In common with local government organisations across the world, local authorities in the UK have responsibility for promoting health. A key part of this function is the frontline enforcement activities of officers responsible for compliance with health and nutrition claims. This study identifies attitudes, values and practices of enforcers: namely trading standards and environmental health officers, when faced with the problem of non-compliance with the Regulation. Semi-structured interviews with frontline enforcers from local authority regulatory services to investigate challenges with the enforcement of Regulation (EC) 1924/2006. Twenty participants were interviewed; sixteen were based in North West England and two in the North and two in the South of England. The participants were selected for their specialist knowledge and experience of enforcement of nutrition and health claims. Regulation (EC) No. 1924/2006 on nutrition and health claims presents particular challenges for enforcers seeking to apply an optimal strategy to flawed regulatory design. As with other regulations, when faced with non-compliance, enforcers, specifically trading standards and environmental health officers have a wide discretion to determine their response: ranging from the deterrent or accommodative styles of enforcement. The participants reported using advice rather than action and by doing so confronting their bifurcating identity of prosecutor and advisor. Enforcers used advice as a regulatory tool in enforcing the law relating to nutrition and health claims.
We reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT). Patients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS). Among 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12–70 Gy) and 69.6 Gy (48–76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56–96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal). OS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.
It is hypothesized that, in simultaneous liver-kidney transplants (SLK), the liver protects the kidney. We sought to compare renal allograft survival in patients with SLK vs kidney transplant alone. Using the UNOS database, we evaluated adult patients who received deceased donor kidney or SLK transplants between 2002 and 2012. We included patients who survived at least three months and excluded patients with hepatitis C. We compared 1430 SLK recipients (GP1) to 66403 kidney alone recipients (GP2). We did a separate analysis of 725 SLK recipients (GP3) with data from 725 paired or mate kidney alone transplant (GP4). The primary endpoint was death censored renal graft survival (DCGS) using Kaplan Meier curves with log-rank analysis. Patient demographic and transplant data was used to allow Cox regression analysis. Results: Patients who received SLK (GP1) had higher DCGS than patients receiving kidney alone (GP2) with 1, 3 and 5 yr DCGS of 94.7%, 92.9% and 91.5% compared to 94.9%, 89.4% and 83.4% (P< 0.001). The significance persisted on multivariate analysis (HR 0.75: p=0.008). Patients in GP1 compared to GP2 also had higher eGFR at 6m, 12m and 5 yr, even though patients in GP1 had higher 1 yr acute renal rejection (AR) rates (OR 1.74; p=0.002). Comparing the SLK patients (GP3) who had a mate kidney alone transplant (GP4), the unadjusted DCGS was higher in GP3 than in GP4 with five year DCGS of 92.4% vs 84.0% (p=0.003), but significance did not persist on multivariate analysis.Table: No Caption available.Figure: No Caption available.Conclusions: Recipients who receive SLK appear to have improved DCGS and eGFR compared to those who receive kidney alone and this significance persists on multivariate analysis. The difference in DCGS is a relatively late effect seen after a year and occurs despite a higher AR rate in the SLK patients. Whether this is an effect of the liver allograft deserves further analysis. The adjusted DCGS was not significantly different in SLK recipients who had a mate or paired kidney alone recipient.
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