Cardiodiabetology: newer pharmacologic strategies for reducing cardiovascular disease risks.

Globally, nearly 500 million adults currently have diabetes, which is expected to increase to approximately 700 million by 2040. Cardiovascular diseases (CVD), including coronary heart disease, stroke, heart failure, and peripheral arterial disease, are the principal causes of death in persons with diabetes. Key to the prevention of CVD is optimization of associated risk factors. However, few persons with diabetes are at recommended targets for key CVD risk factors including low-density lipoprotein-cholesterol (LDL-C), blood pressure, glycated hemoglobin, nonsmoking status, and body mass index. While lifestyle management forms the basis for the prevention and control of these risk factors, newer and existing pharmacologic approaches are available to optimize the potential for CVD risk reduction, particularly for the management of lipids, blood pressure, and blood glucose. For higher-risk patients, antiplatelet therapy is recommended. Medication for blood pressure, statins, and most recently, icosapent ethyl, have evidence for reducing CVD events in persons with diabetes. Newer medications for diabetes, including sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists, also reduce CVD and SGLT2 inhibitors in particular also reduce progression of kidney disease and reduce heart failure hospitalizations (HFHs). Most importantly, a multidisciplinary team is required to address the polypharmaceutical options to best reduce CVD risks persons with diabetes.

Magnetic Resonance Imaging-Targeted Biopsy and Pretherapeutic Prostate Cancer Risk Assessment: a Systematic Review: Biopsie ciblée par Imagerie par résonance magnétique et évaluation pré-thérapeutique du risque de cancer de la prostate : revue systématique.

INTRODUCTION: Multiparametric magnetic resonance imaging (MRI) has been included in prostate cancer (PCa) diagnostic pathway and may improve disease characterization. The aim of this systematic review is to assess the added value of MRI-targeted biopsy (TB) in pre-therapeutic risk assessment models over existing tools based on systematic biopsy (SB) for localized PCa. EVIDENCE ACQUISITION: A systematic search was conducted using Pubmed (Medline), Scopus and ScienceDirect databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We included studies through October 2021 reporting on TB in pretherapeutic risk assessment models. EVIDENCE SYNTHESIS: We identified 24 eligible studies including 24'237 patients for the systematic review. All included studies were retrospective and conducted in patients undergoing radical prostatectomy. Nine studies reported on the risk of extraprostatic extension, seven on the risk of lymph node invasion, three on the risk of biochemical recurrence and nine on the improvement of PCa risk stratification. Overall, the combination of TB with imaging, clinical and biochemical parameters outperformed current pretherapeutic risk assessment models. External validation studies are lacking for certain endpoints and the absence of standardization among TB protocols, including number of TB cores and fusion systems, may limit the generalizability of the results. CONCLUSION: TB should be incorporated in pretherapeutic risk assessment models to improve clinical decision making. Further high-quality studies are required to determine models' generalizability while there is an urgent need to reach consensus on a standardized TB protocol. Long-term outcomes after treatment are also awaited to confirm the superiority of such models over classical risk classifications only based on SB. © 2022 Elsevier Masson SAS. All rights reserved.

Single-center prognostic validation of the risk assessment of the 2015 ESC/ERS guidelines in patients with pulmonary arterial hypertension in Japan.

The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high risk by using a simplified version of the risk assessment that included seven variables: World Health Organization functional class, 6-min walking distance, peak oxygen consumption, brain natriuretic peptide, right atrial pressure, mixed venous oxygen saturation, and cardiac index. The high-risk group showed significantly higher mortality than the low- or intermediate-risk group at baseline (P < 0.001 for both comparisons), and the mortalities in the intermediate- and low-risk groups were both low (P = 0.989). At follow-up, patients who improved to or maintained a low-risk status showed better survival than those who did not (P = 0.041). Our data suggest that this risk assessment can predict higher mortality risk and long-term survival in PAH patients in Japan.

A new approach to the management of emerging diseases of aquatic animals.

