Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients.

BACKGROUND: Studies across healthcare systems have demonstrated between-hospital variation in survival after an emergency laparotomy. We postulate that this variation can be explained by differences in perioperative process delivery, underpinning organisational structures, and associated hospital characteristics. METHODS: We performed this nationwide, registry-based, prospective cohort study using data from the National Emergency Laparotomy Audit organisational and patient audit data sets. Outcome measures were all-cause 30- and 90-day postoperative mortality. We estimated adjusted odds ratios (ORs) for perioperative processes and organisational structures and characteristics by fitting multilevel logistic regression models. RESULTS: The cohort comprised 39 903 patients undergoing surgery at 185 hospitals. Controlling for case mix and clustering, a substantial proportion of between-hospital mortality variation was explained by differences in processes, infrastructure, and hospital characteristics. Perioperative care pathways [OR: 0.86; 95% confidence interval (CI): 0.76-0.96; and OR: 0.89; 95% CI: 0.81-0.99] and emergency surgical units (OR: 0.89; 95% CI: 0.80-0.99; and OR: 0.89; 95% CI: 0.81-0.98) were associated with reduced 30- and 90-day mortality, respectively. In contrast, infrequent consultant-delivered intraoperative care was associated with increased 30- and 90-day mortality (OR: 1.61; 95% CI: 1.01-2.56; and OR: 1.61; 95% CI: 1.08-2.39, respectively). Postoperative geriatric medicine review was associated with substantially lower mortality in older (≥70 yr) patients (OR: 0.35; 95% CI: 0.29-0.42; and OR: 0.64; 95% CI: 0.55-0.73, respectively). CONCLUSIONS: This multicentre study identified low-technology, readily implementable structures and processes that are associated with improved survival after an emergency laparotomy. Key components of pathways, perioperative medicine input, and specialist units require further investigation.

Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model.

BACKGROUND: Among patients undergoing emergency laparotomy, 30-day postoperative mortality is around 10-15%. The risk of death among these patients, however, varies greatly because of their clinical characteristics. We developed a risk prediction model for 30-day postoperative mortality to enable better comparison of outcomes between hospitals. METHODS: We analysed data from the National Emergency Laparotomy Audit (NELA) on patients having an emergency laparotomy between December 2013 and November 2015. A prediction model was developed using multivariable logistic regression, with potential risk factors identified from existing prediction models, national guidelines, and clinical experts. Continuous risk factors were transformed if necessary to reflect their non-linear relationship with 30-day mortality. The performance of the model was assessed in terms of its calibration and discrimination. Interval validation was conducted using bootstrap resampling. RESULTS: There were 4458 (11.5%) deaths within 30-days among the 38 830 patients undergoing emergency laparotomy. Variables associated with death included (among others): age, blood pressure, heart rate, physiological variables, malignancy, and ASA physical status classification. The predicted risk of death among patients ranged from 1% to 50%. The model demonstrated excellent calibration and discrimination, with a C-statistic of 0.863 (95% confidence interval, 0.858-0.867). The model retained its high discrimination during internal validation, with a bootstrap derived C-statistic of 0.861. CONCLUSIONS: The NELA risk prediction model for emergency laparotomies discriminates well between low- and high-risk patients and is suitable for producing risk-adjusted provider mortality statistics.

Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction.

BACKGROUND: Small bowel obstruction (SBO) is a common indication for emergency laparotomy. There are currently variations in the timing of surgery for patients with SBO and limited evidence on whether delayed surgery affects outcomes. The aim of this study was to evaluate the impact of time to operation on 30-day mortality in patients requiring emergency laparotomy for SBO. METHODS: Data were collected from the National Emergency Laparotomy Audit (NELA) on all patients aged 18 years or older who underwent emergency laparotomy for all forms of SBO between December 2013 and November 2015. The primary outcome measure was 30-day mortality, with date of death obtained from the Office for National Statistics. Patients were grouped according to the time from admission to surgery (less than 24 h, 24-72 h and more than 72 h). A multilevel logistic regression model was used to explore the impact of patient factors, primarily delay to surgery, on 30-day mortality. RESULTS: Some 9991 patients underwent emergency laparotomy requiring adhesiolysis or small bowel resection for SBO. The overall mortality rate was 7·2 per cent (722 patients). Within each time group, 30-day mortality rates were significantly worse with increasing age, ASA grade, Portsmouth POSSUM score and level of contamination. Patients undergoing emergency laparotomy more than 72 h after admission had a significantly higher risk-adjusted 30-day mortality rate (odds ratio 1·39, 95 per cent c.i. 1·09 to 1·76). CONCLUSION: In patients who require an emergency laparotomy with adhesiolysis or resection for SBO, a delay to surgery of more than 72 h is associated with a higher 30-day postoperative mortality rate.

