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PubMed2003

Numerical determination of personal aerosol sampler aspiration efficiency.

In this work the determination of the aspiration efficiency of personal aerosol samplers, commonly used in occupational exposure assessment, is investigated by means of CFD techniques. Specifically, it will be described a code to calculate the particle trajectories in a given flow field. At the present state the code considers only the effects of the mean flow field on the particle motion, whereas the turbulent diffusion effects are neglected. Comparisons with experimental measurements are also given in the framework of a research contract, supported by the European Community, with several experimental contributions from the participants. The main objective of the European research is to develop a new approach to experimentation with airborne particle flows, working on a reduced scale. This methodology has the advantage of allowing real-time aerosol determination and use of small wind tunnels, with a better experimental control. In this article we describe how the methodology has been verified using computational fluid dynamics. Experimental and numerical aspiration efficiencies have been compared and the influence of gravity and turbulence intensity in full and reduced scale has been investigated. The numerical techniques described here are in agreement with previous similar research and allow at least qualitative predictions of aspiration efficiency for real samplers, taking care of orientation from the incoming air flow. The major discrepancies among predicted and experimental results may be a consequence of bounce effects, which are very difficult to eliminate also by greasing the sampler surface.

Aerosols↗
PubMed2005

An increase in bronchial responsiveness is associated with continuing or restarting smoking.

RATIONALE: Bronchial responsiveness (BHR) has been found to be associated with smoking, atopy, and lower lung function in cross-sectional studies, but there is little information on determinants of change in adults. OBJECTIVES: To analyze change in bronchial responsiveness in an international longitudinal community study. METHODS: The study was performed in 3,993 participants in the European Community Respiratory Health Survey who had bronchial responsiveness measured in 1991-1993, when aged 20 to 44 yr, and in 1998-2002. MEASUREMENTS: Bronchial responsiveness was assessed by methacholine challenge. Serum samples were tested for total IgE, and for specific IgE to four common allergens. Smoking information was obtained from detailed administered questionnaires. Change in bronchial responsiveness was analyzed by change in IgE sensitization, smoking, and lung function, with tests of interaction terms with age and sex. MAIN RESULTS: Continuing and restarting smokers had increasing bronchial responsiveness, approximately equivalent to a mean reduction in PD20 of 0.68 and 0.75 doubling doses, respectively, over 10 yr, in addition to a small increase explained by decline in FEV1. No other risk factor for change in bronchial responsiveness was identified. CONCLUSIONS: Smoking is a risk factor for increasing bronchial responsiveness over and above the effect of decreasing lung function. Neither baseline IgE sensitization nor change in sensitization was shown to be a risk factor for increasing BHR, the latter possibly due to little overall increase or decrease in sensitization.

Adult↗
PubMed2003

The genetics of coronary heart disease: the contribution of twin studies.

Despite the decline in coronary heart disease in many European countries, the disease remains an enormous public health problem. Although we know a great deal about environmental risk factors for coronary heart disease, a heritable component was recognized a long time ago. The earliest and best known examples of how our genetic constitution may determine cardiovascular risk relate to lipoprotein(a), familial hypercholesterolaemia and apolipoprotein E. In the past 20 years a fair number of polymorphisms assessed singly have shown strong associations with the disease but most are subject to poor repeatability. Twins constitute a compelling natural experiment to establish the genetic contribution to coronary heart disease and its risk factors. GenomEUtwin, a recently funded Framework 5 Programme of the European Community, affords the opportunity of comparing the heritability of risk factors in different European Twin Registries. As an illustration we present the heritabilities of systolic and diastolic blood pressure, based on data from over 4000 twin pairs from six different European countries and Australia. Heritabilities for systolic blood pressure are between 52 and 66% and for diastolic blood pressure between 44 and 66%. There is no evidence of sex differences in heritability estimates and very little to no evidence for a significant contribution of shared family environment. A non-twin based prospective case/cohort study of coronary heart disease and stroke (MORGAM) will allow hypotheses relating to cardiovascular disease, generated in the twin cohorts, to be tested prospectively in adult populations. Twin studies have also contributed to our understanding of the life course hypothesis, and GenomEUtwin has the potential to add to this.