Since 1970, aquaculture has grown at a rate of between 5% and 10% per annum. It has achieved this by expanding into new areas, farming new (often non-native) species and intensifying production. These features of aquaculture, combined with large-scale movements of animals, have driven disease emergence, with negative consequences for both production and biodiversity. Efforts to improve the management of emerging diseases of aquatic animals must include actions to reduce the rate of disease emergence, enhance disease detection and reporting, and improve responses to prevent disease spread. The rate of disease emergence can be reduced by understanding the underpinning mechanisms and developing measures to mitigate them. The three principal mechanisms of disease emergence, namely, host switching, decreased host immunocompetence and increased pathogen virulence, have many drivers. The most important of these drivers are those that expose susceptible hosts to novel pathogens (e.g. the introduction of non-native hosts, translocation of pathogens, and increased interaction between wild and farmed populations), followed by host switching. Exposure to wild populations can be reduced through infrastructure and management measures to reduce escapes or exclude wild animals (e.g. barrier nets, filtration and closed-confinement technology). A high standard of health management ensures immunocompetence and resistance to putative new pathogens and strains, and thus reduces the rate of emergence. Appropriate site selection and husbandry can reduce the likelihood of pathogens developing increased virulence by preventing their continuous cycling in geographically or temporally linked populations. The under-reporting of emerging aquatic animal diseases constrains appropriate investigation and timely response. At the producer level, employing information and communications technology (e.g. smartphone applications and Cloud computing) to collect and manage data, coupled with a farmer-centric approach to surveillance, could improve reporting. In addition, reporting behaviours must be understood and disincentives mitigated. At the international level, improving the reporting of emerging diseases to the World Organisation for Animal Health allows Member Countries to implement appropriate measures to reduce transboundary spread. Reporting would be incentivised if the global response included the provision of support to low-income countries to, in the short term, control a reported emerging disease, and, in the longer term, develop aquatic animal health services. Early detection and reporting of emerging diseases are only of benefit if Competent Authorities' responses prevent disease spread. Effective responses to emerging diseases are challenging because basic information and tools are often lacking. Consequently, responses are likely to be sub-optimal unless contingency plans have been developed and tested, and decision-making arrangements have been well established.

Depuis les années 1970, l'aquaculture connaît un taux de croissance de 5 % à 10 % par an. Cette croissance a été rendue possible par le développement de nouvelles filières, l'élevage d'espèces nouvelles (et souvent non autochtones) et l'intensification de la production. Ces caractéristiques du secteur, associées à des transferts massifs d'espèces aquatiques ont entraîné l'émergence de maladies nouvelles, avec des effets négatifs aussi bien sur la production que sur la biodiversité. Les efforts d'amélioration de la gestion des maladies émergentes des animaux aquatiques doivent comporter des mesures visant à réduire l'incidence des maladies émergentes, à améliorer la détection et la notification des maladies et à optimiser les réponses déployées en cas de maladies afin d'en prévenir la propagation. Il est possible de réduire le taux d'émergence des maladies dès lors que les mécanismes sous-jacents à leur survenue sont bien compris et que les mesures appropriées sont prises pour les contrecarrer. Les trois principaux mécanismes d'émergence de maladies, à savoir la colonisation de nouveaux hôtes par des agents pathogènes, la baisse de l'immunocompétence des hôtes et la virulence accrue des agents pathogènes ont plusieurs facteurs déclenchants. Parmi ceux-ci, les plus importants sont ceux qui exposent les hôtes sensibles à des agents pathogènes nouveaux (par exemple l'introduction d'espèces hôtes non autochtones, les transferts d'agents pathogènes et les interactions accrues entre les populations sauvages et d'élevage), suivis par la colonisation de nouvelles espèces hôtes par des agents pathogènes. L'exposition aux populations sauvages peut être atténuée au moyen d'infrastructures appropriées et de mesures de gestion visant à limiter les évasions ou à exclure les espèces sauvages (par exemple, filets de retenue, filtration des eaux et technologies de confinement en système fermé). Une gestion sanitaire de haut niveau qualitatif permet de préserver l'immunocompétence et la résistance à de nouveaux agents et souches pathogènes potentiels, réduisant ainsi le taux d'émergence de nouvelles maladies. Une sélection appropriée du site de production et des techniques d'élevage permet de réduire la probabilité que les agents pathogènes puissent acquérir une virulence accrue, en les empêchant de prolonger leur cycle dans des populations spatialement ou temporellement reliées. La sous-déclaration de maladies émergentes des animaux aquatiques limite les possibilités de procéder à des enquêtes appropriées et d'organiser la réponse en temps voulu. Au niveau des producteurs, le niveau de notification peut être amélioré en recourant aux technologies de l'information et de la communication (par exemple les applications sur téléphonie mobile et l'informatique en nuage) pour la collecte et la gestion des données et en leur associant une méthodologie de la surveillance centrée sur l'éleveur. En outre, il est essentiel de comprendre les comportements en matière de notification et d'atténuer les facteurs de dissuasion. Au niveau international, la notification de maladies émergentes à l'Organisation mondiale de la santé animale permet aux Pays membres de mettre en place des mesures appropriées pour réduire leur propagation transfrontalière. Une méthode incitative envisageable pour améliorer la notification consiste à ce que la réponse mondiale prévoie d'apporter aux pays à faible revenu le soutien nécessaire pour que ceux-ci puissent, à court terme, lutter contre chaque maladie émergente notifiée et, à plus long terme, créer des Services nationaux chargés de la santé des animaux aquatiques. La détection précoce et la notification rapide des maladies émergentes ne portent leurs fruits que si les réponses mises en place par les Autorités compétentes empêchent toute propagation de ces maladies. Le déploiement de réponses efficaces en cas de maladie émergente est difficile, car les pays manquent souvent d'informations et d'outils de base. En conséquence, les réponses sont souvent inadéquates, à moins que des plans d'urgence n'aient été élaborés et testés, soutenus par des instruments décisionnels bien établis.