Dietary nutritional profile and phenolic compounds consumption in school children of highlands of Argentine Northwest.

The objective of this work was to assess dietary patterns and consumption of phenolic compounds from fruits and vegetables byschoolchildren of high altitude regions from northwest of Argentina. A nutritional survey including food-frequency consumption, 24-h dietary recall and anthropometric measurements was applied to 241 children from 6 to 12years old. The amounts of the different classes of phenolic compounds were established from Food Composition Tables available in phenol-explorer website. Statistics analyses were performed using IBM SPSS 20.0. Nutritional status assessment showed underweight (2.2%), low weight (12.7%), overweight (12.7%) and obesity (7.4%). Mean intake of phenolic compounds was 412mg/day. Most consumed foods were infusions and sugar products, consumption of vegetables, fruits and dairy products were low compared to recommendations for this age. Considering that polyphenols have protective health effects, its low consumption could be a risk of development of chronic non communicable diseases.

Nutritional improvement of corn pasta-like product with broad bean (Vicia faba) and quinoa (Chenopodium quinoa).

In this study, the nutritional quality of pasta-like product (spaghetti-type), made with corn (Zea mays) flour enriched with 30% broad bean (Vicia faba) flour and 20% of quinoa (Chenopodium quinoa) flour, was determined. Proximate chemical composition and iron, zinc and dietary fiber were determined. A biological assay was performed to assess the protein value using net protein utilization (NPU), true digestibility (TD) and protein digestibility-corrected amino acid score (PDCAAS). Iron and zinc availability were estimated by measuring dialyzable mineral fraction (%Da) resulting from in vitro gastrointestinal digestion. Nutritionally improved, gluten-free spaghetti (NIS) showed significantly increased NPU and decreased TD compared with a non-enriched control sample. One NIS-portion supplied 10-20% of recommended fiber daily intake. Addition of quinoa flour had a positive effect on the FeDa% as did broad bean flour on ZnDa%. EDTA increased Fe- and ZnDa% in all NIS-products, but it also impaired sensorial quality.

Prevalence and determinants of the dual burden of malnutrition at the household level in Puna and Quebrada of Humahuaca, Jujuy, Argentina.

OBJECTIVE: The objective of the present study was to identify households in which overweight and underweight coexisted (dual burden of malnutrition) and explore the factors that could be contributing to the dual burden of malnutrition at the household level in this population. STUDY DESIGN: Cross-sectional nutritional survey. METHODS: After applying the exclusion criteria, 136 households were included. Mothers were classified as normal weight or overweight/obese based on body mass index (BMI) cut-off points and children and adolescents were classified as stunted or not based on height-for-age z-score. Households with an obese mother and a stunted children or adolescent were categorized as dual burden households. RESULTS: The prevalence of dual burden household was 12%. Compared with other households, dual burden households tended to have more people living in the house, and the educational level of the head of household was lower. Individuals living in dual burden households showed overall lower energy intakes and were more likely to have inadequate intakes of calcium and iron. CONCLUSIONS: The nutrition transition in this community might be one of the leading causes of the observed dual burden of malnutrition. The results presented here indicate the need to consider whether programs that focus on only one type of nutritional problem come might actually exacerbate the other.

