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Contains fulltext : 290820.pdf (Publisher’s version ) (Open Access) Multiparameter flow cytometry (MFC) is one of the essential ancillary methods in bone marrow (BM) investigation of patients with cytopenia and suspected myelodysplastic syndrome (MDS). MFC can also be applied in the follow-up of MDS patients undergoing treatment. This document summarizes recommendations from the International/European Leukemia Net Working Group for Flow Cytometry in Myelodysplastic Syndromes (ELN iMDS Flow) on the analytical issues in MFC for the diagnostic work-up of MDS. Recommendations for the analysis of several BM cell subsets such as myeloid precursors, maturing granulocytic and monocytic components and erythropoiesis are given. A core set of 17 markers identified as independently related to a cytomorphologic diagnosis of myelodysplasia is suggested as mandatory for MFC evaluation of BM in a patient with cytopenia. A myeloid precursor cell (CD34(+) CD19(-) ) count >3% should be considered immunophenotypically indicative of myelodysplasia. However, MFC results should always be evaluated as part of an integrated hematopathology work-up. Looking forward, several machine-learning-based analytical tools of interest should be applied in parallel to conventional analytical methods to investigate their usefulness in integrated diagnostics, risk stratification, and potentially even in the evaluation of response to therapy, based on MFC data. In addition, compiling large uniform datasets is desirable, as most of the machine-learning-based methods tend to perform better with larger numbers of investigated samples, especially in such a heterogeneous disease as MDS. 01 januari 2023

Contains fulltext : 290818.pdf (Publisher’s version ) (Open Access) BACKGROUND: Flow cytometry (FCM) aids the diagnosis and prognostic stratification of patients with suspected or confirmed myelodysplastic syndrome (MDS). Over the past few years, significant progress has been made in the FCM field concerning technical issues (including software and hardware) and pre-analytical procedures. METHODS: Recommendations are made based on the data and expert discussions generated from 13 yearly meetings of the European LeukemiaNet international MDS Flow working group. RESULTS: We report here on the experiences and recommendations concerning (1) the optimal methods of sample processing and handling, (2) antibody panels and fluorochromes, and (3) current hardware technologies. CONCLUSIONS: These recommendations will support and facilitate the appropriate application of FCM assays in the diagnostic workup of MDS patients. Further standardization and harmonization will be required to integrate FCM in MDS diagnostic evaluations in daily practice. 01 januari 2023

Overweight and obesity is a global concern as a significant risk factor for non-communicable diseases. Increased energy intake due to greater consumption of energy-dense food or non-alcoholic beverages high in fat, saturated fat, sugar or salt ('HFSS food') is the main explanation for population weight gain. The principal drivers underlying this consumption are the commercial determinants of health in the food chain, particularly the marketing of HFSS food. In the UK, some rules do regulate certain forms of HFSS food marketing (such as television and online advertising to children) and the government is considering strengthening these. However, although sports sponsorship by 'HFSS food businesses' (defined as a business preparing, cooking, storing, handling, distributing, supplying or selling food and whose products are primarily HFSS) is increasingly recognised as linked to HFSS food consumption, it has received little attention. This is all the more concerning in light of the recent proliferation of 'HFSS food businesses' and HFSS products partnering with sports organisations. Against this background, we hosted a workshop to focus on the relationship between health, nutrition and the sponsorship of sport and related marketing by 'HFSS food businesses' and to consider the implications for obesity prevention strategies in the UK and beyond. This innovative workshop capitalised on, and contributed to, ongoing efforts to conceptually unite existing research by bringing together an interdisciplinary team of experts providing unique and complementary perspectives on how to address sports sponsorship as one of the channels through which 'HFSS food businesses' contribute to poor nutrition and diet-related diseases. This report summarises the structure, participants and discussions from the workshop; the existing evidence base; and the future research and policy opportunities we plan to pursue.

Current guidelines recommend flow cytometric analysis as part of the diagnostic assessment of patients with cytopenia suspected for myelodysplastic syndrome. Herein we describe the complete work-up of six cases using multimodal integrated diagnostics. Flow cytometry assessments are illustrated by plots from conventional and more recent analysis tools. The cases demonstrate the added value of flow cytometry in case of hypocellular, poor quality, or ambiguous bone marrow cytomorphology. Moreover, they demonstrate how immunophenotyping results support clinical decision-making in inconclusive and clinically 'difficult' cases.