Desde 1970 la acuicultura ha registrado una tasa de crecimiento anual de entre el 5% y el 10%, cosa que ha logrado expandiéndose a nuevos territorios, cultivando nuevas especies (a menudo no autóctonas) e intensificando la producción. Estas características de la acuicultura, combinadas con los desplazamientos a gran escala de animales, han provocado la aparición de enfermedades y su cortejo de efectos negativos sobre la producción y la diversidad biológica. Las iniciativas para gestionar más eficazmente las enfermedades emergentes de los animales acuáticos deben incluir medidas que reduzcan la tasa de aparición de enfermedades, ayuden a detectarlas y notificarlas y mejoren las respuestas destinadas a impedir que se propaguen. La tasa de aparición de enfermedades se puede reducir entendiendo los mecanismos que subyacen al proceso e implantando medidas para contrarrestarlos. Los tres principales de esos mecanismos (a saber, el cambio de hospedador, la menor inmunocompetencia de los organismos hospedadores y la mayor virulencia de los patógenos) resultan de la suma de muchos factores. Los más importantes son aquellos que entrañan la exposición de un hospedador sensible a nuevos patógenos (p.ej. la introducción de hospedadores no autóctonos, el traslado de patógenos y el aumento de las interacciones entre poblaciones salvajes y poblaciones de cultivo) y aquellos que desembocan en un cambio de hospedador. Para reducir los niveles de exposición a poblaciones salvajes se pueden implantar medidas de gestión o de infraestructura que hagan difícil que los animales escapen o los aíslen de la fauna salvaje (como redes de barrera, filtración y tecnología de confinamiento cerrado). Una gestión sanitaria de buena calidad asegura la inmunocompetencia y la resistencia a cepas y patógenos supuestamente nuevos, reduciendo con ello la tasa de aparición de enfermedades emergentes. La selección de emplazamientos apropiados y el uso de métodos de cría convenientes pueden reducir la probabilidad de que los patógenos adquieran mayor virulencia porque evitan la continuidad de sus ciclos reproductivos entre poblaciones conectadas entre sí, ya sea geográfica o temporalmente. La insuficiente notificación de enfermedades emergentes de los animales acuáticos supone un lastre para estudiarlas debidamente y responder a ellas con celeridad. Las soluciones para mejorar los niveles de notificación trabajando desde la propia explotación podrían pasar por el uso de las tecnologías de información y comunicación (como las aplicaciones de teléfono inteligente o la informática «en nube¼) para obtener y gestionar datos, combinado con fórmulas de vigilancia cuya figura central sea el productor. Es preciso además entender los comportamientos ligados al hecho de notificar o no una enfermedad y restar peso a aquellos factores que desincentiven la notificación. A escala internacional, una más eficaz notificación de enfermedades emergentes a la Organización Mundial de Sanidad Animal permite a los Países Miembros aplicar medidas apropiadas para reducir la propagación transfronteriza. Algo que incentivaría la notificación es que entre las medidas mundiales de respuesta estuviera la prestación de apoyo a los países de renta baja para ayudarlos, a corto plazo, a controlar la enfermedad emergente notificada y, a más largo plazo, a dotarse de buenos servicios de sanidad acuícola. La pronta detección y notificación de enfermedades emergentes solo resulta provechosa si la respuesta de las autoridades competentes evita que la enfermedad se propague. Lo que dificulta una respuesta eficaz a las enfermedades emergentes es la frecuente falta de información y herramientas básicas. Lo más probable, por lo tanto, es que las respuestas no sean las idóneas a menos que se tengan elaborados y ensayados planes de emergencia y se tengan bien implantados mecanismos decisorios al respecto.

[Multidisciplinary and systematic preoperatory-assessment in geriatric urologic oncology surgery: Feasibility and results]. / Évaluation pluridisciplinaire préopératoire systématique en chirurgie cancérologique urologique gériatrique : faisabilité et résultats.

INTRODUCTION: The incidence of cancer increases with age, especially for urological cancers. The frailty of the elderly persons may expose them to more postoperative complications resulting in prolonged hospitalization, increased morbidity or even increased mortality, and delayed or impossible return to normal life. In such cases, the benefit of surgery and therefore its realization can be questioned. PATIENTS AND METHOD: This article reports the experience of a pre-operative risk assessment in a population of elderly patients treated for urologic cancer. This retrospective study aims to report the feasibility and the main results of this systematic preoperative multi-professional evaluation. RESULTS: Between April 2016 and February 2017, 31 elderly patients were evaluated. The evaluation revealed: moderate to severe malnutrition in 59 % of cases, a patient judged from a geriatric point of view fit, intermediate or fragile in respectively 25 %, 35 % and 40 % of cases. This evaluation led to propose a modification of an element of care for 66 % of patients and to propose therapeutic abstention for only 3 patients. CONCLUSION: An evaluation whose purpose is to adapt to the physiological age of patients and their overall state of health, surgical treatment and postoperative management is feasible and seems to help unmask elements of fragility usually not detected. LEVEL OF EVIDENCE: 4.