Australia↗
PubMed1994

Plasma vitamin C assays: a European experience. EC FLAIR Concerted Action No. 10: Micronutrient Measurement, Absorption and Status.

Assay procedures for plasma concentrations of vitamin C, and hence for vitamin C status, currently in use in European population-surveillance laboratories and elsewhere, are based on a wide range of disparate techniques and reactions. The problem of achieving harmonisation between these techniques, and between laboratories, is further complicated by the instability of the vitamin, and the existence of several chemical forms. In the course of a European Community FLAIR programme, of inter-laboratory assay method comparisons for micronutrients, nine European laboratories performed either one or two coordinated ring tests, and some coordinated checks on in-house plasma samples, spiked with a low level of ascorbic acid. The principal conclusion was that good agreement was difficult to obtain, between laboratories and between methods, at plasma vitamin C concentrations close to the cut-off for biochemical deficiency, i.e. ca. 11 microM vitamin C in untreated plasma. By the second ring test, and after the correction of some aberrant results due to malfunctioning apparatus, interlaboratory coefficients of variation of 13-20% were achieved, within the biochemically "normal" range of 36-94 microM. There remains, however, a need for critical within and between-laboratory checks and comparisons, and for new quality control materials, with assigned values.

Ascorbic Acid↗
PubMed1990

The evolving horizon of drug registration--Europe and beyond.

The thalidomide tragedy gave rise to national drug regulation without thought to international harmonization. Thus from the early days of the European Community (EC), there has been a barrier to the free movement of medicinal products. Previous attempts have failed to resolve the problem and the European Commission is currently involved in attempting to establish Community drug legislation which will remove these barriers and create a single internal market. The Commission advocates two procedures (a centralized and a decentralized) largely under the control of the Committee for Proprietary Medicinal Products (CPMP) within the framework of a new European Agency for the Evaluation of Medicinal Products. The present authority of the Commission to make decisions binding on all 12 Member States will be utilized by the CPMP. While the present draft legislation should create significant improvement towards the goal of a single market, it contains some areas of potential concern. That this major venture should be a success is not only critical to the EC economy, its research-based pharmaceutical industry and the health care of its citizens but also to the achievement of global harmonization for pharmaceutical marketing authorization for which there is much evidence of enthusiasm and desire.

European Union↗
PubMed1993

Europe's water-wars.

The European Communities need more rational ways of setting environmental standards.

European Union↗
PubMed1999

The mental health care delivery system in greece: regional variation and socioeconomic correlates.