El objetivo del presente estudio fue identificar los hogares en los que coexisten el sobrepeso y bajo peso (doble carga de malnutrición) y explorar los factores que podrían contribuir a la doble carga de malnutrición en los hogares de esta población. Después de aplicar los criterios de exclusión, se incluyeron 136 hogares. Las madres fueron clasificadas como de peso normal o con sobrepeso/ obesidad basado en puntos de corte del índice de masa corporal (IMC), los niños y adolescentes fueron clasificados según z­score de la talla para la edad, si tenían o no retraso en el crecimiento (Stunted). Los hogares con una madre obesa y niños o adolescentes con retraso en el crecimiento fueron clasificados como hogares de doble carga. La prevalencia de hogares con doble carga fue del 12 %. En comparación con los otros hogares, en los hogares con doble carga de malnutrición habitan un mayor número de personas en la casa, y el nivel de educación del jefe de familia fue menor. Las personas que viven en hogares de doble carga mostraron ingestas de energía global más bajas y eran más propensos a tener una ingesta insuficiente de calcio y hierro. Una de las principales causas de la doble carga de malnutrición observada en esta comunidad podría ser la transición nutricional. Los resultados presentados aquí indican la necesidad de considerar a los programas que se centran en un solo tipo de problema nutricional y que en realidad podrían exacerbar el otro.

Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center.

BACKGROUND: Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS: A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS: In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS: Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

Patrón de consumo de la población de los Valles Calchaquíes, Tucumán / Dietary patterns of the Calchaquies Valleys population, Tucumán

El objetivo del trabajo fue analizar el patrón de consumo y evaluar el estado nutricional, y los nutrientes críticos de una muestra representativa de los Valles Calchaquíes (Tucumán). Se encuestó a 113 individuos adultos (n=230; 31,3% hombres y 68,7% mujeres). Mujeres embarazadas y nodrizas fueron excluidas. La ingesta de energía se determinó a partir de un recordatorio de 24 h. Se calculó la adecuación de la ingesta energética (AIE%) y de algunos minerales y vitaminas en base a los criterios propuestos por WHO/FAO/UNU (1985, 2002). La AIE% fue 76,1 para hombres y 86,9% para mujeres. La ingesta energética promedio encontrada fue baja, no compatible con un estado de salud adecuado a largo plazo. Los patrones dietarios mostraron elevado consumo de productos farináceos y azúcares refinadas, bajo consumo de fibras, legumbres y lácteos. Más del 25% de la población presentó riesgo moderado o elevado de ingestas inadecuadas de calcio, hierro, folatos y vitamina E. Conclusión: la sustitución de platos tradicionales por patrones de alimentación tipo occidental y la pérdida de producciones típicas de la Región se refleja en el patrón dietario. Este explicaría las deficiencias de nutrientes observadas. Estos resultados podrían ser el punto de partida para desarrollar programas de producción y conservación de alimentos autóctonos que mejoren la alimentación y cubran las demandas energéticas de la población. Serviría para promover la cultura alimenticia de la región y revalorizar los alimentos regionales.

Patrón de consumo de la población de los Valles Calchaquíes, Tucumán / Dietary patterns of the Calchaquies Valleys population, Tucumán

El objetivo del trabajo fue analizar el patrón de consumo y evaluar el estado nutricional, y los nutrientes críticos de una muestra representativa de los Valles Calchaquíes (Tucumán). Se encuestó a 113 individuos adultos (n=230; 31,3% hombres y 68,7% mujeres). Mujeres embarazadas y nodrizas fueron excluidas. La ingesta de energía se determinó a partir de un recordatorio de 24 h. Se calculó la adecuación de la ingesta energética (AIE%) y de algunos minerales y vitaminas en base a los criterios propuestos por WHO/FAO/UNU (1985, 2002). La AIE% fue 76,1 para hombres y 86,9% para mujeres. La ingesta energética promedio encontrada fue baja, no compatible con un estado de salud adecuado a largo plazo. Los patrones dietarios mostraron elevado consumo de productos farináceos y azúcares refinadas, bajo consumo de fibras, legumbres y lácteos. Más del 25% de la población presentó riesgo moderado o elevado de ingestas inadecuadas de calcio, hierro, folatos y vitamina E. Conclusión: la sustitución de platos tradicionales por patrones de alimentación tipo occidental y la pérdida de producciones típicas de la Región se refleja en el patrón dietario. Este explicaría las deficiencias de nutrientes observadas. Estos resultados podrían ser el punto de partida para desarrollar programas de producción y conservación de alimentos autóctonos que mejoren la alimentación y cubran las demandas energéticas de la población. Serviría para promover la cultura alimenticia de la región y revalorizar los alimentos regionales.(AU)

