EuroFIR: Where we are now?

EuroFIR (European Food Information Resource) Association Internationale Sans But Lucratif (AISBL) is an international non‐profit association to ensure sustained advocacy for food information in Europe. This article describes the importance of providing up‐to‐date food composition data and summarises the history of EuroFIR from its inception to its end (2005–2010), including the British Nutrition Foundation's involvement in the project. Also highlighted are the main EU projects that EuroFIR is/has been involved in, along with the many benefits that EuroFIR continues to offer its members.     

Statins: where are we now?

Statin therapy reduces the risk of cardiac events by 30% in both primary and secondary prevention. Although fine-tuning of the evidence will occur as more clinical trials report, the challenge is now to implement the evidence to the benefit of patients.     

Medicare: Where have we been? Where are we going?

This is an edited version of the paper delivered by Professor John Deeble as the Gordon Oration at the 31st Public Health Association of Australia Annual Conference in Darwin, Northern Territory, on September 29, 1999.     

Hepatocellular carcinoma: Where are we?

Hepatocellular carcinoma (HCC) is the second cause of death due to malignancy in the world, following lung cancer. The geographic distribution of this disease accompanies its principal risk factors: Chronic hepatitis B virus and hepatitis C virus infection, alcoholism, aflatoxin B1 intoxication, liver cirrhosis, and some genetic attributes. Recently, type II diabetes has been shown to be a risk factor for HCC together with obesity and metabolic syndrome. Although the risk factors are quite well known and it is possible to diagnose HCC when the tumor is less than 1 cm diameter, it remains elusive at the beginning and treatment is often unsuccessful. Liver transplantation is thus far considered the best treatment for HCC as it cures HCC and the underlying liver disease. Using the Milan criteria, overall survival after liver transplantation for HCC is about 70% after 5 years. Many attempts have been made to go beyond the Milan Criteria and according to recent works reasonably good results have been achieved by using a histochemical marker such as cytokeratine 19 and the so-called “up to seven criteria” to divide patients into categories according to their risk of relapse. In addition to liver transplantation other therapies have been proposed such as resection, tumor ablation by different means, embolization and chemotherapy. An important step in the treatment of advanced HCC has been the introduction of sorafenib, the first oral, systemic drug that has provided significant improvement in survival. Treatment of HCC patients must be multidisciplinary and by using the different approaches discussed in this review it is possible to offer prolonged survival and quite good and sometimes even excellent quality of life to many patients.     

Condom effectiveness: where are we now?

After performing a review of prospective cohort evaluations, a focussed assessment of the current knowledge base and methodology pertaining to condom effectiveness against sexually transmissible infections, including HIV, was also conducted. Key observations included the point that studies of condom effectiveness are inherently complex and the potential forms of study bias all generally favour the null hypothesis. Perhaps the most challenging obstacle to rigor in these studies lies in determining which events of condom-protected sex occurred before infection as opposed to after infection when, in fact, infection occurs. This problem leads to misclassification bias; however, other sources of misclassification bias are common. Greater attention to the selection of a recall period, improved precision of self-reported measures, and accounting for condom use errors and problems are critical steps that must occur to promote rigor in these studies. Despite multiple shortcomings, prospective studies of condom effectiveness provide a reasonably favourable evaluation. Subsequent studies, however, should be designed to greatly reduce the error variance that predisposes condom effectiveness studies to type 2 errors that mask the potential value of condoms.     

Lone atrial fibrillation: where are we now?

