Partnering to change the world for people with haemophilia: 6(th) Haemophilia Global Summit, Prague, Czech Republic, 24-26(th) September 2015.

The 6(th) Haemophilia Global Summit was held in Prague, Czech Republic, in September 2015. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and aimed to share optimal management strategies for haemophilia at all life stages, explore recent potential advances in the management of haemophilia A and B and discuss challenges in haemophilia care. In this supplement from the meeting, Dan Hart reviews the lessons that can be learnt from cost-constrained environments with regard to improving care for people with haemophilia globally. Sébastien Lobet discusses the importance of physical activity for optimising care and Roseline d'Oiron and Jan Blatný consider the role of real-world data in understanding the effect of treatment in a clinical setting over the long term and the true impact of treatment on the day-to-day life of the patient. Gili Kenet addresses the current challenges relating to the optimal management of prophylaxis, and Gerry Dolan and Cedric Hermans discuss the value of pharmacokinetic (PK) parameters in informing treatment decisions. Cedric Hermans and Valérie Libotte explore the importance of considering social and occupational development factors as an integral part of haemophilia care, and Jan Astermark reviews key strategies to predict and prevent inhibitor development.

Compliance with follow-up after occupational exposure to hepatitis C.

BACKGROUND: Accidental percutaneous exposure to blood containing hepatitis C virus (HCV) is reported by health care workers more frequently than exposure to human immunodeficiency and hepatitis B virus. The transmission rate following such an exposure is approximately 1.9%. Little is known about the attendance rate of such staff for follow-up testing following exposure to HCV. AIM: To determine whether our follow-up programme for staff exposed to hepatitis C would allow the early detection and treatment of infected staff members. METHOD: We reviewed all staff exposures to hepatitis C reported to the occupational health department of a London teaching hospital over a 8-year period. RESULTS: Of 105 exposures, 21% of staff attended for early (6 or 12 weeks) and late (26 weeks) post-exposure follow-up. Thirty-seven per cent attended early follow-up only and 1% attended late having not attended early follow-up. Forty per cent did not attend any follow-up appointments with us. CONCLUSION: With the availability of effective treatment for early HCV infection, it is vital that occupational health departments encourage staff to attend at least for early follow-up. Access to HCV-RNA testing at this early stage should allow detection and early treatment of the small proportion who seroconvert.

Review and meta-analysis of risk estimates for prostate cancer in pesticide manufacturing workers.

PURPOSE: The purpose of the present paper is to review cohort studies that examined the occurrence of prostate cancer in pesticide manufacturing workers in order to undertake a qualitative and quantitative evaluation of the risk as well as to assess the level of epidemiological evidence for each class of chemical compounds. METHODS: Following a systematic literature search, relative risk (RR) estimates for prostate cancer were extracted from 18 studies published between 1984 and 2004. All studies were summarised and evaluated for homogeneity and publication bias. As no significant heterogeneity was detected, combined RR estimators were calculated using a fixed effect model. Meta-analyses were performed both on the whole set of data and for each chemical class separately. RESULTS: The meta-rate ratio estimate for all studies was 1.28 [95% confidence interval (CI) 1.05-1.58]. After stratification by specific chemical class, consistent increases in the risk of prostate cancer were found in all groups but statistical significance was found only for accidental or non-accidental exposure to phenoxy herbicides contaminated with dioxins and furans. There was no obvious indication of publication bias. CONCLUSION: The overall meta-analysis provides additional quantitative evidence consistent with prior reviews focusing on other groups exposed to pesticides (farmers, pesticide applicators). The results again point to occupational exposure to pesticides as a possible risk factor for prostate cancer but the question of causality remains unanswered. Epidemiological evidence did not allow identifying a specific pesticide or chemical class that would be responsible for the increased risk but the strongest evidence comes from workers exposed to phenoxy herbicides possibly in relation with dioxin and/or furan contamination.