Sport mega-events including the FIFA World Cup are a central component of consumer culture. Major brands are long associated with the World Cup, with many known for unhealthy products. This study quantified visual marketing references to unhealthy brands in the UK broadcasting of the 2018 Men’s World Cup. Eight matches were recorded, and all segments of the recordings were coded for marketing references to unhealthy brands using predefined criteria. A total of 1794 such marketing references were recorded, an average of 224 per broadcast and 1.2 per minute, 95.4% of which were official sponsors. The total time of exposure to unhealthy brand marketing was six hours, 30 minutes and 45 seconds, with 22.7% of the footage including at least one unhealthy brand marketing reference. The results show the World Cup is a platform for the marketing of unhealthy brands with implications for those responsible for public health and television broadcasters.

Tobacco, alcohol and foods that are high in fat, salt and sugar generate much of the global burden of noncommunicable diseases. We therefore need a better understanding of how these products are promoted.The promotion of tobacco products through sporting events has largely disappeared over the last two decades, but advertising and sponsorship continues bycompanies selling alcohol, unhealthy food and sugar-sweetened beverage. The sponsorship of sporting events such as the Olympic Games, the men's FIFA World Cup and the men's European Football Championships in 2016, has received some attention in recent years in the public health literature. Meanwhile, British football and the English Premier League have become global events with which transnational companies are keen to be associated, to promote their brands to international markets. Despite its reach, the English Premier League marketing and sponsorship portfolio has received very little scrutiny from public health advocates. We call for policy-makers and the public health community to formulate an approach to the sponsorship of sporting events, one that accounts for public health concerns.Le tabac, l'alcool et les aliments riches en graisse, en sel et en sucre génèrent la plus large partie de la charge mondiale des maladies non transmissibles. Il est donc nécessaire de mieux comprendre la manière dont ces produits sont promus. La promotion des produits du tabac dans le cadre d’événements sportifs a largement disparu au cours des vingt dernières années, mais la publicité et le sponsoring par des entreprises qui vendent de l'alcool, des produits alimentaires peu sains et des boissons sucrées sont encore d'actualité. Depuis quelques années, la littérature sur la santé publique commence à porter son attention sur le sponsoring d'événements sportifs, tels que les Jeux olympiques, la Coupe du monde masculine de la FIFA ou encore le Championnat d'Europe de football masculin de 2016. Mais dans le même temps, le football britannique et laEl tabaco, el alcohol y los alimentos que son ricos en grasa, como la sal y el azúcar, generan gran parte de la carga mundial de enfermedades no contagiosas. Por tanto, necesitamos una mejor comprensión de la forma en que se promueven estos productos. La promoción de los productos del tabaco a través de eventos deportivos ha desaparecido en gran medida en las últimas dos décadas, pero la publicidad y el patrocinio continúan por parte de las empresas que venden alcohol, alimentos poco saludables y bebidas azucaradas. El patrocinio de