There is a growing pandemic of atrial fibrillation (AF), affecting nearly 2% of the general adult population. Atrial fibrillation is commonly associated with structural heart disease, and AF itself causes a sequence of complex processes of electrical, contractile, and structural remodeling of the atrial myocardium, which facilitate further AF progression. Nonetheless, AF may also affect individuals aged ≤ 65 years who have no evidence of associated cardiopulmonary or other disease, including hypertension; this is otherwise referred to as "lone" AF and is considered to have a generally favorable prognosis. The true prevalence of lone AF is unknown. Growing insights into the diversity of numerous mechanisms involved in the pathogenesis of AF, including acute atrial stretch, structural and electrophysiological alterations, systemic inflammation, oxidative stress, autonomic imbalance, genetic predisposition, and many others, and increasing recognition of novel risk factors for AF, including obesity, metabolic syndrome, subclinical atherosclerosis, sleep apnea, alcohol consumption, and endurance sports, suggest that apparently lone AF might not be so "lone" in many patients, which could have important prognostic and therapeutic implications. In this article, we summarize the current knowledge of epidemiology, etiopathogenesis, and pathophysiology of so-called lone AF and discuss the issues of long-term prognosis and management of patients who have an apparently lone AF.     

Treatment of bulimia nervosa: Where are we and where are we going?

OBJECTIVE: The purpose of this article is to review the extant treatment literature on bulimia nervosa and to offer suggestions for future research directions. METHOD: The available treatment studies regarding both pharmacotherapy and psychotherapy are reviewed. RESULTS: Both pharmacotherapy and psychotherapy appear to play a role in the treatment of bulimia nervosa; however, available data suggest that cognitive behavioral therapy remains the treatment of choice. CONCLUSION: Additional work is clearly indicated regarding assisted and unassisted self-help. An enhanced form of CBT and the integrative cognitive-affective therapy both deserve further study. New approaches need to be piloted. More research is needed on treatment modeling.     

Professional regulation of nutritionists: where are we now?

Waterlow's (1981) Sixth Boyd Orr Lecture on a 'crisis of identity for nutrition' stimulated the Nutrition Society's drive to professionalisation. Twenty-five years on, the Society begins a new stage; first, towards an independent voluntary regulator, and then towards statutory regulation. It is timely to reflect on progress and identify the remaining challenges. The Society has made impressive progress as a voluntary regulator since 1991 when the Institute of Biology opened a register in cooperation with the Institute of Food Science and Technology and the Nutrition Society; the present register is 2.75-fold larger. The Society has specialist standards for course accreditation that enable graduates to apply for direct entry to the register, having met standards of competency in nutrition or public health nutrition. A code of ethics and a statement of professional conduct underpin a functioning system for oversight and governance that protects the public, the hallmark of all professions. Registered nutritionists lay easy claim to a unique science basis for their profession. A scheme for continuing professional development (CPD) started in July 2006, 1 year before a sample audit starts to show the link between CPD and re-registration. The scheme will be piloted in the first year. The critical challenge is the issue of identity. Waterlow (1981) stated that professional registration must lead explicitly and formally to a specific vocation, an occupation that provides services that society requires and one that contributes to the well-being and health of all. The present time may be the last and best chance for nutritionists, as nutrition has a higher priority for government in the UK than ever before. The Society has begun to help in strategic public health workforce planning and development; new and still plastic, it is the ideal locus from which a discipline and a profession can emerge. The CPD scheme will work if it helps nutritionists meet their own needs; more mutual cooperation and consensus about real world standards of performance are needed. Nutritionists need to show how they actually contribute to national health and/or wealth. Then, sustained resources can be advocated for and the support of the voting public and legislators secured, without which it will not be possible to get the legal protection that is desirable for the profession.     

Genetics of ischemic stroke: where are we now?

As stroke is the third leading cause of death after heart failure and tumors worldwide, cerebrovascular diseases reached substantial attention. In the past few years, significant progression has been seen in identification of genetic variants in the background of stroke and other cerebrovascular and cardiovascular events. Examination of these variants is a new approach to recognize pathogenesis of disorders that hopefully helps in future prevention and prospects of screening and, optimistically, it contributes to special care of patients susceptible for stroke. In the background of ischemic stroke several genetic variants have been identified, which localize in genes encoding proteins involved in hemostasis, renin-angiotensin system and lipid metabolism. The number of these variants exponentially increases permanently due to rapid spreading of genome wide association studies. The goal of this review is to summarize the results of genetic studies on ischemic stroke. Here the authors focus on genetic variants which can have major role in personalized medicine and prevention of stroke.