The etiology of glaucoma is multifactorial. Intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Currently, based on evidence-based glaucoma therapy, the only approach proven to be efficient in preserving visual function is lowering IOP. Lowering IOP by 20-40% has been shown to reduce the rate of progressive visual field loss by half. Despite the fact that IOP-lowering interventions reduce the risk of progression and delay the onset of glaucoma, its pathogenesis is controversial and not completely understood. In this matter, non-IOP-dependent risk factors appear to be responsible for around 50% of glaucoma cases. New drugs are now entering the clinic, along with new ways to deliver them. There is growing consensus that the future of glaucoma management will be based more on the optic nerve pathway from the retina to the visual cortex and will not be strictly limited to improving outflow or reducing inflow. But still, many future IOP-lowering options will be developed, including neuroprotective strategies aiming to directly prevent or significantly hinder neuronal cell damage. The goal of glaucoma treatment is to maintain the patient's visual function and related quality of life at a sustainable cost. The cost of treatment in terms of inconvenience and side effects as well as financial implications for the individual and society requires careful evaluation. In conclusion, IOP lowering is the only proven therapy for glaucoma at present. Neuroprotection may be clinically useful (based on one trial), but this needs to be confirmed. So far, we have no evidence of potential therapies related to ocular blood flow and glaucoma care, and evidence to support the use of acupuncture, vitamins, minerals, or herbal medicines such as marijuana for treating glaucoma is insufficient.

The six largest tobacco companies have a turnover of some USD 350 billion and profits of USD 35 billion, so for good reason are called Big Tobacco. Nearly 20% of the world's adult population smoke, and smoking diseases account for 1 in 10 of all deaths globally. Tobacco is a huge public health problem and a major cause of inequalities in health and mortality. Evidence-based tobacco control policies are highly cost-effective and more so than most medical and surgical treatments; many are cost saving. A 10% price rise via a tax increase is estimated to be the most cost-effective at USD 18-457 per disability-adjusted life year (2013 prices) plus substantial tax revenue benefits: compared to USD 523-2,799 for cessation support and USD 212-4,228 for other effective policies. In all cases, interventions are far more cost-effective in low- and middle-income countries than in high-income countries. Price differences account for much of the differences in countries' smoking rates, which tend to be highest where prices are lowest. Raising cigarette prices by 10% would save 10 million smoking-attributable deaths globally in the long run. The effects of electronic cigarettes need to be studied, as a significant switch to these products may significantly reduce mortality and morbidity. Evidence-based policies to reduce smoking and its harm are in place in many countries, but are frequently hampered by inadequate government action and the hostile influence of the transnational tobacco companies including foreign investment. Addressing these with serious action across the world will save lives and strengthen economies.

The rapid increase in obesity prevalence during the past decades points to the important impact of environmental changes on the development of overweight in children and adolescents. A mismatch between increasing energy consumption in an attractive and abundant food environment and decreasing physical activity with the adoption of a more sedentary lifestyle is the key factor underlying constant increases in body mass index. Considering the effect of energy imbalance on body weight, a small but persistent average daily imbalance between intake and expenditure is sufficient to explain the weight gain observed during the development of overweight and obesity, and the influences of nutrition on the development of these conditions vary according to life stage and circumstance. Parental dietary intake and familial nutritional behaviour are important components in the development of childhood nutritional habits. We discuss the possible contributions of several nutritional factors to the antenatal and postnatal environments and the impacts of nutrition during infancy, childhood and adolescence. However, nutrition involves a complex interplay among dietary behaviour, food selection and nutrient supply that complicates the aetiological analysis of the development of adiposity. In particular, a diet comprising foods with high energy densities may be a key factor that increases the risk of developing overweight during childhood and adolescence. The establishment of an optimised mixed diet may serve as a guideline to evaluate and further improve dietary intake in the family setting and in the catering industry, thus reducing the nutritional causes of the development of obesity and metabolic syndrome.

Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central line-associated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus, enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

Until the last decade, little was known about the effects of chronic hypercortisolism on the brain. In the last few years, new data have arisen thanks to advances in imaging techniques; therefore, it is now possible to investigate brain activity in vivo. Memory impairments are present in patients with Cushing's syndrome (CS) and are related to hippocampal damage; functional dysfunctions would precede structural abnormalities as detected by brain imaging. Earlier diagnosis and rapid normalization of hypercortisolism could stop the progression of hippocampal damage and memory impairments. Impairments of executive functions (including decision-making) and other functions such as visuoconstructive skills, language, motor functions and information processing speed are also present in CS patients. There is controversy concerning the reversibility of brain impairment. It seems that longer disease duration and older age are associated with less recovery of brain functioning. Conversely, earlier diagnosis and rapid normalization of hypercortisolism appear to stop progression of brain damage and functional impairments. Moreover, brain tissue functioning and neuroplasticity can be influenced by many factors. Currently available studies appear to be complementary, evaluating the same phenomenon from different points of view, but are often not directly comparable. Finally, CS patients have a high prevalence of psychopathology, such as depression and anxiety which do not completely revert after cure. Thus, psychological or psychiatric evaluation could be recommended in CS patients, so that treatment may be prescribed if required.