BACKGROUND: In Greece, the functional capacity of the mental health care system until 1980, was totally inadequate to meet the increasing mental health needs of the population and to provide efficient and community-based services. This situation was brought to the attention of the Commission of European Communities and a special EEC Regulation No 815/84 provided the financial technical support for an extended psychiatric reform programme. The psychiatric reform programme initiated in 1984 and ended in 1995. AIMS OF THE STUDY: This study compared the geographical distribution of neuropsychiatrists and the mental health care delivery system structural components (psychiatric beds, extramural mental health units and places in rehabilitation services), according to the regional socioeconomic development for the years 1984, 1990 and 1996. Additionally the possible effects of the operation of community-based mental health services on the psychiatric hospitalizations were examined. METHODS: Data on the geographical distribution of neuropsychiatrists in the previously mentioned years were drawn from local Medical Association from each of 54 prefectures of the country. The corresponding distribution of the mental health care delivery system components was made available from the database of the Monitoring and Evaluation of Mental Health Services Unit. Pearson product moment correlations of the regional distribution of neuropsychiatrists and the various components of the mental health care system, as population-based ratios, with the corresponding socioeconomic development in the form of the general index of development were performed. Mental hospital age standardized rates were collected from the Hospital Central Register for the periods 1984-1987 and 1990-1993. Discharge rates were elaborated according to the existence of mental health services in specific regions. RESULTS: A wide regional variation in neuropsychiatrists per 100000 population was found in all three years, with the majority of them working in the greater Athens and Thessaloniki areas. In the geographical distribution of health regions, there is an uneven significant decrease in psychiatric beds between 1984 and 1996. However in almost all regions an increase in extramural services between the two critical periods was noticed, as part of the implementation of the psychiatric reform programme. A parallel and more dramatic increase in the places of rehabilitation in 12 out of 13 regions has been observed during the implementation of the reform programme. At the level of prefectures, the changes across time, in the mean ratios of beds, extramural services and rehabilitation places were not found to be significant. A significant decrease of discharges in prefectures covered by newly established extramural services for the period 1990-1993, compared to discharge rates during the period 1984-1987, when none of these services were in operation in these prefectures, was noticed. The intercorrelation matrix between the various mean values (1990-1996) of the mental health care system components in the 54 prefectures and the local general index of development scores produced statistically significant correlation coefficients. It seems that the greater the level of local socioeconomic development the higher the degree of mental health care delivery system growth. DISCUSSION: Our results have shown uneven regional distribution of neuropsychiatrists, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system. The positive correlation between the various structural components of the system in the 54 prefectures and the local socioeconomic conditions could be interpreted as follows. Urban areas of higher socioeconomic growth had a long history of development of inpatient services in mental hospitals. In these several community-based alternatives have been established for their transformation into modern ones. Urban areas exhibit also higher psychiatric morbidity and therefore increasing mental health needs. Additionally in several cities local University Psychiatric Departments have developed a variety of mental health and rehabilitation services. Many new services highly specialized and complementary to existing mental hospitals were established in urban areas. Rural areas are mostly uncovered by mental health care facilities. However it seems that the establishment of community-based services could have an effect on mental hospital utilization. CONCLUSION: It becomes evident that after the implementation of the psychiatric reform programme in Greece significant progress in the areas of decentralization of mental health and rehabilitation services has been observed. However there are still areas in many prefectures, mainly rural or semirural, lacking the appropriate delivery of mental health care. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: Our results suggest that flexible models of services should be introduced for the benefit of population living in areas lacking the necessary socioeconomic resourses. IMPLICATIONS FOR FUTURE RESEARCH: Mental health services research in Greece should focus on quasi-experimental studies on the effectiveness of various models of mental health care in areas of different socioeconomic growth.

Journal Article↗
PubMed2006

Does body weight affect wages? Evidence from Europe.

We use data from the European Community Household Panel to investigate the impact of body weight on wages in nine European countries. When we pool the available data across countries and years, we find that a 10% increase in the average body mass index reduces the real earnings of males and females by 3.27% and 1.86%, respectively. Since European culture, society and labour market are heterogeneous, we estimate separate regressions for Northern and Southern Europe and find that the negative impact of the body mass index on earnings is larger--and statistically significant--in the latter area.

Adolescent↗
PubMed2004

The prevalence of known diabetes in eight European countries.

BACKGROUND: The prevalence of diabetes has been proposed as a European Community Health Indicator. The prevalence of diabetes known to general practitioners (GPs) in different European countries has been investigated and the usefulness of sentinel practice networks in delivering prevalence data on diabetes has been evaluated. METHODS: Patients presenting with diabetes in a 12 month period (1999/2000) to GPs in established European sentinel practice surveillance networks in eight European countries were registered. Estimates of prevalence were standardized to the 1998 European population. RESULTS: All-age prevalence reported in the network populations was lowest in Slovenia (male 16, female 16 per 1000) and highest in Belgium (male 31, female 34). The range of estimates obtained in this study was narrower than that published by the WHO in the Health For All database. The range was further reduced by age standardization. In males aged 45 years and over, age standardized prevalence ranged from 39 (Slovenia) to 76 (Belgium) and in females from 37 (Slovenia) to 75 (Belgium). There were no consistent gender differences in national prevalence rates. CONCLUSIONS: The study demonstrates the capacity of sentinel practice networks to deliver data on the prevalence of known diabetes in persons over 45 years. National differences in prevalence are less than hitherto reported. Prevalence in Belgium measured in all ages and in 45 years and over males and females was higher than in the seven other countries.

Adolescent↗
PubMedDate not supplied

Development of security guidelines for existing healthcare systems.