Biosafety and biosecurity in veterinary laboratories.

With recent outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV), anthrax, Nipah and the highly pathogenic avian influenza virus, much emphasis has been placed on the rapid identification of infectious agents globally. As a result, laboratories are building capacity, conducting more advanced and sophisticated research, increasing their staff, and establishing reference collections of dangerous pathogens in an attempt to reduce the impact of infectious disease outbreaks and to characterise disease-causing agents. With this expansion, the global laboratory community has started to focus on laboratory biosafety and biosecurity in order to prevent the accidental and/or intentional release of these agents. Laboratory biosafety and biosecurity systems are used around the world to help to mitigate the risks posed by dangerous pathogens in the laboratory. Veterinary laboratories carry unique responsibilities with regard to workers and communities to handle disease-causing microorganisms safely and securely. Many microorganisms studied in veterinary laboratories not only infect animals, but also have the potential to infect humans. This paper will discuss the fundamentals of laboratory biosafety and biosecurity.

Suite aux nombreux foyers récents dus à divers agents pathogènes (coronavirus responsable du syndrome respiratoire du Moyen-Orient [MERS-CoV], agent de la fièvre charbonneuse, virus Nipah, virus de l'influenza aviaire hautement pathogène), la nécessité d'identifier rapidement les agents pathogènes en n'importe quel endroit de la planète est désormais au centre des préoccupations. Par conséquent, les efforts des laboratoires sont axés sur le renforcement des capacités, la conduite de travaux de recherche de pointe de plus en plus spécialisés, l'accroissement des effectifs et l'élaboration de référentiels d'agents pathogènes dangereux dans le but de réduire l'impact des foyers de maladies infectieuses et de caractériser les agents responsables de ces maladies. Dans ce contexte d'activité accrue, le réseau international des laboratoires a commencé à accorder une grande importance aux questions de biosûreté et de biosécurité afin de se prémunir contre le risque de libération accidentelle et/ou délibérée de ces agents pathogènes. Les systèmes de biosécurité et de biosûreté sont appliqués dans le monde entier pour contribuer à l'atténuation des risques liés aux agents pathogènes dangereux détenus par les laboratoires. Les laboratoires vétérinaires ont à l'égard de leur personnel et de la société tout entière la responsabilité majeure de garantir la sécurité et la sûreté de la manipulation des microorganismes pathogènes. En plus d'infecter les animaux, nombre des microorganismes analysés dans les laboratoires vétérinaires ont également un potentiel zoonotique. Les auteurs examinent les aspects essentiels de la biosécurité et de la biosûreté au laboratoire.

Los recientes brotes de coronavirus del síndrome respiratorio de Oriente Medio (MERS-CoV), carbunco bacteridiano, virus de Nipah y virus de la influenza aviar altamente patógena han llevado a hacer especial hincapié en la rápida identificación de agentes infecciosos a escala mundial. Obrando en consecuencia, los laboratorios están dotándose de medios de acción, llevando a cabo investigaciones más avanzadas y sofisticadas, reforzando su plantilla y creando colecciones de referencia de patógenos peligrosos con la voluntad de reducir los efectos de los brotes infecciosos y caracterizar a los agentes patógenos. Al mismo tiempo, en todo el mundo los profesionales del ramo han empezado a prestar atención a la seguridad y la protección biológicas en el laboratorio, con el fin de prevenir toda liberación accidental y/o deliberada de los mencionados agentes. Los laboratorios del mundo entero emplean sistemas de seguridad y protección biológicas como elemento auxiliar para reducir los riesgos derivados de la presencia de patógenos peligrosos en sus instalaciones. Los laboratorios veterinarios tienen una especial responsabilidad para con los trabajadores y las poblaciones por lo que respecta a la manipulación de microorganismos patógenos en las debidas condiciones de seguridad y protección. Muchos de los microorganismos estudiados en los laboratorios veterinarios infectan no solo a los animales, sino también, en potencia, al ser humano. Los autores examinan los aspectos fundamentales de la seguridad y la protección biológicas en laboratorio.

International health threats and global early warning and response mechanisms.