The inhalation of smoke exhaled by a smoker, second-hand smoke (SHS), environmental smoke or the smoke produced at the lit end of smoked tobacco (sidestream smoke) by the act of smoking is referred to as passive smoking. These inhaled products of tobacco combustion have been shown to have detrimental effects on most organs in the body. Assessment of exposure is measured by a number of direct and indirect methods, which include measurement of air nicotine and the measurement of small particles (<2.5 μm) in air. Cotinine, the main breakdown product of tobacco, is measured in body fluids as well as self-report and observed exposure measurements. The adverse health effects were largely established by large-scale epidemiological studies carried out over many years. The finding that SHS caused lung cancer led the International Agency for Research on Cancer to declare SHS as a class A carcinogen. The health benefits of smoke-free legislation have been observed all over the world and corroborate the predictions from known health effects of exposure to SHS and seem to be even greater than expected. A further side effect of smoke-free legislation is a major contribution to the denormalisation of smoking in public to which electronic cigarettes are perceived as a possible threat. The extension of smoke-free legislation to other areas as well as indoor public spaces has started and is under consideration in many countries.

Humans are social animals that communicate disproportionately via potent genetic signals imbued in the skin and hair, including racial, ethnic, health, gender, and age status. For the vast majority of us, age-related hair pigment loss becomes the inescapable signal of our disappearing youth. The hair follicle (HF) pigmentary unit is a wonderful tissue for studying mechanisms generally regulating aging, often before this becomes evident elsewhere in the body. Given that follicular melanocytes (unlike those in the epidermis) are regulated by the hair growth cycle, this cycle is likely to impact the process of aging in the HF pigmentary unit. The formal identification of melanocyte stem cells in the mouse skin has spurred a flurry of reports on the potential involvement of melanocyte stem cell depletion in hair graying (i.e., canities). Caution is recommended, however, against simple extrapolation of murine data to humans. Regardless, hair graying in both species is likely to involve an age-related imbalance in the tissue's oxidative stress handling that will impact not only melanogenesis but also melanocyte stem cell and melanocyte homeostasis and survival. There is some emerging evidence that the HF pigmentary unit may have regenerative potential, even after it has begun to produce white hair fibers. It may therefore be feasible to develop strategies to modulate some aging-associated changes to maintain melanin production for longer.

The speech-language pathologist (SLP) plays an important role in the assessment and management of children with velopharyngeal insufficiency (VPI). The SLP assesses speech sound production and oral nasal resonance and identifies the characteristics of nasal air emission to guide the clinical and surgical management of VPI. Clinical resonance evaluations typically include an oral motor exam, identification of nasal air emission, and analysis of the speech sound repertoire. Additional elements include perceptual assessment of intra-oral air pressure, the degree of hypernasality, and vocal loudness/quality. Clinical speech and resonance evaluations are typically the gold-standard evaluation method until a child reaches 3-4 years of age, when sufficient compliance levels and speech-language abilities allow for participation in instrumental testing. At that time, objective assessment measures are introduced, including nasometry, videofluoroscopy, and/or nasopharyngoscopy. Nasometry is a computer-based tool that quantifies nasal air escape and allows comparison of the score against normative data. Videofluoroscopy is a radiographic tool used to assess the shaping of the velum and closure of the velopharyngeal mechanism during speech production. Evaluation findings guide decision making regarding surgical candidacy and/or the therapeutic management of VPI. Surgery should always be pursued first when an anatomic deficit prevents velopharyngeal closure. Therapy should always be pursued in children who present with velopharyngeal mislearning and/or motor planning issues resulting in VPI. It is not uncommon for children to receive a combination of surgical intervention and speech resonance therapy during their VPI management course. Collaborative decision making between the otorhinolaryngologist and the SLP provides optimal patient care.

Psoriasis is a common chronic inflammatory skin disease observed in about 1-3% of the general population. About 60-90% of patients with psoriasis suffer from itching. Interestingly, in the past itch was not considered as an important symptom of psoriasis. Despite the high frequency of itch in psoriasis, the pathogenesis of this symptom is still not fully elucidated. Although most studies indicate neurogenic inflammation and the role of neuropeptides, other mediators may be important as well. The majority of psoriatic patients consider itch as the most bothersome symptom of the disease as it significantly alters daily functioning and psychosocial well-being. Patients with itch showed greater impairment of their health-related quality of life compared to those without itch, and the intensity of itch correlated with the degree of quality-of-life reduction. However, treatment options for itch in psoriasis are limited. Therapy of itch in patients with psoriasis should be directed toward the resolution of skin lesions, as disease remission usually is linked with itch relief. Recent studies have clearly pointed to an important role of apremilast and biologic agents in itch intensity reduction in subjects suffering from psoriasis. Other treatment modalities include antihistamines, especially with a sedative effect, narrowband ultraviolet B, and antidepressants (doxepin, mirtazapine, paroxetine). Support by family members and/or health professionals may also be of importance in helping psoriatic subjects cope with itch.

The basic principles in quitting smoking are to set a target quit day and try to cut down to zero cigarettes in a few weeks - but best at target quit day - and then use one of the primary drugs for smoking cessation for 2-3 months. In this period, the ex-smoker has to break the psychological addiction as well as the nicotine dependence. Using one of the primary drugs reduces the withdrawal symptoms. Any support will increase quit rate and counselling should be used in combination with one of the primary drugs, i.e. varenicline, nicotine replacement treatment (NRT) and bupropion SR. Varenicline and the combination of two NRT formulations is equally effective, while varenicline is more effective than either single NRT or bupropion SR. NRTs are especially safe. All three drugs have also been shown to be especially effective in patients with chronic obstructive pulmonary disease and in patients with cardiovascular disorders; the main reason for the larger effect in this subgroup is the low quit rate among placebo-treated subjects. There is extensive and solid scientific proof that underlines the efficacy of these three primary drugs in smoking cessation as well as the very high cost-effectiveness of smoking cessation. Vaccines against nicotine have not been effective until now.