Folate content and retention in selected raw and processed foods / Contenido de folatos y retención en determinados alimentos crudos y procesados

Adequate intake of folate reduced the risk of abnormalities in early embryonic brain development such as the risk of malformations of the embryonic brain/spinal cord, collectively referred to as neural tube defects (NTDs). Folate is extremely sensitive to destruction by heat, oxidation and UV light. The purpose of this study was to evaluate the use of different extraction procedures and enzymatic treatment to determine folate concentrations in variety of foods using a microbiological assay (MA) with Lactobacillus rhamnosus as the test organism. This study also aimed to evaluate the retention of folate in foods after using different cooking processes. Nine of the most commonly consumed foods in Argentina and that contain folate were analyzed: broccoli, spinach, potato, lentil, soy (raw and boiled); hen whole egg and yolks (raw, boiled and fried); beef liver (raw and cooked); strawberry (raw) and white bread. For this study, rat plasma (RP) and human plasma (HP) conjugases together with acetate and phosphate buffers were tested. In extraction step for all analyses, RP conjugase was selected since it was easily available in our laboratory and small quantities were required. The acetate buffer was chosen since better growth and more reproducible results were obtained in the different conditions assayed. The results allowed the foods to be grouped into a) rich sources of folate: hen eggs, yolks, spinach, soybean (raw) and strawberry (100 and 350mg/100g fresh weight (FW); b) good sources of folate: broccoli (raw), soybean (boiled), lentils (raw) and potato (56 to 83mg/100g FW) and c) moderate sources of folate: broccoli, lentils (boiled), white breads, onions and beef liver (15 to 30mg/100g FW). The folate retention was in the range 14-99% according to both type of food and method of processing. Contents and losses of folate vary widely according to type of food and cooking method.

La ingesta adecuada de folatos reduce el riesgo de las anormalidades en el desarrollo temprano del cerebro embrionario, tales como el riego de malformaciones en el cerebro/médula espinal, conocidas en conjunto como defectos del tubo neural (NTDs). Los folatos son extremadamente sensibles al tratamiento con calor, la oxidación y la luz UV. El objetivo de este trabajo fue evaluar el uso de diferentes procedimientos de extracción y de tratamientos enzimáticos para determinar el contenido de folato en distintos alimentos empleando un método microbiológico que utiliza el microorganismo Lactobacillus rhamnosus. En este trabajo se evaluó también la retención de folatos en alimentos sometidos a diferentes procesos de cocción. Se analizaron 9 de los alimentos que contienen folatos y más comúnmente consumidos en Argentina: brócoli, espinaca, papa, lente ja, soja (crudos y cocidos): huevo entero de gallina y yema (crudo, hervido y frito). Bife de hígado vacuno (crudo y cocido); frutillas (crudas) y pan: blanco. Se probó para este estudio conjugasas de plasma de rata (PR) y de plasma humano (PH) conjuntamente con buffers fosfato y acetato. En la extracción para todos los análisis se escogió la conjugasa de PR por ser accesible para nuestro laboratorio y por que se utiliza en pequeñas cantidades. El buffer acetato fue elegido debido a que se obtuvo resultados más reproducibles y un mejor crecimiento en las diferentes condiciones ensayadas. Los resultados permitieron agrupar los alimentos en: a) fuente rica de folatos: huevo y su yema, espinaca, soja (cruda) y frutilla (100 a 350mg/100g peso fresco); b) fuente buena de folatos: brócoli (crudo), soja (hervidas), lentejas (cruda) y papa (cruda y hervida) (56 a 83mg/100g peso fresco) y c) fuente moderada de folatos: brócoli y lentejas (hervidos), bife de hígado, pan blanco y cebollas (15 a 30mg/100g peso fresco). La retención de folato estuvo en el rango de 14-99% de acuerdo al tipo de alimento y el método de procesado. El contenido de folato y sus perdidas fueron muy variables dependiendo del alimento y del método de cocción empleados.