The global community continues to incur the high costs of crisis mitigation and emergency response to outbreaks of emerging infectious diseases, such as those caused by the H5N1 highly pathogenic avian influenza virus, Ebola virus, Nipah virus, Zika virus or the Middle East respiratory syndrome coronavirus. These viruses are particularly dangerous in regions associated with poor development indicators and high vulnerability. The drivers of these disease crises include failures in the way that animal diseases are detected and reported and failures in the way in which disease response is implemented by animal health and public health systems. In addition, the lack of a coordinated response hampers disease control efforts. A comprehensive approach for disease prevention, detection and response, however, requires a coordinated and joint effort among governments, communities, donors and international networks to invest effectively in prevention systems that can identify early signals of the emergence, spillover and spread of animal pathogens at the local level. These signals include trade bans, market closures, civil unrest, heavy rains and droughts associated with climate change, and livestock intensification or changes in consumer behaviour. The global community needs to increase its investment in early warning and detection systems that can provide information that enables action to be taken at the national, regional and global levels in the event of an outbreak of a transboundary animal disease (TAD). Like any preventive measure, an early warning system requires financial resources, but these are insignificant when compared to the losses that are avoided. Building a global early warning and effective response system for outbreaks is value for money, as the benefits far outweigh the costs. The goal of the Food and Agriculture Organization of the United Nations (FAO) is to end hunger and poverty, which is a challenging and complex task. Building global capacity to prepare for and respond to TADs is an important element of the FAO's strategic objective to increase the resilience of livelihoods to threats and crises. Each year, livestock, and the people who rely upon them for their livelihoods, are confronted with animal disease and crises. They can strike suddenly, causing obvious illness and death, or emerge insidiously and become well established before becoming apparent. Animal disease emergencies threaten the production of, and access to, food; consequently, one of the FAO's missions is to help countries to prepare for and respond to animal health disasters.

La communauté mondiale continue à supporter le coût élevé de l'atténuation des crises ainsi que des réponses apportées en urgence aux foyers de maladies infectieuses émergentes, par exemple les infections dues au virus H5N1 de l'influenza aviaire hautement pathogène, au virus Ebola, au virus Nipah, au virus Zika ou au coronavirus responsable du syndrome respiratoire du Moyen-Orient. Ces virus sont particulièrement dangereux dans les régions les plus vulnérables et dont les indicateurs de développement sont bas. Les défaillances dans la détection et la notification des maladies animales jouent un rôle déterminant dans ces crises sanitaires, de même que l'incapacité des systèmes de santé animale et publique à mettre en œuvre une réponse sanitaire appropriée. En outre, l'absence de coordination dans les réponses apportées affaiblit les efforts pour lutter contre les maladies. La mise en place d'une méthode de prévention, de détection et de réponse intégrée face aux maladies exige que les gouvernements, les communautés, les donateurs et les réseaux internationaux associent leurs efforts et se concertent afin d'investir efficacement dans des systèmes de prévention capables de détecter à l'échelle locale les tout premiers signes d'émergence d'un agent pathogène chez les animaux, de sa transmission à d'autres espèces et de sa propagation. Parmi ces signes révélateurs on peut citer certaines interdictions d'importer, mais aussi la fermeture des marchés, l'existence de troubles civils, les changements climatiques tels que de fortes précipitations ou une sécheresse prolongée et la modification de certaines tendances en production animale ou du comportement des consommateurs. La communauté mondiale doit investir davantage dans des systèmes d'alerte précoce et de détection afin d'obtenir l'information nécessaire pour prendre des mesures appropriées, à l'échelle nationale, régional et mondiale, en cas d'apparition d'une maladie animale transfrontalière. Comme toute mesure de prévention, les systèmes d'alerte précoce doivent être correctement financés, mais cet effort est insignifiant lorsqu'on le compare aux pertes qu'il permet d'éviter. La création d'un système mondial d'alerte précoce et de réponse en cas de foyers constitue un investissement rentable, qui génère des bénéfices bien supérieurs à ses coûts. L'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO) a pour objectif de mettre un terme à la faim et à la pauvreté dans le monde, ce qui constitue une tâche complexe et difficile. Le renforcement des capacités mondiales de préparation et de réponse en cas de maladies animales transfrontalières est un aspect important des objectifs stratégiques de la FAO visant à accroître la résilience des moyens d'existence face aux crises et aux menaces. Chaque année, le cheptel domestique et les personnes qui en tirent leur subsistance sont confrontés à des maladies animales et à des crises sanitaires. Celles-ci peuvent se déchaîner brutalement et présenter un tableau clair de morbidité et de mortalité, ou bien émerger de manière insidieuse et se propager avant l'apparition de signes manifestes. Puisque la production et l'accès aux denrées alimentaires sont menacés par les catastrophes sanitaires dues aux maladies animales, l'une des missions de la FAO consiste à aider les pays à répondre à ces catastrophes et à s'y préparer.

