The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalit?t'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).     

Time trends and geographic variations for thyroid cancer in New Caledonia, a very high incidence area (1985-1999).

Thyroid cancer incidence in New Caledonia is the highest reported in the world and is approximately 10-fold higher than in most developed countries. We describe the incidence patterns in this country according to histological and sociodemographic characteristics to give clues about potential etiologic factors. Another objective is to see whether the incidence figures are related to enhanced detection of small size carcinomas. The study included all 498 cases of thyroid cancer diagnosed in 1985-1999. Pathology reports were systematically reviewed to determine the histological type of the tumor and the size of the cancerous nodules. The incidence of carcinomas < or =10 mm was taken as an indicator of enhanced detection due to improved screening procedures. The age-standardized incidence rates in 1985-1999 were exceptionally high in Melanesian women (71.4/100,000) and men (10.4/100,000). The incidence increased three-fold in women from 1995 onwards. The increase in incidence was more striking for papillary carcinomas < or =10 mm than for large size carcinomas, but an increased incidence of carcinomas >10 mm was also observed among women. The analysis by municipality of residence in Melanesian women showed that the incidence was twice as high in 1995-1999 in the Loyalty Islands as in the rest of the country. The sharp increase of thyroid cancer incidence in 1985-1999 in New Caledonia was partly related to enhanced detection of small size carcinomas. The elevated incidence of thyroid cancers, as well as the ethnic and geographic disparities, may result from common environmental or lifestyle risk factors that need to be identified.     

99mTc-labeled interleukin 8 for the scintigraphic detection of infection and inflammation: first clinical evaluation.

Interleukin 8 (IL-8) is a chemotactic cytokine that binds with a high affinity to receptors expressed on neutrophils. Previous studies with various animal models showed that (99m)Tc-labeled IL-8 accumulates specifically and rapidly in infectious and inflammatory foci. The aims of the present study were to evaluate the safety of IL-8 in humans and to assess the value of (99m)Tc-IL-8 scintigraphy in patients with suspected localized infections. METHODS: (99m)Tc-IL-8 was intravenously injected at 400 MBq into 20 patients with various suspected localized infections. Patients were monitored for IL-8-related side effects for 4 h. Whole-body imaging was performed directly after injection and at 4 h after injection. Imaging after 24 h was performed for the first 7 patients and for subsequent patients when the results of (99m)Tc-IL-8 scintigraphy at 4 h after injection were normal or equivocal. Blood was drawn at several time points to determine the total number of leukocytes and leukocyte differentiation (all patients) and to determine pharmacokinetics (6 patients). RESULTS: (99m)Tc-IL-8 scintigraphy was performed for 20 patients (13 men and 7 women) with a mean age of 60 y (range, 21-76 y). No significant side effects were noted. Patients had suspected joint prosthesis infections (n = 9), osteomyelitis (n = 8), liver abscess (n = 1), and soft-tissue infections (n = 2). (99m)Tc-IL-8 was rapidly cleared from the blood and most other organs. In 10 of 12 patients with infections, (99m)Tc-IL-8 localized the infection at 4 h after injection. In 1 patient with vertebral osteomyelitis and in 1 patient with an infected knee prosthesis, (99m)Tc-IL-8 scintigraphy results were false-negative. In 8 patients with noninfectious disorders, no focal accumulation of (99m)Tc-IL-8 was found. CONCLUSION: Injection of (99m)Tc-IL-8 is well tolerated. (99m)Tc-IL-8 scintigraphy is a promising new tool for the detection of infections in patients as early as 4 h after injection.     

Mutations in PLCE1 are a major cause of isolated diffuse mesangial sclerosis (IDMS)

Background and objectives. Diffuse mesangial sclerosis (DMS)is a histologically distinct variant of nephrotic syndrome (NS)that is characterized by early onset and by progression to end-stagekidney disease (ESKD). Besides syndromic DMS, isolated (non-syndromic)DMS (IDMS) has been described. The etiology and pathogenesisof DMS is not understood. We recently identified by positionalcloning recessive mutations in the gene PLCE1/NPHS3 as a novelcause of IDMS. We demonstrated a role of PLCE1 in glomerulogenesis.Mutations in two other genes WT1 and LAMB2 may also cause IDMS.We therefore determine in this study the relative frequencyof mutations in PLCE1, WT1 or LAMB2 as the cause of IDMS ina worldwide cohort. Methods. We identified 40 children from 35 families with IDMSfrom a worldwide cohort of 1368 children with NS. All the subjectswere analyzed for mutations in all exons of PLCE1 by multiplexcapillary heteroduplex analysis and direct sequencing, by directsequencing of exons 8 and 9 of WT1, and all the exons of LAMB2. Results. The median (range) age at onset of NS was 11 (1–72)months. We detected truncating mutations in PLCE1 in 10/35 (28.6%)families and WT1 mutations in 3/35 (8.5%) families. We foundno mutations in LAMB2. Conclusions. PLCE1 mutation is the most common cause of IDMSin this cohort. We previously reported that one child with truncatingmutation in PLCE1 responded to cyclosporine therapy. If thisobservation is confirmed in a larger study, mutations in PLCE1may serve as a biomarker for selecting patients with IDMS whomay benefit from treatment.     

