed with marshmallow crème, and delivery was followed by 3 mg/kg of TZ intramuscularly. Chimpanzees from both groups were recovered after administration of atipamezole at 0.3 mg/kg intramuscularly. All chimpanzees were compliant with oral transmucosal drug administration, although two chimpanzees preferred oral MED mixed with applesauce. All animals exhibited some anxiety and excitatory behavior associated with darting, but this was reduced in group B, which was premedicated with oral transmucosal MED. The mean time from TZ administration to sedation sufficient for human contact was 16.4 and 14.7 min with and without oral transmucosal premedication, respectively. The mean time for recovery for those chimpanzees given oral transmucosal premedication was 13.8 min, which was significantly shorter than the time of recovery for the group not given oral premedication (P = 0.02). Oral transmucosal administration of MED provided light sedation in 16 of 17 chimpanzees to the level of arousable recumbency and a heavier sedation in one chimpanzee with no adverse side effects. TZ combined with MED by either oral transmucosal or injectable administration provided safe, heavy, long sedation with rapid, smooth, uneventful recoveries.

Diagnosis and treatment of Sarcocystis neurona in a captive harbor seal (Phoca vitulina).

A captive harbor seal (Phoca vitulina) presented with partial anorexia, ataxia, and head bobbing, which progressed to complete anorexia, lethargy, and persistent whole-body intention tremors within several days. Response to treatment with ponazuril, serology, and cerebrospinal fluid analysis supported a diagnosis of Sarcocystis neurona. Analysis of serum levels for ponazuril indicated that therapeutic levels could be achieved at a dosage of 5 mg/kg p.o. s.i.d., whereas clinical response was improved at a dosage of 10 mg/kg. Several months after initiation of antiprotozoal therapy, the neurologic signs resolved, although rare intermittent tremors were seen with significant exertion.

Overweight and obesity on the island of Ireland: an estimation of costs.

OBJECTIVES: The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches. METHODS: Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality. RESULTS: The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease. CONCLUSIONS: The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

Chemical immobilization of rhebok (Pelea capreolus) with carfentanil-xylazine or etorphine-xylazine.

Twelve adult rhebok (Pelea capreolus) were immobilized using a combination of 0.4 mg/kg xylazine and either 0.01 mg/kg of carfentanil (n = 6) or 0.01 mg/kg etorphine (n = 6), delivered i.m. using a remote injection system. Induction and recovery times, heart rate, respiratory rate, rectal temperature, oxygen saturation, end-tidal CO2 (ETCO2), anesthetic depth, indirect blood pressure, and arterial blood gases were recorded. Rhebok were not intubated but nasal oxygen was administered. Forty minutes after induction, anesthesia was antagonized with naltrexone and yohimbine. Mean initial heart rate was significantly higher in the carfentanil group than in the etorphine group. Mean initial oxygen saturation was consistent with hypoxia in both the carfentanil group and the etorphine group. In both groups, arterial pH decreased and partial pressure of carbon dioxide increased during the first 15 min of anesthesia, and values were similar in both groups. These findings were consistent with respiratory acidosis and decreased ventilation. Values for respiratory rate, temperature, oxygen saturation, ETCO2, and blood pressure were similar for both groups at all time periods. During the first 5 min of anesthesia, rhebok in the carfentanil group were more responsive to stimuli than rhebok in the etorphine group. After administration of antagonists, time to first arousal was significantly shorter in the etorphine group than in the carfentanil group. Although cardiopulmonary values were similar for the two groups, rhebok in the carfentanil group were at a comparatively lighter plane of anesthesia, and some individuals in this group required additional manual and chemical restraint for medical procedures to be performed. In conclusion, for captive adult rhebok, 0.01 mg/kg of etorphine and 0.4 mg/kg of xylazine are recommended over 0.01 mg/kg carfentanil and 0.4 mg/kg xylazine because of qualitatively better anesthetic episodes and shorter recovery times.

The direct and indirect costs of both overweight and obesity: a systematic review.

BACKGROUND: The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. METHODS: A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. RESULTS: Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. CONCLUSION: A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.

A telomerase enzymatic assay that does not use polymerase chain reaction, radioactivity, or electrophoresis.

A telomerase assay has been developed for high-throughput screening in 96-well microtiter plates. A crude cell lysate which adds telomere repeats to a biotinylated DNA primer is the source of telomerase. The telomerase-extended primer is hybridized to a digoxigenin-labeled telomere antisense DNA probe. The hybrid is further processed by enzyme-linked immunosorbent assay (ELISA) as follows. The biotinylated hybrid is captured on streptavidin-coated microtiter plates. The immobilized hybrid is probed with alkaline phosphatase-antidigoxigenin and detected via chemiluminescent readout. The limit of detection of a chemically synthesized tetra-telomere repeat was about 10 attomoles. Apparent telomerase activity was detected in lysates of 293T cells. The signal to background for the assay (ratio of signal for the complete assay mixture divided by the signal for the assay mixture without primer) was around 10. An automated system that performed unattended runs of up to 17 96-well microtiter plates in 8h was constructed.