Worse than we thought? The AIDS epidemic at the end of the year 2001

HIV/AIDS is a global emergency with far-reaching effects. There is no country that has been left unscathed by the epidemic. It affects all countries socially, economically and culturally. It three-tens development and human security. In spite of our hopes and calculations the situation regarding the world's AIDS epidemic further worsened. Momentarily about 40 million persons live with HIV/AIDS. Their number steadily grows. Globally the worst situation still exists in Sub-Saharan Africa but the fastest growing epidemic is in Eastern-Europe (Russian Federation, Ukraine) which threatens with a possibility of a new and fast wave of epidemic. Although there are new drugs in the clinical practice, the most important task is further on, a vigorous health education, to prevent further catastrophe.     

Can we cut out the meat of the dish? Constructing consumer-oriented pathways towards meat substitution

The shift towards a more sustainable diet necessitates less reliance on foods of animal origin. This study presents data from a representative survey of Dutch consumers on their practices related to meat, meat substitution and meat reduction. The practices reflected a cultural gradient of meat substitution options running from other products of animal origin and conventional meat free meals to real vegetarian meals. To investigate feasible substitution options, a variety of meals without meat were presented using photos, which were rated by the participants in terms of attractiveness and chances that they would prepare a similar meal at home. The results demonstrated the influence of meal formats, product familiarity, cooking skills, preferences for plant-based foods and motivational orientations towards food. In particular, a lack of familiarity and skill hampered the preparation of real vegetarian meals. Based on the findings we propose a diversified understanding of meat substitution and we specify four policy-relevant pathways for a transition towards a more plant-based diet, including an incremental change towards more health-conscious vegetarian meals, a pathway that utilizes the trend towards convenience, a pathway of reduced portion size, and practice-oriented change towards vegetarian meals.     

Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program

Objetive: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking?Methods: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months.Results: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1).Conclusions: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.     

Can supplements help meet the micronutrient needs of the developing world?

Supplementation has many potential advantages over fortification and dietary approaches for improving micronutrient intake. Pregnant and lactating women and infants are most likely to benefit from supplementation. Recent experience with vitamin A supplementation in young children has proved to be remarkably successful. Demonstrated efficacy of vitamin A supplements for improved child survival in many settings and a technical consensus on how to implement interventions were major factors in achieving this success. Bilateral and UN agencies worked together so that in 1999 80 % of children under 5 years of age in the least-developed countries received a vitamin A capsule in the last 6 months. At least one million child lives saved were associated with the increase in coverage in the last 2 years of the 1990s. Experience with Fe-folate supplements has not been as successful. Whilst a technical consensus has been reached on how to implement programmes to control Fe deficiency, the lack of convincing evidence of efficacy of Fe-folate supplements in terms of maternal and child survival outcomes has undoubtedly contributed to the limited pursuit of effective action. A new multiple micronutrient supplement for use amongst women of reproductive age in developing countries has been formulated. UNICEF is employing the supplement in programmes aimed at helping to prevent low birth weight. The new supplement is likely to be more efficacious than Fe-folate supplements for both maternal and child survival and development outcomes. Successful completion of rigorous efficacy trials will be critical for creating the political support needed to achieve universal coverage.     

The analysis of tobacco consumption in Croatia--are we successfully facing the epidemic?

Tobacco is the largest cause of morbidity and mortality. The aim of this study is to analyse several health and economically related indicators of tobacco consumption: smoking prevalence, standardized death rates (SDRs) from lung cancer and the proportion of GDP spent on tobacco in Croatia and other transitional countries--the Czech Republic, Slovakia, Poland, Hungary, Slovenia, Romania, and Bulgaria. The overall smoking prevalence in Croatia decreased by 5.2% during 1994-2005, more among females (-9.9%) than males (-0.3%). There is no significant difference in the smoking prevalence between Croatia (27.4%) and other countries. However, 33.8% of Croatian males smoked during 2002-2005, more than in Romania and the Czech Republic, and less than in Hungary and Poland. The prevalence of female smoking (21.7%) in Croatia is similar to the female smoking prevalence in Poland, the Czech Republic, and Hungary, but male smoking is predominant in all countries. The proportion of smokers among youth is above 20% and it is the highest in the Czech Republic (29.7%), followed by Hungary (26.7%), Slovenia (24.9%), Croatia (24.1%), and Poland (21.5%). The proportion of smokers among girls is higher than among boys in Slovenia, Hungary, the Czech Republic, and Croatia, contrary to Slovakia, Bulgaria, and Poland where boys smoke slightly more. There is no significant difference between the prevalence of smoking among girls in Croatia and Bulgaria, Poland, the Czech Republic, Hungary, Slovenia, and Slovakia. According to the SDR from lung cancer in males (70.3/100,000), Croatia is ranked high assuming the 3rd place, after Hungary (99.7) and Poland (72.0). With a SDR of 15.9/100,000 for females, Croatia is ranked slightly better--5th place. Tobacco consumption continues to be a major public health problem in transitional countries. Croatia conducted several campaigns and programmes in the past. However, results reveal that current anti-tobacco strategies are ineffective in reducing the smoking prevalence among men and youth. Men do not smoke less than a decade ago and, despite the observed decline among women, increasing trends are observed among teenage girls. Croatia should apply a comprehensive approach that would include raising awareness of health risks, restriction of smoking in public places, higher taxing, implementing stricter bans on advertising and promotion of tobacco as well as supporting smoking cessation. This last measure is believed to bring about some results in the medium term in targeted population groups, provided that it is supported by all health professionals. Otherwise, we may expect progress at the population level in the field of social stigmatization of smoking and wider intolerance to second-hand smoke. The full impact of smoking on the population health is yet to be seen and in the future it will undoubtedly remain one of the major contributors to the poor public health situation in Croatia.     