Photo- and bio-physical characterization of novel violet and near-infrared lipophilic fluorophores for neuronal tracing.

Lipophilic fluorescent dyes have been used to trace neuronal connections because of their ability to diffuse laterally within nerve cell membranes. Given the hundreds to thousands of connections that a typical neuron makes with its neighbours, a diffusion-matched set of spectrally distinct dyes is desirable. To extend a set of these dyes to obtain six independent labels, we have characterized the properties of novel violet and near-infrared candidates. By combining two-photon and confocal microscopy all of these candidates can be imaged using a single Titanium Sapphire laser. Here we present measurements of the two-photon action cross-sections and diffusion properties of the dyes, using either the relative diffusion distance or fluorescence recovery after photobleaching techniques, and demonstrate six-colour neuronal tracing within the spinal cord and brain tissue.

Folate content and retention in selected raw and processed foods.

Adequate intake of folate reduced the risk of abnormalities in early embryonic brain development such as the risk of malformations of the embryonic brain/spinal cord, collectively referred to as neural tube defects (NTDs). Folate is extremely sensitive to destruction by heat, oxidation and UV light. The purpose of this study was to evaluate the use of different extraction procedures and enzymatic treatment to determine folate concentrations in variety of foods using a microbiological assay (MA) with Lactobacillus rhamnosus as the test organism. This study also aimed to evaluate the retention of folate in foods after using different cooking processes. Nine of the most commonly consumed foods in Argentina and that contain folate were analyzed: broccoli, spinach, potato, lentil, soy (raw and boiled); hen whole egg and yolks (raw, boiled and fried); beef liver (raw and cooked); strawberry (raw) and white bread. For this study, rat plasma (RP) and human plasma (HP) conjugases together with acetate and phosphate buffers were tested. In extraction step for all analyses, RP conjugase was selected since it was easily available in our laboratory and small quantities were required. The acetate buffer was chosen since better growth and more reproducible results were obtained in the different conditions assayed. The results allowed the foods to be grouped into (a) rich sources of folate: hen eggs, yolks, spinach, soybean (raw) and strawberry (100 and 350 microg/100 g fresh weight (FW); (b) good sources of folate: broccoli (raw), soybean (boiled), lentils (raw) and potato (56 to 83 microg/100 g FW) and c) moderate sources of folate: broccoli, lentils (boiled), white breads, onions and beef liver (15 to 30 microg/100g FW). The folate retention was in the range 14-99% according to both type of food and method of processing. Contents and losses of folate vary widely according to type of food and cooking method.

A randomised placebo-controlled trial to explore the effect of suppressive therapy with acyclovir on genital shedding of HIV-1 and herpes simplex virus type 2 among Zimbabwean sex workers.

OBJECTIVES: To determine the effect of daily acyclovir on genital shedding of HIV-1 and herpes simplex virus type 2 (HSV-2) in a randomised placebo-controlled trial among rural Zimbabwean sex workers. METHODS: 214 women were recruited and tested for HIV-1 and HSV-2 antibodies, HIV plasma viral load, CD4 lymphocyte count and genital swabs for qualitative detection of HIV-1 and HSV-2 genital shedding. Women were randomly assigned to acyclovir 400 mg twice a day for 12 weeks or matching placebo and were followed weekly to detect HIV-1 or HSV-2 genital shedding. Shedding analyses were only undertaken on 125 women co-infected with HSV-2 and HIV-1. Data were analysed using logistic regression, with random effects modelling used to account for repeated measurements on the same women. RESULTS: All women were randomly assigned to acyclovir or placebo; 125 of whom were co-infected with HIV-1 and HSV-2. 69 women were randomly assigned to acyclovir and 56 to placebo. Although twice daily acyclovir reduced rates of HSV-2 genital shedding, (adjusted odds ratio (AOR) 0.24; 95% CI 0.12 to 0.48; less than p<0.001), it had no effect on the proportion of visits at which HIV-1 shedding was detected (AOR 1.08; 95% CI 0.48 to 2.42; p = 0.9). Adherence varied between participants but even when adherence was high (as determined by pill count and extent of HSV-2 suppression) HIV-1 shedding was not reduced. CONCLUSION: Among these HIV-1 and HSV-2-seropositive women, suppressive acyclovir therapy had no effect on the rate of HIV genital shedding despite a reduction in genital HSV-2. Treatment adherence and its measurement clearly affect the interpretation of these results.