Pet birds and risks of respiratory disease in Australia: a review

Objective: Exposure to birds has long been associated with disease in humans. Three respiratory diseases (psittacosis, allergic alveolitis and asthma) were reviewed in association with pet bird ownership with the aim to clarify the spectrum of avian-related respiratory illnesses.
Approach: Nineteen studies were selected for review based on recreational bird exposure in relation to psittacosis, allergic alveolitis and asthma.
Conclusion: Literature reveals little consensus on the relationship between pet bird ownership and respiratory illness.
Implications: Future studies should aim to clarify the spectrum of avian-related illnesses, and to direct the dissemination of public health information to clinicians and members of the public who keep birds as pets.     

Targeted Screening for Chronic Q Fever,the Netherlands

Early detection of and treatment for chronic Q fever might prevent potentially life-threatening complications. We performed a chronic Q fever screening program in general practitioner practices in the Netherlands 10 years after a large Q fever outbreak. Thirteen general practitioner practices located in outbreak areas selected 3,419 patients who had specific underlying medical conditions, of whom 1,642 (48%) participated. Immunofluorescence assay of serum showed that 289 (18%) of 1,642 participants had a previous Coxiella burnetii infection (IgG II titer >1:64), and 9 patients were suspected of having chronic Q fever (IgG I y titer >1:512). After medical evaluation, 4 of those patients received a chronic Q fever diagnosis. The cost of screening was higher than estimated earlier, but the program was still cost-effective in certain high risk groups. Years after a large Q fever outbreak, targeted screening still detected patients with chronic Q fever and is estimated to be cost-effective.     

Darbepoetin, effective treatment of anaemia in paediatric patients with chronic renal failure

Darbepoetin alfa (DA) is a unique long-acting treatment for anaemia in patients with chronic renal failure (CRF). This study assessed the mean dose of DA to achieve and maintain haemoglobin (Hb) levels between 11 g/dl and 13 g/dl in CRF children aged 11 years to 18 years. This observational, prospective study was conducted in 39 patients treated with DA. Twenty-nine patients were switched from recombinant human erythropoietin (r-HuEPO), and ten patients were naive to r-HuEPO. Naive patients received initial doses of 0.45 μg/kg of DA. Switched patients received a dose adjusted to the prior dose of r-HuEPO (200 IU r-HuEPO:1 μg DA). Among the switched patients, 79.3% received dialysis. No naive patients underwent dialysis. Overall, 74% of patients showed increased Hb level, with a mean value of 11.6 ± 1.6 g/dl, using a mean DA dose of 0.63 ± 0.48 μg/kg per week, and 66.7% patients reached the target Hb level. Hb increased in naive patients from 9.5 (95% CI: 7.7, 11.4) to 11.7 (95% CI: 10.9, 12.6) g/dl and in switched patients from 11.1 (95% CI: 10.6, 11.5) to 11.5 (95% CI: 10.8, 12.2) g/dl). Higher doses of DA were needed in the “switched” than in the “naive” patients to maintain Hb levels over 11 g/dl, respectively 0.73 (95% CI: 0.54, 0.92) and 0.34 (95% CI: 0.16, 0.52) μg/kg per week. Our results indicate the doses of DA necessary to treat CRF patients aged 11 years to 18 years. DA was an effective treatment to stabilise CRF patients at extended dosing intervals. A prospective observational study, on behalf of the French Society for Pediatric Nephrology. Preliminary results of this study were published in part as an abstract and presented as a poster at the European Society of Pediatric Nephrology in Istanbul 11–13 September 2005 and at the ASN Renal Week in Philadelphia (Pennsylvania) 8–13 November 2005.     

Preparedness for clinical research during pandemics: a perspective from the Platform for European Preparedness Against (Re-)emerging Epidemics (PREPARE)

Background

A new or re-emerging infectious disease pandemic ranks among the highest priorities for civic contingency planning. Despite advances in preclinical and clinical research methods, patient-centered clinical research is not effectively embedded in outbreak responses to inform clinical management of patients and public health responses. Prefunded clinical research networks offer a solution but require well-specified processes for rapid response. We aimed to define a model for how a prefunded clinical research network, Platform for European Preparedness Against (Re-)emerging Epidemics (PREPARE), could rapidly respond at the earliest stages of a new or re-emerging infectious disease outbreak.