eventos deportivos como los Juegos Olímpicos, la Copa Mundial de la FIFA masculina y el Campeonato de Fútbol Europeo del 2016 ha recibido cierta atención en los últimos años en la bibliografía sobre salud pública. Mientras tanto, el fútbol británico y la Premier League inglesa se han convertido en eventos globales con los que las empresas transnacionales están dispuestas a asociarse, para promocionar sus marcas ante los mercados internacionales. A pesar de su alcance, la cartera de comercialización y patrocinio de la Premier League inglesa apenas han sido objeto de escrutinio por parte de los defensores de la salud pública. Pedimos a los responsables de la formulación de políticas y a la comunidad de la salud pública que formulen un enfoque para el patrocinio de eventos deportivos, que tenga en cuenta estas preocupaciones sobre la salud pública.يسبب كل من التبغ والكحول والأغذية الغنية بالدهون والملح والسكر، الكثير من العبء العالمي الخاص بالأمراض غير المعدية.وعلى ذلك، فإننابحاجة لفهم كيفية ترويج هذه المنتجات.نجد أن الترويجلمنتجات التبغ خلال الأحداث الرياضية قد اختفى إلى حد بعيد على مدى العقدين الماضيين، إلا أن حملات الإعلان والرعاية مستمرة من جانب الشركات التي تبيع الكحوليات، والطعام غير الصحي، والمشروبات المحلاة بالسكر.أولت حملات رعاية الأحداث الرياضية مثل الألعاب الأولمبية، وبطولة كأس العالم لكرة القدم للرجال، وبطولة الأمم الأوروبية للرجال في عام 2016، بعض الاهتمام في السنوات الأخيرة للأمور المتعلقة بالصحة العامة.وفي نفس الوقت، أصبحت كرة القدم البريطانية والدوري الإنجليزي الممتاز أحداثعالمية تحرص الشركات متعددة الجنسيات على الارتباط بها للترويج لعلامتها التجارية في الأسواقحول العالم.وعلى الرغم من شعبية الدوري الإنجليزي الممتاز، إلا أنحافظة التسويق والرعاية لم تحصلإلا على القليل من الفحص من جانب المهتمين بالصحة العامة.من هذا المنطلق، نحن ندعو واضعي السياسات ومجتمع الصحة العامة لوضعأسلوب لرعاية الأحداث الرياضية، بحيث يبرز هذا الأسلوب الأولويات الصحية العامة.烟草、酒类和高脂、高盐、高糖食物会导致全球非传染性疾病负担加重。因此，我们有必要更好地了解这些产品的促销方式。尽管在过去二十多年里，通过体育赛事推广烟草产品的行为已经在很大程度上消失，但酒类、不健康食物和含糖饮料行业的广告宣传和赞助活动却依然存在，这让人们更加担心其对公共健康产生的潜在影响。奥运会、国际足联男子世界杯和 2016 年男子欧洲足球锦标赛等体育赛事的赞助活动在近年来的公共卫生文献中备受关注。与此同时，跨国公司热衷于将自己的品牌通过英国足球和英超联赛这类全球性赛事推向全球市场。考虑到英超联赛触及的范围，其市场营销和赞助系列产品却很少受到公共卫生倡导者认真彻底的审查。我们呼吁政策制定者和公共卫生社会团体制定出一种将公共健康问题纳入考量的体育赛事赞助方法。.Табак, алкоголь и пищевые продукты с высоким содержанием жиров, соли и сахара служат причиной большей части мирового бремени неинфекционных заболеваний. Следовательно, нам нужно хорошо понимать, как рекламируются такие продукты. Продвижение табачных изделий через спорт значительно сократилось за последние два десятилетия, но рекламное сопровождение и поддержка спорта производителями алкоголя, нездоровой пищи и сахаросодержащих безалкогольных напитков продолжается. В последнее время в литературе, посвященной здоровью общества, затрагивались вопросы спонсорской поддержки таких спортивных событий, как Олимпийские игры, чемпионат мира по футболу среди мужчин и чемпионат Европы по футболу среди мужчин в 2016 году. Между тем британский футбол и Английская премьер-лига стали глобальными брендами, с которыми транснациональные компании стремились ассоциироваться для рекламы своей продукции на международном рынке. Несмотря на свою популярность, Английская премьер-лига и ее спонсорское портфолио практически не рассматривались сторонниками защиты общественного здоровья. Авторы призывают ответственных за принятие стратегических решений и сообщество общественного здравоохранения сформировать подход к спонсорству спортивных мероприятий, который бы учитывал проблемы здоровья общества.