As modern healthcare establishments become increasingly dependent upon information systems it is vital to ensure that adequate security is present to safeguard the confidentiality and integrity of data and the availability of systems. Whilst this is now generally recognized in the design of new systems, many existing operational systems have been implemented without security in mind. This paper describes the need for a standardized approach in the protection of existing healthcare systems within Europe and presents an overview of a new set of information security guidelines that have been developed specifically for the medical community. The guidelines discussed have been produced as a deliverable of the Commission of European Communities (CEC) SEISMED (Secure Environment for Information Systems in Medicine) project, under the Advanced Informatics in Medicine (AIM) programme.

Computer Security↗
PubMedDate not supplied

The menopause in Europe.

Most women in developed countries will live a third of their lives after the menopause. Vasomotor symptoms (hot flushes, night sweats, irritability, sleep disturbances, mood swings), and urogenital complications (atrophic vaginal irritation and dryness, dyspareunia) occur frequently during this period of life, but their severity and duration may vary widely between individuals. The menopause also induces accelerated bone loss and is the principal risk factor for osteoporosis. Hormone replacement therapy (HRT; estrogen or estrogen plus progestogen) alleviates these symptoms and can be administered orally, transdermally, topically, intranasally, or as subcutaneous implants. HRT is also effective for prevention and treatment of postmenosausal osteoporosis throughout the time that it is used. It is not surprising that HRT use has increased substantially during the past decade. Nevertheless, there are still considerable variations in use between different countries within the European community. This presentation will analyze: the frequency of menopausal symptoms among women in different European countries and the factors that influence them; the frequency of other postmenopausal women's health issues in Europe; the use of HRT in Europe as well as the type of HRT and its evolution during the last decade; and possible reasons explaining heterogeneity between countries.

Aged↗
PubMed2004

Streptococcus pneumoniae and Streptococcus pyogenes isolated from a paediatric population in Great Britain and Ireland: the in vitro activity of telithromcycin versus comparators.

OBJECTIVES: To investigate the antimicrobial susceptibility profiles of clinical isolates of Streptococcus pneumoniae and Streptococcus pyogenes, isolated from children within Great Britain and Ireland (Northern Ireland and Eire), with particular reference to the new oral ketolide telithromycin. To determine the distribution of macrolide resistance genes within the erythromycin resistant population. METHODS: MICs were determined using NCCLS microbroth dilution methodology and macrolide resistance mechanisms were investigated using PCR. RESULTS: Penicillin susceptibility was found to be 92.6% in S. pneumoniae isolates ( n=831; 3.7% intermediate, MIC 0.12-1 mg/l, 3.7% resistant, MIC >2.0 mg/l) and 100% in S. pyogenes isolates (n=1333) 8.8% of S. pneumoniae and 2.5% of S. pyogenes isolates demonstrated erythromycin-A resistance (EryA(R)). One hundred percent of S. pneumoniae and 99.8% of S. pyogenes isolates were susceptible to telithromycin (MIC<or=1.0 mg/l). Of the 73 EryA(R) S. pneumoniae isolates tested, 55 (75.3%) were mef (A) positive, 17 (23.3%) erm (B) positive and one isolate (1.4%) was positive for both mechanisms. Of the 34 isolates of EryA(R) S. pyogenes tested, 23 (67.6%) were erm (A) subclass erm (TR) positive, 4 (11.8%) erm (B) and 7 (20.6%) mef (A) positive. CONCLUSIONS: This paper presents baseline data on penicillin and macrolide resistance in S. pneumoniae and S. pyogenes isolates in the paediatric population of Great Britain and Ireland. Telithromycin, recently approved for the treatment of community acquired respiratory tract infections (CARTI) in patients over 12 years of age throughout the European community, demonstrated high in vitro activity against these pathogens, including EryA(R) strains.

Child↗
PubMed2005

Resurgence of pertussis in Europe.

