Ronan Conroy

European guidelines on cardiovascular disease prevention in clinical practice

Guidelines aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of guidelines have been issued in recent years by different organisations--European Society of Cardiology (ESC), American Heart Association (AHA), American College of Cardiology (ACC), and other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing guidelines. In spite of the fact that standards for issuing good quality guidelines are well defined, recent surveys of guidelines published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources. In addition, the legal implications of medical guidelines have been discussed and examined, resulting in position documents, which have been published by a specific task force. The ESC Committee for practice guidelines (CPG) supervises and coordinates the preparation of new guidelines and expert consensus documents produced by task forces, expert groups or consensus panels. The Committee is also responsible for the endorsement of these guidelines or statements.

Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use

Objective  To assess the extent and causes of microbiological contamination of household drinking water between source and point‐of‐use in developing countries.

Maternal central hemodynamics in hypertensive disorders of pregnancy

OBJECTIVE To document maternal central hemodynamics during the preclinical and clinical phases of nonproteinuric gestational hypertension and preeclampsia. METHODS We conducted a longitudinal study of 400 primigravidas who were monitored throughout pregnancy using Doppler echocardiography. Multinomial logistic regression was used to identify variables associated with risk of hypertension. RESULTS Gestational hypertension developed in 24 women and preeclampsia developed in 20. Compared with normotensive controls, women who had preeclampsia had significantly elevated cardiac outputs before clinical diagnosis, but total peripheral resistance was not significantly different during this latent phase. During the clinical phase of preeclampsia, there was a marked reduction in cardiac output and increase in peripheral resistance. All women who had gestational hypertension had significantly elevated cardiac outputs before and during the clinical course of the condition. CONCLUSION Our data support the concept of a hyperdynamic disease model for preeclampsia, with a subsequent hemodynamic crossover to low cardiac output and high resistance circulation coinciding with the onset of the clinical syndrome. Women with gestational hypertension had no such hemodynamic crossover and maintained hyperdynamic circulation throughout pregnancy.

Solar disinfection of drinking water contained in transparent plastic bottles : characterizing the bacterial inactivation process

A series of experiments is reported to identify and characterize the inactivation process in operation when drinking water, heavily contaminated with a Kenyan isolate of Escherichia coli, is stored in transparent plastic bottles that are then exposed to sunlight. The roles of optical and thermal inactivation mechanisms are studied in detail by simulating conditions of optical irradiance, water turbidity and temperature, which were recorded during a series of solar disinfection measurements carried out in the Kenyan Rift Valley. Optical inactivation effects are observed even in highly turbid water (200 ntu) and at low irradiances of only 10 mW cm−2. Thermal inactivation is found to be important only at water temperatures above 45 °C, at which point strong synergy between optical and thermal inactivation processes is observed. The results confirm that, where strong sunshine is available, solar disinfection of drinking water is an effective, low cost method for improving water quality and may be of particular use to refugee camps in disaster areas. Strategies for improving bacterial inactivation are discussed.

Silencing microRNA-134 produces neuroprotective and prolonged seizure-suppressive effects

Temporal lobe epilepsy is a common, chronic neurological disorder characterized by recurrent spontaneous seizures. MicroRNAs (miRNAs) are small, noncoding RNAs that regulate post-transcriptional expression of protein-coding mRNAs, which may have key roles in the pathogenesis of neurological disorders. In experimental models of prolonged, injurious seizures (status epilepticus) and in human epilepsy, we found upregulation of miR-134, a brain-specific, activity-regulated miRNA that has been implicated in the control of dendritic spine morphology. Silencing of miR-134 expression in vivo using antagomirs reduced hippocampal CA3 pyramidal neuron dendrite spine density by 21% and rendered mice refractory to seizures and hippocampal injury caused by status epilepticus. Depletion of miR-134 after status epilepticus in mice reduced the later occurrence of spontaneous seizures by over 90% and mitigated the attendant pathological features of temporal lobe epilepsy. Thus, silencing miR-134 exerts prolonged seizure-suppressant and neuroprotective actions; determining whether these are anticonvulsant effects or are truly antiepileptogenic effects requires additional experimentation.

Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly

Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community‐dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.

Solar water disinfection (SODIS): A review from bench-top to roof-top

Solar water disinfection (SODIS) has been known for more than 30 years. The technique consists of placing water into transparent plastic or glass containers (normally 2L PET beverage bottles) which are then exposed to the sun. Exposure times vary from 6 to depending on the intensity of sunlight and sensitivity of the pathogens. Its germicidal effect is based on the combined effect of thermal heating of solar light and UV radiation. It has been repeatedly shown to be effective for eliminating microbial pathogens and reduce diarrhoeal morbidity including cholera. Since 1980 much research has been carried out to investigate the mechanisms of solar radiation induced cell death in water and possible enhancement technologies to make it faster and safer. Since SODIS is simple to use and inexpensive, the method has spread throughout the developing world and is in daily use in more than 50 countries in Asia, Latin America, and Africa. More than 5 million people disinfect their drinking water with the solar disinfection (SODIS) technique. This review attempts to revise all relevant knowledge about solar disinfection from microbiological issues, laboratory research, solar testing, up to and including real application studies, limitations, factors influencing adoption of the technique and health impact.