While the nature of gambling practices is contested, a strong evidence\ud base demonstrates that gambling can become a serious disorder and have\ud a range of detrimental effects for individuals, communities and societies.\ud Over the last decade, football in the UK has become visibly entwined with\ud gambling marketing. To explore this apparent trend, we tracked shirt\ud sponsors in both the English and Scottish Premier Leagues since 1992 and\ud found a pronounced increase in the presence of sponsorship by gambling\ud companies. This increase occurred at the same time the Gambling Act 2005,\ud which liberalized rules, was introduced. We argue that current levels of\ud gambling sponsorship in UK football, and the global visibility it provides to\ud gambling brands, is a public health concern that needs to be debated and\ud addressed. We recommend that legislators revisit the relationship between\ud football in the UK and the sponsorship it receives from the gambling industry.

Sport has a history of seeking commercial funding to support its growing overheads, and big food and beverage corporations have been willing to oblige. For example, Coca-Cola has been associated with the Olympics since at least 1928. Sponsoring companies often claim that their sponsorship campaigns are not aimed at children and therefore should not be subject to scrutiny, but the global television (TV) audience that mega events such as the Olympics and sports like football achieve (reflecting fan bases of individuals across the lifespan) renders this argument barely credible. Because of the types of products most promoted through sport (foods and beverages high in fats, sugars and/or salt), health academics are now questioning the potential health impact of these sponsorships in professional sport.1 Even at grass roots and junior sport, one study in Australia found that 9 in 10 companies sponsoring children’s sports development were promoting unhealthy food.2 The detrimental effects of unhealthy food and beverage marketing on children’s diets are well documented,3 and as a result, policies have been put in place in the UK and other nations to try to restrict children’s exposure to such marketing via TV and the internet. Here, we suggest that sports sponsorship by the food and drink industry warrants similar regulatory attention. Kellogg’s were long associated with swimming, a sport that traditionally receives much less income than football (whether American Football or association football), baseball or cricket. Kellogg’s relationship with the English ASA (formerly the Amateur Swimming Association rebranded as Swim England in 2017) dates back to 1997. The Kellogg’s logo was reproduced on millions of badges and certificates awarded to …

Background Professional sport occupies a prominent place in cultures across the globe. Commercial organisations often use this prominence as a vehicle to promote their brands and products. There are increasing concerns about the growing number of people who are overweight and obese and the contributory role that marketing of processed food and drink plays. We therefore undertook a scoping review to explore the relationship between professional sports clubs and food and drink marketing. Methods We searched six databases (CINALH Plus, MEDLINE, PsycINFO, PubMed, SPORTDiscus, and Web of Science) from database start dates to March 27–31, 2017, using Boolean operators and search terms around professional sports clubs, marketing, food and drink, and health impacts (appendix). Experts were also consulted. Only English language publications were included. We excluded mega events (eg, Olympics, football World Cup) because of the attention already given to them. We likewise excluded alcohol marketing and sport, in view of the established literature exploring that relationship. Findings We identi ed 18166 titles for examination after removing duplicates and 163 abstracts for reviews; and obtained the full text for 26 publications. We included six papers in the review; four were from Australia and New Zealand. The Australasian literature was concerned with the marketing of (unhealthy) food and beverages to children and the potential (negative) impact on eating patterns. Rugby league, Australian football, and cricket were sports that were identi ed. Single papers from Turkey and the USA explored issues around marketing and professional sports clubs. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed that food and beverage (including alcohol) companies were the most common sponsors. The paper from the USA examined a mixed reaction to a football team named after an energy drink. Interpretation Given the current focus on how processed food is marketed to children, it is surprising that professional sports clubs have eluded the scrutiny of academic public health in the UK. Our review highlights the lack of public health research in this area. Research that explores the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed.

Virulent Francisella tularensis subsp. tularensis (Ftt) is a dynamic, intracellular, bacterial pathogen. Its ability to evade and rapidly suppress host inflammatory responses is considered a key element for its profound virulence. We previously established that Ftt lipids play a role in inhibiting inflammation, but we did not determine the lipid species mediating this process. Here, we show that a unique, abundant, phosphatidylethanolamine (PE), present in Francisella, contributes to driving the suppression of inflammatory responses in human and mouse cells. Acyl chain lengths of this PE, C24: 0 and C10: 0, were key to the suppressive capabilities of Francisella PE. Addition of synthetic PE 24: 0-10: 0 resulted in the accumulation of PE in host cells for up to 24 h of incubation, and recapitulated the inhibition of inflammatory responses observed with native Ftt PE. Importantly, this novel PE significantly inhibited inflammatory responses driven by a medically and globally important flavivirus, dengue fever virus. Thus, targeting these lipids and/or the pathways that they manipulate represents a new strategy to combat immunosuppression engendered by Ftt, but they also show promise as a novel therapeutic intervention for significant viral infections.