BACKGROUND: A resurgence of pertussis has been observed in Canada, the United States and Australia since the 1980s, but inconsistent data are currently available for Europe. The objective of this paper is to describe the epidemiology of pertussis in Western European countries to discuss future vaccination strategies. METHODS: The European Community funded a network for the epidemiologic surveillance of measles and pertussis in 1998. Sixteen European countries provided national surveillance data for pertussis for the period 1998-2002 in a standard format. Data were pooled and analyzed to describe incidence rates by age group, seasonality, proportion of hospitalized patients and deaths among notified cases. RESULTS: Children younger than 1 year had the highest incidence during the entire period. Rates in the older than 14 years age group increased by 115% during the study period. Northern countries showed the highest incidence figures in all age groups. Among children younger than 1 year, 70% were admitted into hospital. Children younger than 6 months of age and those not vaccinated were most likely to be hospitalized. Thirty-two deaths were reported, 87% of which were in children younger than 6 months of age. CONCLUSIONS: Pertussis is far from being controlled in Europe. Whereas the incidence in children younger than 1 year was high but remained stable, rates in adults doubled in 5 years.

Adolescent↗
PubMed2004

Retrolective, comparative, epidemiological cohort study with parallel groups design for evaluation of efficacy and safety of drugs with "well-established use".

UNLABELLED: The randomized controlled clinical trial (RCT) is accepted as the "golden standard" for the evaluation of efficacy and safety of new drugs. In contrast, to demonstrate efficacy and safety of drugs with "well-established use" that have been on the European Community market for long time, observational comparative epidemiological studies can be used according to the European drug regulation directive. However, because comparative epidemiological cohort studies can share some risk of bias with other nonrandomized observational study designs, there is a need for an approach that could effectively reduce the bias risk in this type of studies. STUDY OBJECTIVES: The purpose of the study was to evaluate the therapeutic efficacy and safety of a long-term complementary therapy of primary, non-metastatic breast carcinoma patients treated with standardized European mistletoe extract Iscador("mistletoe") in addition to the conventional adjuvant oncologic therapy, and compared to the control group treated with the conventional therapy alone. METHODS: The multicenter, comparative, retrolective, pharmaco-epidemiological cohort study with parallel groups design and randomly selected centers that routinely used both treatments was carried out according to Good Epidemiological Practice rules under a standard operating procedure control. The test group patients received the mistletoe extract treatment subcutaneously for at least 3 months, while the control group patients of the same cohort was exclusively treated with the conventional therapy. The patients were followed up for at least 3 years or until death. The primary endpoint of efficacy was the incidence of adverse reactions to the conventional oncologic therapy. Secondary endpoints were change from baseline of the symptoms associated with the disease and treatment as well as overall survival. All endpoints were adjusted to baseline imbalance and confounders. Safety was assessed descriptively by the number of patients with adverse drug reactions (ADRs) attributed to the test treatment. RESULTS: 1442 patients (710 tests and 732 controls) were eligible for the "per protocol" analysis of efficacy and safety. At baseline, the test group had a more advanced disease and worse prognostic factors profile. After a median follow-up of 66 vs. 60 months, and a median mistletoe therapy duration of 52 months, significantly fewer test group patients (16.2%) than control patients (54.0%) developed ADRs attributed to the conventional therapy [adjusted odds ratio, OR (95% confidence interval, CI), OR = 0.47 (0.32-0.67), p < 0.001]. In the test group, the majority of the symptoms disappeared more frequently, and overall mortality hazard was significantly lower [adjusted hazard ratio, HR (95% CI), HR = 0.46 (0.22-0.96), p = 0.038] than in the control group. Systemic ADRs attributed to the test treatment developed in 0.8%, and local ADRs in 17.3% of the patients. ADR severity was mild to intermediate. Tumor enhancement was not observed. CONCLUSIONS: Complementary therapy of patients with primary, non-metastatic breast carcinoma with the mistletoe extract Iscador was safe and in comparison to the control group within the same study cohort showed considerably fewer ADRs attributed to concurrent conventional therapy, reduced disease symptoms, and suggested a significant improvement of survival. Despite some methodical limitations that require careful study planning and conduction as well as critical interpretation, the applied study design seems suitable to evaluate the efficacy and safety of drugs with "well-established use", particularly in oncology.

Antineoplastic Agents, Phytogenic↗
PubMed1997

Published models and local data can bridge the gap between reference values of lung function for children and adults.