La comunidad mundial sigue soportando los elevados costos de las actividades de atenuación de crisis y de respuesta de emergencia ante brotes de enfermedades infecciosas emergentes como los causados por el virus de la influenza aviar altamente patógena H5N1, el del Ébola, el Nipah, el Zika o el coronavirus del síndrome respiratorio de Oriente Medio. Estos virus resultan especialmente peligrosos en regiones que presentan indicadores de desarrollo mediocres y un elevado nivel de vulnerabilidad. Entre los factores que subyacen a estas crisis sanitarias están las deficiencias en la forma de detectar y comunicar estas enfermedades y la inadecuada aplicación de medidas de respuesta por parte de los sistemas de salud pública y sanidad animal. Por añadidura, la ausencia de una respuesta coordinada lastra también las actividades de lucha. Un trabajo integral de prevención y detección de enfermedades y de respuesta a ellas exige sin embargo un esfuerzo coordinado y conjunto de gobiernos, poblaciones, donantes y redes internacionales para invertir eficazmente en sistemas de prevención que sirvan para detectar las señales precoces de aparición, extensión y propagación de patógenos animales a nivel local, señales como prohibiciones comerciales, cierres de mercados, desórdenes civiles, cambios climáticos como lluvias o sequías intensas o modificación de la dinámica de producción ganadera o los patrones de consumo. La comunidad mundial debe invertir en mayor medida en sistemas de alerta y detección rápidas que aporten información que pueda traducirse en acciones de ámbito nacional, regional y mundial en caso de brote de una enfermedad animal transfronteriza. Como toda medida de carácter preventivo, un sistema de alerta rápida requiere recursos económicos, pero su cuantía resulta insignificante en comparación con las pérdidas que se evitan. La construcción de un sistema mundial de alerta rápida y respuesta eficaz en caso de brote ofrece gran rentabilidad, por cuanto los beneficios superan holgadamente los costos. La Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO) persigue el objetivo de poner fin al hambre y la pobreza, empresa harto difícil y compleja. Dotar al mundo de la capacidad de preparación y respuesta ante enfermedades animales transfronterizas es un elemento importante del objetivo estratégico de la FAO de lograr que los medios de sustento gocen de mayor resiliencia ante crisis y amenazas. Cada año, los rebaños de animales domésticos y las personas que dependen de ellos para vivir hacen frente a enfermedades y crisis zoosanitarias, que pueden golpear de forma súbita y extender abiertamente la enfermedad y la muerte o, por el contrario, surgir insidiosamente y arraigar antes de que su presencia resulte patente. Las emergencias zoosanitarias hacen peligrar la producción de alimentos y el acceso a ellos. Una de las misiones de la FAO, por consiguiente, es la de ayudar a los países a prepararse para episodios de catástrofe zoosanitaria y a responder a este tipo de eventos cuando se produzcan.

[Assessment of radon-induced health risk for occupants of a house built on uranium ore residue]. / Évaluation des risques sanitaires induits par le radon pour les occupants d'une maison construite sur des résidus de minerais d'uranium.

BACKGROUND: At the request of French public authorities, the Institute of Radiological Protection and Nuclear Safety has assessed the radiological situation of a house built on uranium ore residues in Haute-Vienne and the health risks induced from exposure to radon for all occupants. Classified as a lung carcinogen by the World Health Organization, radon is a proven cause of lung cancer in case of regular inhalation over a long period, and the risk increases with cumulative exposure. METHODS: Radon exposure was reconstructed for various standard profiles of house occupancy. A risk model derived from a European epidemiological study was used to calculate the lifetime probability of death from lung cancer according to these standard profiles. RESULTS: Risk assessment of the occupants of the house highlighted the following main findings. For a resident school child having been exposed to radon from birth to the age of 7, the lifetime relative risk (LRR) was estimated at 5. For last adult and young adult residents having lived more than 10years in the house, the probability of death from lung cancer was in the same order of magnitude as that of a regular cigarette smoker, with a LRR from 10 to 13 and a lifetime probability of death from lung cancer between 3 and 4%. If these individuals smoked regularly, in addition to being exposed to radon, this probability would be between 6 and 32% (supposing an additive or multiplicative interaction). CONCLUSION: For former occupants (non-smokers) having been exposed 10years during childhood, the LRR was two-fold lower. For children having been in day care in the house, the increased probability of death from lung cancer was low, with a LRR lower than 2. Supposing, as in adults, that the risk decreases beyond 30years after the end of radon exposure, the increase was almost zero for former occupants exposed during childhood and during day care, with a LRR close to 1.

Integrating groundwater into land planning: a risk assessment methodology.

Generally, groundwater is naturally of good quality for human consumption and represents an essential source of drinking water. In Canada, small municipalities and individuals are particularly reliant on groundwater, since they cannot afford complex water treatment installations. However, groundwater is a vulnerable resource that, depending on its characteristics, can be contaminated by almost any land use. In recent decades, governments have launched programs to acquire more information on groundwater, in order to better protect it. Nevertheless, the data produced are rarely adequate to be understood and used by land planners. The aim of this study was to develop a method that helps planners interpret hydrogeological data in the Province of Quebec, Canada. Based on the requests and needs of planners during semi-directed interviews, a methodology was developed to qualitatively evaluate groundwater contamination risk by land uses. The method combines land planning data and hydrogeological data through the MACBETH multicriteria analysis method, to obtain maps of groundwater contamination risk. The method was developed through group and individual meetings with numerous hydrogeology, land planning, water's economics and drinking water specialists. The resulting maps allow planners to understand the dynamics of groundwater within their territory, identify problem areas where groundwater is threatened and analyse the potential impact of planning scenarios on the risk of groundwater contamination.

