Which cost of alcohol? What should we compare it against?

This paper explores and develops issues raised by recent debates about the cost of alcohol to England and Wales. It advances two arguments. First, that the commonly used estimates for alcohol harm in England and Wales are outdated, not fully reliable and in need of revisiting. These estimates rely on data that are between 4 and 12 years out of date and sensitive to questionable assumptions and methodological judgements. Secondly, it argues that policymakers, academics and non‐governmental organizations should be more careful in their use of these numbers. In particular, it is imperative that the numbers quoted fit the argument advanced. To help guide such appropriate usage, the different types of cost of alcohol are surveyed, alongside some thoughts on the questions they help us to answer and what they imply for policy. For example, comprehensive estimates of the total social cost of alcohol provide an indication of the scale of the problem, but have limited policy relevance. External cost estimates represent a ‘lowest common denominator’ approach acceptable to most, but require additional assumptions to guide action. Narrower perspectives, such as fiscal, economic or health costs, may be relevant in specific contexts. However, optimal policy should take a holistic view of all the relevant costs and benefits. Similarly, focusing solely on tangible costs may be less controversial, but will result in an under‐estimate of the relevant costs of alcohol.     

Which anti-inflammatory drug should we use in asthma?

Asthma is a chronic and heterogeneous inflammatory disorder of the airways defined by its clinical, physiological and pathological characteristics. Accordingly to currently available guidelines inhaled glucocorticosteroids (ICS) represent the most effective anti-inflammatory medication for the treatment of persistent asthma, and this class of drugs is recommended as the first-line controller therapy both in children and adults. Leukotriene modifiers (LTRAs) are usually used as a second line of add-on therapy, although they may be regarded as the first-line therapy in exercise induced bronchoconstriction, in patients with comorbid allergic rhinitis and in children with asthma and frequent viral infections. A recently published pragmatic (real-life) study showed that LTRAs provide an alternative treatment for asthma, which, at least for the evaluated endpoints, may be as effective as ICS in our every-day practice. To assess how the recent data may affect our every-day practice and current guidelines for clinical management of asthma, it needs to be clearly understood what pragmatic trials add to our knowledge. In our opinion, it is premature to change current guidelines. However, pragmatic and observational studies are clearly needed as they provide additional information to randomized controlled trials. The main goal of all those efforts is to improve asthma control and decrease the burden of the disease for patients and societies. It may be that the future approach will introduce several new strategies based on system biology studies for the treatment of asthma guided in a personalized medicine approach.     

Comparison of Mini-Mental State Examination and Addenbrooke’s Cognitive Examination III in detection of cognitive impairment in patients with type 2 diabetes

International Journal of Diabetes in Developing Countries - There is an increased prevalence of cognitive impairment (CI) in patients with type 2 diabetes; thus, there is a need for a sensitive and...     

Which radiographic techniques should we use for research and clinical practice?

Based upon published data, the different methods of imaging the knee joint are evaluated with respect to the radiographic procedure and anatomical structures recorded in: (1) images from radiographs of the tibiofemoral joint that have been obtained from the non-weight-bearing and weight-bearing extended knee views and the standardized knee flexion positions using fluoroscopy (semi-flexed and Lyon Schuss views) and non-fluoroscopic methods (MTP and fixed flexion); and (2) images from radiographs of the patellofemoral joint obtained from the lateral and the different axial views of the joint. Non-weight-bearing and weight-bearing radiographs of the knee in extension were found to be of limited value in assessing disease status, whereas all standing flexed knee positions reliably imaged joint space width and bone changes in the tibiofemoral joint. Fluoroscopic positioning of the joint is more demanding on equipment and personnel than non-fluoroscopic methods. Skyline rather than lateral views of the patellofemoral joint were better at detecting joint changes in osteoarthritis. It is concluded that for both clinical practice and research purposes the non-fluoroscopic MTP and fixed flexion methods are recommended for imaging the tibiofemoral compartment, and the standing skyline view is recommended for the patellofemoral joint.     

Genetic diagnosis of cancers? Which cancers should be screened?

Our knowledge in the genetic basis of hereditary human cancer has improved over the last 10 years. Molecular diagnoses have become feasible in major hereditary cancer-prone syndromes, as well as in other hereditary diseases in which cancer appears as symptoms or complications. The major cancer-prone syndromes are described here with a table summarizing the links between various cancer types and the genetic syndromes to which they could belong. Clinicians should be aware of these new diagnostic tools. Specific consultations in oncogenetics are being settled to help clinicians and patients in the course of establishing molecular diagnoses, and providing guidelines for a better surveillance of high-risk persons.     

State of the Art: Which Stent for Which Lesion in Peripheral Interventions?

Applications of endovascular procedures have been expanded dramatically throughout the human body for both occlusive and aneurysmal disease; arteries at the aortoiliac and femoropopliteal levels are no exception. Currently, interventional procedures are the 1st treatment option for most patients who have peripheral artery disease. Although balloon angioplasty alone offers good immediate and long-term results, the addition of stents has been proposed to improve the procedural success of angioplasty and extend its application to more patients with vascular disease. Stenting, however, is controversial. Its use is considered acceptable in the aortoiliac vessels but is more in dispute for the femoropopliteal vessels. Moreover, the rapid development of endovascular stents for peripheral applications has made stent selection a complicated task for clinical practitioners. Many factors influence the type of stent selected; therefore, knowledge of the stents available--including various designs and individual properties--is mandatory. Appropriate selection depends on adequate preprocedural evaluation of the lesion; the choice of approach; the choice of primary versus selective stent placement; the location and characteristics of the lesion; the availability of stents in the intervention suite; and the experience of the operator Several stents are now available, but they are not equivalent; it is important to select the stent that is best suited to the lesion. On the basis of our experience using different types of stents, as well as our review of the world medical literature, we summarize the properties of various stents and specific indications for their application. This report is intended for use as a practical guide to stent selection.     

Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing

BACKGROUND: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. OBJECTIVE: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. SETTING: community settings in Britain. METHODS: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. RESULTS: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) = 2.655-11.364]. CONCLUSION: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations.     

At what wavelengths should we search for signals from extraterrestrial intelligence?

It has often been concluded that searches for extraterrestrial intelligence (SETI) should concentrate on attempts to receive signals in the microwave region, the argument being given that communication can occur there at minimum broadcasted power. Such a conclusion is shown to result only under a restricted set of assumptions. If generalized types of detection are considered—in particular, photon detection rather than linear detection alone—and if advantage is taken of the directivity of telescopes at short wavelengths, then somewhat less power is required for communication at infrared wavelengths than in the microwave region. Furthermore, a variety of parameters other than power alone may be chosen for optimization by an extraterrestrial civilization. Hence, while partially satisfying arguments may be given about optimal wavelengths for a search for signals from extraterrestrial intelligence, considerable uncertainty must remain.