The aim of this study was to create reference equations for pulmonary function tests (PFTs) that span the age range from childhood to young adulthood. PFT results (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of FEV1 to FVC (FEV1/FVC), total lung capacity (TLC), transfer factor) of 348 healthy 13-24 yr old Caucasian never-smokers from a local population study were compared with 13 selected sets of published reference equations. Predicted and observed PFT results differed significantly for 63 of 92 reference equations tested, and most equations accounted poorly for the increase in PFT variables which takes place during adolescence. We selected the equations with the best fit and adjusted their parameters, so that the level and variance of predicted values agreed with the local data. For subjects older than 18 yrs, we selected the European Community for Steel and Coal (ECSC) equations. For subjects younger than 18 yrs, we chose European summary equations for FVC, FEV1, and FEV1/FVC, and recent British equations for TLC and transfer factor. The customized reference equations are the best available (maximum likelihood) for analysing PFTs of patients tested in our laboratory. Our approach can be used whenever generally accepted reference equations are lacking and a local sample of normal subjects is available.

Adolescent↗
PubMed1992

Oral manifestations of the HIV-infection: classification problems.

As more than 40 different oral lesions may be associated with the HIV-infection there is a need for classifying these lesions as a tool to be used in epidemiological studies. The paper deals with the classification proposed by the European Community.

Bacterial Infections↗
PubMed1994

Assessment of quality of bone in osteoporosis--BIOMED I: fundamental study of relevant bone.

Although osteoporosis is the most common bone disease of the Western world, the diagnosis of osteoporosis or risk for osteoporosis remains problematic despite major advances in technology to measure bone mass in recent years. There is a need to perform more fundamental studies on bone in normal and pathological conditions, in order to progress our knowledge and to detect in time patients at risk for osteoporotic fracture. The BIOMED I project "Assessment of Quality of Bone in Osteoporosis" (PL920296) and 116 other projects were chosen out of a total of 1200 proposals by the Commission of the European Communities, Directorate General XII, Science, Research and Development. The present paper outlines the project proposals. European centers with recognised expertise in assessment of bone, micro-macro-structure, biochemistry, geochemistry and biomechanics will concert their findings on ex vivo bone tissue samples, with the aim to discover a new assessment or combination of assessments for the appreciation of bone quality in vivo. The following modalities for assessment of bone in addition to the established techniques as radiogrammetry, photonabsorptiometry, DEXA, QCT and single photonabsorptiometry, will be incorporated: mechanical testing and fracture mechanics, ultrasound, bone biochemistry, three dimensional imaging, NMR spectroscopy and MRI. Special attention will be given to the standardization of ultrasound velocity and attenuation measurements in a working group bringing together the expertise of 10 centers.

Bone and Bones↗
PubMed2002

Urban wastewater treatment by a nutrient film technique system with a valuable commercial plant species (Chrysanthemum cinerariaefolium Trev.).

Urban wastewater causes rapid eutrophication of natural waters and requires treatment before discharge. This is expensive and produces huge quantities of sludge. In the European Community, it will no longer be lawful to dispose of this sludge as landfill after 2005 (European Directive 91/271/CEE of May 21, 1991). Wastewater treatment by the Chrysanthemum cinerariaefolium plants in horizontal flow was investigated using the nutrient film technique (NFT), a widely used hydroponic system in the commercial greenhouse industry. After a 48 h plant treatment, the purification efficiency was 95%, 91%, and 99% with respect to suspended solids (SS), biochemical oxygen demand (BOD5), and chemical oxygen demand (COD), and the elimination of nutrients (total nitrogen and total phosphorus) varied between 40% and 80%. SS and thus indirectly BOD5 and COD were removed by filtration and adsorption; the solids trapped in the root systems were then decomposed and mineralized. The system with 25 plants purified 30 L of wastewater in 48 h. One-hundred people communities wastewater could be treated with a 6 m2 area of production. Pyrethrin contents and chlorophyll a fluorescence of plants grown on raw urban waters were not significantly different from those grown on a standard nutrient solution.

Adsorption↗