[Predicting bipolar disorder: what can we learn from prospective cohort studies?]. / Prédire le trouble bipolaire : que pouvons-nous apprendre des études prospectives de cohortes ?

INTRODUCTION: Bipolar disorder (BD) is a life course illness; and there is increasing awareness of the many personal, social and economic consequences of the illness in older adults. However, it is important to emphasize that BD usually begins in late adolescence or early adulthood and 75 % cases have a first episode in this age period. This early onset and the associated level of disability mean that BD is the 4th leading cause of global disease burden in adolescents and young adults. Internationally, mental health services are increasingly striving to diagnose and treat BD as early as possible to try to prevent poor outcomes. In addition, researchers are using methods employed previously in psychosis studies as these may help us to recognise the earliest manifestations of BD. If it is possible to identify sub-threshold and 'ultra high risk' syndromes for BD, this might lead to new interventions that could target the prevention of first episodes of mania. One approach to understanding these risk syndromes is to examine prospective community cohort studies and BD offspring studies. METHODS: This paper reviews prospective cohort studies that identify robust risk factors in early illness onset, which was defined as age at onset of BD between 15-25 years. RESULTS: We found that although > 50 % of individuals who developed BD had developed a putative BD prodrome prior to 14 years of age, this usually began with non-specific symptoms that overlap with similar presentations for those who later develop psychosis or severe depression. However, there are some features that seem to better identify groups with a BD "at-risk" syndrome. This syndrome is frequently composed of several factors such as mood lability, depressive episodes, prior anxiety, sleep and/or conduct disorders, attention and concentration impairment, altered energy patterns, and a family history of mania and/or depression. The course of these early predictors suggests the precursor syndromes are composed of mini-clusters of symptoms many of which are episodic and change over time. During the early phases of BD, most of the affective disturbances reported were depressive in polarity and started during adolescence, there were few manic or mixed or psychotic episodes with an onset before puberty. The pathogenesis of BD demonstrates a gradual progression from non-specific to more specific symptoms and then to frank BD features. CONCLUSION: Prospective community and offspring BD cohort studies are approaches that together can help us understand the evolution of BD and allow us to define the developmental pathways. Further, identifying subjects with BD "at-risk" syndrome using a clinical staging model may allow benign interventions to be used as first-line treatment - such as neuroprotective agents like essential fatty acids; second line treatments, with a less benign risk to benefit ratio should be reserved for severe or resistant cases.

Perspectives and strategies of alternative methods used in the risk assessment of personal care products.

Risk assessment for personal care products requires the use of alternative methods since animal testing is now totally banned. Some of these methods are effective and have been validated by the "European Union Reference Laboratory for alternatives to animal testing"; but there is still a need for development and implementation of methods for specific endpoints. In this review, we have focused on dermal risk assessment because it is the prime route of absorption and main target organ for personal care products. Within this field, various areas must be assessed: irritation, sensitisation and toxicokinetic. Personal care product behaviour after use by the consumer and potential effects on the environment are also discussed. The purpose of this review is to show evolution and the prospects of alternative methods for safety dermal assessment. Assessment strategies must be adapted to the different chemical classes of substances studied but also to the way in which they are used. Finally, experimental and theoretical technical parameters that may impact on measured effects have been identified and discussed.

Association Between Parental Type 1 and Type 2 Diabetes Diagnosis and Major Osteoporotic Fracture Risk in Adult Offspring: A Population-Based Cohort Study.

OBJECTIVES: Previous research suggests an intergenerational influence of diabetes on bone health. We examined the association between parental diabetes and major osteoporotic fracture (MOF) risk in offspring. METHODS: This population-based cohort study used de-identified administrative health data from Manitoba, Canada, which capture population-level records of hospitalizations, physician visits and drug dispensations. The cohort included individuals ≥40 years of age with at least 1 parent identified in the data between 1997 and 2015. The exposure was parental diagnosis of diabetes since 1970; the outcome was offspring incident MOF diagnosis of the hip, forearm, spine or humerus. Both measures were identified from hospital and physician visit records using validated case definitions. Multivariable Cox proportional hazards regression models tested the association of parental diabetes and offspring MOF risk. RESULTS: The cohort included 279,085 offspring; 48.5% were females and 86.8% were ≤44 years of age. Both parents were identified for 89.4% of the cohort; 36.7% had a parental diabetes diagnosis. During a median follow up of 12.0 (interquartile range, 6.0 to 18.0) years, 8,762 offspring had an MOF diagnosis. After adjusting for fracture risk factors, parental diabetes diagnosis was not associated with MOF risk, whether diagnosed in fathers (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.97 to 1.08), mothers (aHR, 1.02; 95% CI, 0.97 to 1.07) or both parents (aHR, 1.01; 95% CI, 0.93 to 1.11). The results remained consistent in a stratified analysis by offspring sex, secondary analysis based on MOF site and sensitivity analyses. CONCLUSIONS: The results indicate parental diabetes is not associated with offspring MOF risk.