Selling sugary drinks at Christmas I suppose we should have realised that Coca-Cola was up to something when it opened a head office next to the Royal Society of Medicine in Wimpole Street. The path of associating unhealthy products with health, wellbeing, and healthy lifestyles is one that has been well trodden down the years by the tobacco industry. The lessons have not been lost on Coca-Cola. In fact, you could argue that Coca-Cola started even earlier than tobacco.1 And the stakes have never been higher for the UK sugary drinks industry. In October 2015, Public Health England (PHE) published a report stating that not only is the consumption of sugar sweetened drinks particularly high in school age children but tends to be highest among the most disadvantaged.2 It suggested the introduction of a tax or levy on full sugar soft drinks. In August 2016, the government did just this, announcing a soft drinks …

SUMMARY Healthy Stadia (HS) is a European public health pilotprogram started in 2007 to support sports stadia in promoting the health of people who work and visit sports stadia, as well as inhabitants of the surrounding communities. The aim of this study is to describe the process evaluation of the program, from its beginning in July 2007 to December 2009, in order to assess the feasibility and sustainability of an HS network across Europe. The program involved nine associate partners involved in the coordination of activities at a local level, in the recruitment of stadia, in the development of specific program tasks and in the dissemination of the program at a national level. The activities of associate partners were evaluated through structured questionnaires administered every 6 months. The questionnaire response rate from associate partners was 77.8% for the first and third evaluations and 88.9% for the second and fourth evaluations. According to the evaluation’s results, several good practices such as alcohol prevention policies and those supporting people with disabilities were implemented in stadia over the course of the program. Conversely, practices supporting mental health and green transport were generally not achieved. The implemented activities mainly involved staff and visitors. Lack of human and economic resources, especially toward the end of the program, was considered the principal challenge for program development. In conclusion, the process evaluation presented the feasibility of the HS program and the development of health promoting practices in sport stadia over time.

ObjectiveTo examine the potential public health impact on CHD and stroke mortality of replacing one ‘unhealthy’ snack with one ‘healthy’ snack per person, per day, across the UK population.MethodsNutritional information was obtained for different ‘unhealthy’ (such as crisps, chocolate bars, cakes and pastries) and ‘healthy’ snack products (such as fresh fruit, dried fruit, unsalted nuts or seeds). Expected changes in dietary intake were calculated. The mean change in total blood cholesterol levels was estimated using the Keys equation. The effect of changing cholesterol and salt levels on CHD deaths and on stroke deaths was calculated using the appropriate equations from the Law and He meta-analyses. The estimated reductions in cardiovascular deaths were then tested in a sensitivity analysis.ResultsSubstituting one ‘healthy’ snack would reduce saturated fat intake by approximately 4·4 g per person per day, resulting in approximately 2400 fewer CHD deaths and 425 fewer stroke deaths per year. The associated 500 mg decrease in salt intake would result in approximately 1790 fewer CHD deaths and 1330 fewer stroke deaths.ConclusionsSimply replacing one unhealthy snack with one healthy snack per day might prevent approximately 6000 cardiovascular deaths every year in the UK.

Studies are reported on the use of short dialysis, sequential ultrafiltration/short dialysis and hemoperfusion in chronic renal failure. Short dialysis (less than 12 hours/week) is a satisfactory regime with good patient acceptance, adequate small and middle molecule clearance and control of fluid and blood pressure. Sequential ultrafiltration in the first hour improves fluid removal and reduces the side effects of dialysis. The addition of hemoperfusion increases clearance of small and middle molecules and has little effect on the osmolality of the serum. Thus, it does not increase the side effects of dialysis. Preliminary results suggest that hemoperfusion may be useful in the treatment of chronic renal failure in combination with ultrafiltration and dialysis.

OBJECTIVE: To estimate the burden of cardiovascular disease within 15 European Union countries (before the 2004 enlargement) as a result of excess dietary saturated fats attributable to the Common Agricultural Policy (CAP). METHODS: A spreadsheet model was developed to synthesize data on population, diet, cholesterol levels and mortality rates. A conservative estimate of a reduction in saturated fat consumption of just 2.2 g was chosen, representing 1% of daily energy intake. The fall in serum cholesterol concentration was then calculated, assuming that this 1% reduction in saturated fat consumption was replaced with 0.5% monounsaturated and 0.5% polyunsaturated fats. The resulting reduction in cardiovascular and stroke deaths was then estimated, and a sensitivity analysis conducted. FINDINGS: Reducing saturated fat consumption by 1% and increasing monounsaturated and polyunsaturated fat by 0.5% each would lower blood cholesterol levels by approximately 0.06 mmol/l, resulting in approximately 9800 fewer coronary heart disease deaths and 3000 fewer stroke deaths each year. CONCLUSION: The cardiovascular disease burden attributable to CAP appears substantial. Furthermore, these calculations were conservative estimates, and the true mortality burden may be higher. The analysis contributes to the current wider debate concerning the relationship between CAP, health and chronic disease across Europe, together with recent international developments and commitments to reduce chronic diseases. The reported mortality estimates should be considered in relation to the current CAP and any future reforms.