Calibración de la tabla SCORE de riesgo cardiovascular para España

Introduccion y objetivos La tercera Task Force Conjunta Europea de prevencion cardiovascular recomendo el uso de la funcion de riesgo SCORE de prediccion del riesgo de muerte cardiovascular en 10 anos para la toma de decisiones en las intervenciones clinicas. El objetivo de este estudio es calibrar dicha funcion para Espana. Metodos Se desarrollo un modelo aplicando las hazard ratio de muerte cardiovascular en 10 anos de las cohortes del estudio SCORE a los valores medios especificos por la edad y el sexo de los factores de riesgo del tercer examen del estudio MONICA-Cataluna (1994- 1996) y a las funciones de supervivencia cardiovascular en 10 anos de la poblacion espanola basadas en la mortalidad del ano 2002. Resultados El riesgo estimado mediante la funcion calibrada SCORE fue un 13% mas alto que el estimado con la funcion de bajo riesgo, aunque las diferencias entre ambas oscilaron segun la edad, el sexo y especialmente el tabaco. La tabla SCORE calibrada identifico 32 situaciones de alto riesgo no reconocidas en la tabla original SCORE de bajo riesgo, aunque el 50% tenia una prevalencia baja o nula. El porcentaje maximo de sujetos nuevamente identificados de alto riesgo con la tabla calibrada fue del 22%, observandose mas diferencias en los varones mayores de 55 anos. Conclusiones Mientras no se disponga de estimaciones del riesgo basadas en cohortes poblacionales espanolas suficientemente grandes, la utilizacion de las funciones originales de riesgo cardiovascular calibradas para el pais permitiria adoptar decisiones clinicas y de salud publica adecuadas.

Solar disinfection of drinking water and diarrhoea in Maasai children: a controlled field trial

BACKGROUND Solar radiation reduces the bacterial content of water, and may therefore offer a method for disinfection of drinking water that requires few resources and no expertise. METHODS We distributed plastic water bottles to 206 Maasai children aged 5-16 years whose drinking water was contaminated with faecal coliform bacteria. Children were instructed to fill the bottle with water and leave it in full sunlight on the roof of the hut (solar group), or to keep their filled bottles indoors in the shade (control group). A Maasai-speaking fieldworker who lived in the community interviewed the mother of each child once every 2 weeks for 12 weeks. Occurrence and severity of diarrhoea was recorded at each follow-up visit. FINDINGS Among the 108 children in households allocated solar treatment, diarrhoea was reported in 439 of the 2-week reporting periods during the 12-week trial (average 4.1 [SD 1.2] per child). By comparison, the 98 children in the control households reported diarrhoea during 444 2-week reporting periods (average 4.5 [1.2] per child). Diarrhoea severe enough to prevent performance of duties occurred during 186 reporting periods in the solar group and during 222 periods in the control group (average 1.7 [1.2] vs 2.3 [1.4]). After adjustment for age, solar treatment of drinking water was associated with a reduction in all diarrhoea episodes (odds ratio 0.66 [0.50-0.87]) and in episodes of severe diarrhoea (0.65 [0.50-0.86]). INTERPRETATION Our findings suggest that solar disinfection of water may significantly reduce morbidity in communities with no other means of disinfection of drinking water, because of lack of resources or in the event of a disaster.

Effect of Enteric Coating on Antiplatelet Activity of Low-Dose Aspirin in Healthy Volunteers

Background and Purpose— Aspirin resistance may be relatively common and associated with adverse outcome. Meta-analysis has clearly shown that 75 mg plain aspirin is the lowest effective dose; however, it is not known whether the recent increased use of enteric-coated aspirin could account for aspirin resistance. This study was designed to determine whether enteric-coated aspirin is as effective as plain aspirin in healthy volunteers. Methods— Seventy-one healthy volunteers were enrolled in 3 separate bioequivalence studies. Using a crossover design, each volunteer took 2 different aspirin preparations. Five aspirin preparations were evaluated, 3 different enteric-coated 75-mg aspirins, dispersible aspirin 75 mg and asasantin (25-mg standard release aspirin plus 200-mg modified-release dipyridamole given twice daily). Serum thromboxane (TX) B2 levels and arachidonic acid–induced platelet aggregation were measured before and after 14 days of treatment. Results— All other aspirin preparations tested were inferior to dispersible aspirin (P<0.001) in their effect on serum TXB2 level. Treatment failure (<95% inhibition serum TXB2 formation) occurred in 14 subjects, none of whom were taking dispersible aspirin. Mean weight for those demonstrating treatment failure was greater than those with complete TXB2 (>99%) inhibition (P<0.001). Using logistic regression analysis an 80-kg subject had a 20% probability of treatment failure. Asasantin was the most potent preparation in terms of inhibition of platelet aggregation. Conclusions— Equivalent doses of the enteric-coated aspirin were not as effective as plain aspirin. Lower bioavailability of these preparations and poor absorption from the higher pH environment of the small intestine may result in inadequate platelet inhibition, particularly in heavier subjects.