The Performance Assessment of Self-Care Skills to Predict Adverse Events Post-Discharge.

Background. The Performance Assessment of Self-Care Skills (PASS) is a standardized assessment of the ability to perform daily activities. Purposes. This preliminary exploratory study aimed to 1) explore the ability of four PASS tasks to predict adverse events (readmissions and injuries) in older adults following hospitalization; 2) compare PASS's predictive validity to that of a generic tool (SMAF) and OT clinical judgement. Method.Twenty-two older patients were assessed in hospital at discharge and at home one week later. Adverse events were documented for six months post-discharge. Sensitivity and specificity analyses (ROC curves, Fisher's exact tests) were performed. Findings. Two PASS tasks (telephone, medication), the SMAF-Social and OT clinical judgement could identify individuals at risk of readmission (AUC > 0.7; p < 0.05). Implications. Using the PASS to assess more cognitively demanding tasks could be a promising way to predict adverse events after discharge, as a complement to clinical judgment.

Evaluation of screening for myocardial ischaemia in women at cardiovascular risk.

BACKGROUND: Cardiovascular disease is the primary cause of death in women. Prevention, screening and diagnosis are generally implemented at later stages and less frequently than in men, and provision of treatment is not optimal in women. AIMS: To assess the relevance of targeted screening for myocardial ischaemia in women with multiple risk factors, and to identify which specific factors target women more effectively. METHODS: We undertook a prospective observational study with retrospective data collection based on a cohort of symptomatic or asymptomatic women with multiple cardiovascular risk factors. All women underwent non-invasive diagnostic testing through the "Heart, arteries and women", healthcare pathway available at Lille University Hospital, between 1 January 2013 and 30 June 2014. RESULTS: Screening was positive in 15.7% of the 287 participants. Thirty women had a coronary angiography: of these, 22 (73.3%) had no evidence of obstructive coronary artery disease. The independent predictive factors for positive screening were >5 years since menopause (odds ratio [OR] 3.9; P=0.0016); high-density lipoprotein cholesterol ≤0.5g/dL (OR 2.3; P=0.0356); and body mass index ≥30kg/m2 (OR 3.7; P=0.0009). Symptoms were predictive of positive screening (P=0.010), but were mostly atypical. Based on these observations, we developed a clinical coronary score to target screening more efficiently (area under the curve 0.733). Positive screening resulted in low rates of revascularization (16.6%), but a significant increase in the prescription of statins (P=0.002), antiplatelet agents (P<0.0001) and beta-blockers (P=0.024). CONCLUSION: Screening for myocardial ischaemia among selected women at risk of cardiovascular disease can be useful to improve medical treatment.

Agreement between the new EuroSCORE II, the Logistic EuroSCORE and the Society of Thoracic Surgeons score: implications for transcatheter aortic valve implantation.

BACKGROUND: The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). AIMS: To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. METHODS: From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. RESULTS: Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. CONCLUSIONS: A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.

Simple bedside clinical evaluation versus established scores in the estimation of operative risk in valve replacement for severe aortic stenosis.

BACKGROUND: The operative risk of cardiac surgery is ascertained preoperatively on the basis of scores validated in multinational studies. However, the value they add to a simple bedside clinical evaluation (CE) remains controversial. AIMS: To compare operative mortality (defined as death from all causes before the 31st postoperative day) predicted by CE with that predicted by additive and logistic EuroSCOREs, EuroSCORE II and Society of Thoracic Surgeons (STS), Ambler and age-creatinine-ejection fraction (ACEF) scores in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis. METHODS: Overall, 314 consecutive patients were included who underwent AVR between October 2009 and November 2011 (22% with coronary artery bypass graft); mean age 73.4 ± 9.7 years (29% aged>80 years). Based on CE, patients were divided into four predefined groups of increasing estimated mortality risk: I ≤ 3.9%; II 4-6.9%; III 7-9.9%; IV ≥ 10%. The positive and negative predictive values of the six scores and CE were compared. RESULTS: The observed overall operative mortality was 5.7%. The distribution of the four predicted mortality groups by each score was highly variable. The positive predictive value, calculated for the 64 patients classified at highest risk by CE (groups III or IV) or each score, was 17.2% for EuroSCORE II, 14.1% for CE and STS scores, 10.9% for additive and logistic EuroSCOREs, 10.6% for ACEF and 10.2% for Ambler. The positive predictive value of each score in the low-risk groups (I and II) ranged from 2.8% to 4.4%. CONCLUSION: A simple bedside CE appears as reliable as the various established scores for predicting operative risk in patients undergoing surgical aortic valve replacement. The development and validation of more comprehensive risk stratification tools, including risk factors thus far neglected, seems warranted.