Background Professional sport occupies a prominent place in cultures across the globe. Commercial organisations often use this prominence as a vehicle to promote their brands and products. There are increasing concerns about the growing number of people who are overweight and obese and the contributory role that marketing of processed food and drink plays. We therefore undertook a scoping review to explore the relationship between professional sports clubs and food and drink marketing. Methods We searched six databases (CINALH Plus, MEDLINE, PsycINFO, PubMed, SPORTDiscus, and Web of Science) from database start dates to March 27–31, 2017, using Boolean operators and search terms around professional sports clubs, marketing, food and drink, and health impacts (appendix). Experts were also consulted. Only English language publications were included. We excluded mega events (eg, Olympics, football World Cup) because of the attention already given to them. We likewise excluded alcohol marketing and sport, in view of the established literature exploring that relationship. Findings We identified 18 166 titles for examination after removing duplicates and 163 abstracts for reviews; and obtained the full text for 26 publications. We included six papers in the review; four were from Australia and New Zealand. The Australasian literature was concerned with the marketing of (unhealthy) food and beverages to children and the potential (negative) impact on eating patterns. Rugby league, Australian football, and cricket were sports that were identified. Single papers from Turkey and the USA explored issues around marketing and professional sports clubs. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed that food and beverage (including alcohol) companies were the most common sponsors. The paper from the USA examined a mixed reaction to a football team named after an energy drink. Interpretation Given the current focus on how processed food is marketed to children, it is surprising that professional sports clubs have eluded the scrutiny of academic public health in the UK. Our review highlights the lack of public health research in this area. Research that explores the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. Funding University of Glasgow in collaboration with the Medical Research Council's Social and Public Health Sciences Unit.

Background: Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are\ud focusing on the need to prevent child access to these devices. However, little is currently known about the\ud characteristics of those young people that are accessing e-cigarettes.\ud Methods: Using a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we\ud examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol\ud consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a\ud question asking students if they had ever tried or purchased e-cigarettes.\ud Results: One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among\ud smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes\ud had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently\ud associated with male gender, having parents/guardians that smoke and students’ alcohol use. Compared with\ud non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed\ud e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers\ud (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence,\ud consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult\ud proxy purchasers outside shops.\ud Conclusions: There is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings\ud suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those\ud most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.

In response to, and support of the Editorial by Pekka Puska in the August 2007 edition of the Journal (Health in all Policies. European Journal of Public Health 2007;17(4):328), this article describes the Heart of Mersey (HoM) cardiovascular disease (CVD) prevention programme, which aims to improve the health of the local population by tackling inequalities via structural changes at regional, national and European level. Principally, the programme advocates that health improvement will be achieved primarily through healthy public policy, effective partnership and community integration. ### Heart of Mersey: the programme The HoM CVD Prevention Programme was launched in 2003 as a result of a visit to Finland in January 2001 to see how levels of heart disease have been dramatically reduced in North Karelia. The HoM programme focusses upon smoking and food, reflecting the evidence base of the main risk factors for CVD (i.e. raised blood cholesterol, high blood pressure and cigarette smoking),1,2 and more specifically the big gains that can be achieved in reducing the three main risk factors for CVD by structural policy changes at regional, national or European levels.3–5 Although the programme is focussed upon reducing CVD prevalence, it also recognises the impact that poor nutrition and smoking can have on the wider public health agenda, for example, on non-communicable diseases such as Type 2 diabetes and some types of cancer, reducing obesity and health inequalities. The two core programmes, food and tobacco control, are supported by two further programme areas, research and corporate communications. Both the food and tobacco- free programmes take a campaigning on public health approach, working through advocacy, public affairs, capacity building and partnership to support policy and …