Time to hand over our old way of working?

The European Working Time Directive and the change to shift working have highlighted the need for a high level of continuity of patient care. Continuity of information, through a competent and professional handover allows doctors to be not only made aware of the issues important to each patient's care, but also allows a knowledge-based approach to that patient's management.     

Can the unit world model concept be applied to hazard assessment of both organic chemicals and metal ions?

A unit world model that has the potential to be used for the hazard assessment of both metal ions and organic chemicals is described and discussed, with an emphasis on the problems that arise when treating metal ions. It is based on the steady-state equilibrium criterion model that is designed to simulate the fate of organic chemicals in a 100,000-km(2) region and comprises four well-mixed compartments: Air, water, soil, and sediment. To be applicable to metal ions, modifications are required. The single soil and sediment layers should be replaced by two layers to accommodate aerobic and anaerobic conditions. The more complex and variable partitioning of metals resulting from dependence on pH, redox conditions, ionic oxidation state, and presence of sulfide also must be addressed, but preferably in a separate geochemical model, because these factors can result in nonlinearity. For metals, a dynamic as well as a steady-state model is desirable. It is shown that the resulting model can be applied to both organics and metals. Rather than seeking to apply the hazard criterion of persistence to metal ions, the model can be used to deduce a critical loading that results in a defined toxic end point, thus integrating the hazard criteria of persistence, toxicity, and possibly, bioaccumulation. This approach is applied illustratively to naphthalene as a typical organic substance and to four environmentally relevant metal ions. Results are discussed and recommendations made for further development. Specifically, the absence of metal degradation can result in large, steady-state quantities in soils and sediments corresponding to residence times of many centuries. Consequently, the dynamic calculations are more relevant for fate assessments of metals over a period of years, and more focus on the aquatic environment is justified.     

Can research change the way MDs practice medicine?

Health care clinicians are inundated with data from health services research, and many providers are pioneering local applications of the research findings. But are the fruits of this data revolution finding practical application at the patient's bedside? In many cases, yes. A significant number of health care executives and physicians are pioneering programs that bring the lofty goals and methods of national health services research down to "real world" applications appropriate for their hospitals. Lack of applicability is the main reason community hospitals have been slow to use health services research generated at teaching hospitals, say experts. Now, that is changing. Executives are finding that the exacting work required to design tailored clinical appropriateness studies for their institution results in improved physician relations and better patient care. "Almost consistently we find that physicians who practice at the high end respond [to this feedback] by altering their practice patterns and cutting the rate at which they perform a particular service or procedure," says Robert Keller, M.D., executive director of the Maine Medical Assessment Foundation.     

Can we, should we, eradicate the meningococcus?

The eradication of infectious agents is an attractive means of disease control that, to date, has been achieved for only one human pathogen, the smallpox virus. The introduction of vaccines against Neisseria meningitidis into immunisation schedules, and particularly the conjugate polysaccharide vaccines which can interrupt transmission, raises the question of whether disease caused by this obligate human bacterium can be controlled, eliminated, or even eradicated. The limited number of meningococcal serogroups, lack of an animal reservoir, and importance of meningococcal disease are considerations in favour of eradication; however, the commensal nature of most infections, the high diversity of meningococcal populations, and the lack of comprehensive vaccines are all factors that suggest that this is not feasible. Indeed, any such attempt might be harmful by perturbing the human microbiome and its interaction with the immune system. On balance, the control and possible elimination of disease caused by particular disease-associated meningococcal genotypes is a more achievable and worthwhile goal.