Evaluation of perceived usefulness of activity scheduling in an inpatient depression group.

Recent studies have documented that inpatient care on acute psychiatric wards is ineffective. Government directives suggest that wards should initiate and provide a choice of therapeutic and recreational activities. Priority should be given to effective treatments, such as cognitive behavioural therapy. Homework tasks, such as activity scheduling (AS), form an important part of cognitive behavioural therapy for depression. To address inactivity on the wards and use more evidence-based interventions, a quality improvement project was carried out that implemented AS in an inpatient depression group programme. Both inpatients' and staff's perception of its usefulness was evaluated. Sixteen inpatients completed the Beck Depression Inventory-II, and a questionnaire, which was specifically designed to assess the perceived usefulness of AS. In addition, 14 nursing staff completed a similar questionnaire. Both quantitative and qualitative analyses were carried out. Results showed that all participants found AS useful. Eight inpatients had not engaged in any activity prior to being involved in AS. Most inpatients reported gaining some pleasure and satisfaction out of doing AS and experienced a positive effect on their mood and recovery. While 12 staff expressed interest in learning more about AS, 10 needed more information before carrying it out themselves, and only four had the time to do so. The perceived usefulness of AS will be discussed within the context of a psychiatric inpatient setting.

Developing complex interventions for rigorous evaluation--a case study from rural Zimbabwe.

Much attention has been placed on the need to develop and evaluate complex interventions targeting public health issues, such as reproductive health. However, and as has been the case in the recent past, even well-designed trials will be flawed unless meticulous attention is paid to ensuring the most appropriate intervention is designed and developed. This requires a well-resourced and carefully planned feasibility study, incorporating both formative and process evaluation, with particular attention being paid to the context of the proposed intervention. In this paper, we describe the way in which a feasibility study helped redesign and shape a complex intervention targeting adolescent sexual health in rural Zimbabwe. By using a mixture of in-depth interviews, focus groups and participant observation with pupils, parents, teachers and education officers, we were able to show that the intervention as originally conceived was unlikely to be deliverable. Process evaluation findings from the feasibility study led to substantial changes to both the content and delivery of the proposed intervention, which is now subject to testing for effectiveness in a large community randomized trial.

The 16189 variant of mitochondrial DNA occurs more frequently in C282Y homozygotes with haemochromatosis than those without iron loading.

BACKGROUND: Patients with hereditary haemochromatosis (HH) are usually homozygous for the C282Y mutation in the HFE gene. They have variable expression of iron overload and present with a variety of complications, including liver disease, diabetes, arthropathy, fatigue, and cardiomyopathy. The mitochondrial 16189 variant is associated with diabetes, dilated cardiomyopathy, and low body fat at birth, and might contribute to genetic predisposition in further multifactorial disorders. The objective of this study was to determine the frequency of the 16189 variant in a range of patients with haemochromatosis, who had mutations in the HFE gene. METHODS: Blood DNA was analysed for the presence of the 16189 variant in British, French, and Australian C282Y homozygotes and controls, with known iron status, and in birth cohorts. RESULTS: The frequency of the mitochondrial 16189 variant was found to be elevated in individuals with haemochromatosis who were homozygous for the C282Y allele, compared with population controls and with C282Y homozygotes who were asymptomatic (42/292 (14.4%); 102/1186 (8.6%) (p = 0.003); and 2/64 (3.1%) (p = 0.023), respectively). CONCLUSIONS: Iron loading in C282Y homozygotes with HH was exacerbated by the presence of the mitochondrial 16189 variant.

Assessing health impact assessment: multidisciplinary and international perspectives.

Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion-increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)-that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world.