Francisella tularensis (FT) is a highly pathogenic bacterium which can cause acute, lethal disease following exposure to fewer than 20 bacteria. FT is a successful pathogen due to its ability to potently and rapidly suppress inflammatory responses in host cells. We previously established that crude lipid preparations from virulent FT dampen inflammation in vitro and in vivo, but did not characterize the active specie(s). Utilizing a variety of biochemical techniques, we identified one of the active lipids found in FT as a unique phosphatidylethanolamine (PE) consisting of tetracosanoyl and decanoyl acyl chains (PE2410). Similar to crude lipid, enriched PE2410 restricted production of cytokines in human and mouse cells stimulated with well-defined microbial ligands. PE2410 was also effective at dampening inflammation provoked by infection with West Nile Virus. Activity of PE2410 was dependent on presence of the host phosphatase SHP-1. Importantly, a synthetic version of the PE2410 mimicked the ability of natural PE2410 to inhibit inflammation triggered by a variety of sources. Together our data support use of PE2410 as a novel therapeutic for pathogenic inflammation triggered by viral, or other, infection.

SUMMARY Sport plays an important role within society and sports stadia provide significant settings for public health strategies. In addition to being places of mass gathering, stadia are often located in less affluent areas and are traditionally attended by ‘harder to reach’ communities. Unfortunately sports stadia and the clubs they host are rarely perceived as places that promote healthy lifestyles. Fast food, alcohol and tobacco are commonly advertized, served and consumed during sports games giving the spectators and TV fans contradictory messages concerning healthy choices. As part of a wider programme of work part-funded by the European Union, a study was therefore designed to explore current ‘good practice’ relating to positive health interventions in sports stadia across a number of European countries. Using a specially designed questionnaire, information about health policies and good practices relating to food offerings in stadia, physical activity promotion among local communities, tobacco policy, positive mental health initiatives, environmental sustainability practices and social responsibility policies were collected in 10 European countries (England and Northern Ireland, Finland, Georgia, Greece, Ireland, Italy, Latvia, Poland, Spain and Sweden) involving 88 stadia. The audit results show that stadia health policies differ considerably between specific countries and sports. Based on the literature analysed, the examples of good practices collected through the study, and the subsequent instigation of a European Healthy Stadia Network, it shows that there is considerable potential for stadia to become health promoting settings.

The National Institute for Clinical Excellence (NICE) defined the process of care for haematological malignancies in Improving outcomes in haematological cancers. The manual in 2003. The most challenging recommendation has been the requirement to develop integrated laboratory services for accurate diagnosis. This is an aim that has not been fully achieved. The unified concept of haematological malignancy is recent and based on an understanding of the cellular pathology of the bone marrow and immune systems. Historical UK pathology practice has previously resulted in the separation of laboratory haematology from histopathology and of liquid and tissue specimens. Proposals for reintegration and centralization with specialist-led, centralized diagnostic and reporting services challenge the fragmented historical model. Accuracy and certainty of diagnosis remains problematic, particularly for lymphomas, with evidence that the accuracy of diagnosis is slowly improving but still only approaches 85%. There is a potentially significant human and financial cost of diagnostic errors. No nationwide, validated and comparable epidemiology/population-based data exist for accurate and complete ascertainment of new cases of haematological cancer, service planning or clinical outcomes monitoring. This article examines the original rationale behind the NICE guidance and outlines the key components and processes of an integrated diagnostic service.

Objective. To investigate the predisposing role of major histocompatibility complex (MHC) genes to systemic lupus erythematosus (SLE) in a Chinese population. Methods. Polymorphism in the HLA-DRB, DQB, complement component C4, and 21-hydroxylase genes was analyzed by restriction fragment length polymorphism analysis and oligonucleotide probing of in vitro-amplified DNA from 88 Chinese patients with SLE and 69 matched control subjects. Results. HLA-DRw15 and DQw1 were significantly more frequent in patients (corrected P < 0.006, relative risk 5.2), but none of the 9 sequence variants of DQw1 were increased. The C4A gene deletion usually associated with SLE in Caucasoid and black patients was absent from all Chinese subjects, but possession of other C4 deletions and of DRw15 conferred the greatest risk (relative risk = 8.3). Conclusion. Different MHC haplotypes predispose to lupus in Chinese than in other ethnic groups. Our data suggest that the susceptibility lies at, or telomeric to, the DR locus, and that DRw15 and C4 deletions may act synergistically in conferring disease susceptibility.

EDITOR—Choosing medical students is more difficult than it might seem at first glance.1 Lowering entrance requirements for medical school is not the answer—medical school and subsequent medical practice require intellect and application. Equally, favouring mature students with a first degree or qualification in time may lead to a situation where …

This chapter concentrates on the work of local authority leisure services departments. It begins by giving an impression of the national picture and social and economic factors, before considering the work of the local authority itself. Some time will be spent considering the implications of compulsory competitive tendering (CCT), before looking at issues surrounding past and present collaborations between health promotion and leisure professionals.

Objective: Although there is growing awareness of the impact of diet on health, little attention has been given to the food available in our sports stadia. We used a football club (Citygrene FC) – Citygrene is a fictional name – in the English Premier League as a case study to examine the attitudes of male and female football supporters to the food and drink available at their home stadium (Citygrene Stadium). Design: The research design used five focus groups of male and female fans. The discourse was audiotaped, transcribed, coded and analysed for themes. Setting: A football stadium in the English Premier League, England. Subjects: The participants were season ticket holders drawn from two stands at Citygrene Stadium. Results: The research showed a high level of dissatisfaction with the food and drink supplied. There were key differences in the views of the male and female participants in the focus groups, with the women more concerned about wider issues such as the lack of healthy food. Both men and women were aware of their role as consumers and felt that there was an opportunity for Citygrene to improve their catering profits, if they provided a better selection of food and drink and an improved service. Conclusions: The study shows that there is a demand for healthier food options (and a wider choice of food and drink in general), which may provide an economic opportunity for stadium and catering managers. In addition, a stadium may be considered a potential ‘healthy setting’, which can serve as a supportive environment for healthier food choices.

Addition of exogenous granulocyte-macrophage colony stimulating factor (GM-CSF) to cultures of adult murine spleen cells with sheep red blood cells (SRBC) results in an augmented plaque forming cell (PFC) response. The influence of GM-CSF on the ability of neonatal spleen cells to suppress the anti-SRBC plaque forming response of adult spleen cells was tested by adding GM-CSF to cultures of neonatal and adult spleen cells. The suppressive capacity of the neonatal spleen cells was augmented by exogenous GM-CSF. The augmented suppression of the neonatal spleen cells was dependent on a G-10 adherent population since the addition of GM-CSF to cultures containing G-10 passed neonatal spleen cells resulted in an augmented PFC response and not suppression. Neonatal splenic glass adherent cells were also capable of suppressing the response. Neonatal spleen cells or purified neonatal glass adherent spleen cells cultured in the presence of GM-CSF had markedly increased levels of PGE2 in the culture supernatant. Neonatal spleen cells cultured with GM-CSF had increased numbers of morphologically identifiable macrophages after 48 hr of culture. Both irradiation and G-10 passage of the neonatal spleen diminished the numbers of macrophages formed in response to GM-CSF, and both of these manipulations resulted in reversal of suppression in response to GM-CSF. Thus, the augmented suppressive capacity of neonatal spleen cells in response to GM-CSF is probably mediated by its ability to drive monocyte to macrophage differentiation as well as increase the suppressive capacity of the existing neonatal splenic macrophages by increasing their production of PGE2.

EDITOR,—As a result of their survey of drug users' views on general practitioners Charles Hindler and colleagues suggest that general practitioners should adopt a central role in the management of drug misuse.1 As vocationally trained general practitioners currently working in a substance misuse service, we disagree with this interpretation and suggest that wider issues concerning training and the provision of services need to be considered. Rather than recommend a central role for general practitioners, …

WHEN Liverpool Town Council appointed William Henry Duncan as the first Medical Officer of Health in 1847, the appointment was not made out of any particular sense of vision. Rather, housing and environmental conditions were so bad that urgent action appeared to be necessary. Duncan had been the one physician locally with the necessary insight into the living conditions of his patients, and the necessary motivation to bring the situation to public attention1.2. The liberal reforms that were under way in response to the harsh effects of the industrial revolution meant that he was in the right place at the right time with pertinent things to say, and as a result he was listened to. As with Duncan, so with present-day health promoters, if only they are prepared to take their opportunities and involve themselves with what is now becoming well established — the new public health.