Qualifying instrument for evaluation of food and nutritional care in hospital

Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal management dietitian activities." (Nutr Hosp. 2012;27:1170-1177) DOI:10.3305/nh.2012.27.4.5868

Gene expression down-regulation in CD90+ prostate tumor-associated stromal cells involves potential organ-specific genes

Abstract Background The prostate stroma is a key mediator of epithelial differentiation and development, and potentially plays a role in the initiation and progression of prostate cancer. The tumor-associated stroma is marked by increased expression of CD90/THY1. Isolation and characterization of these stromal cells could provide valuable insight into the biology of the tumor microenvironment. Methods Prostate CD90+ stromal fibromuscular cells from tumor specimens were isolated by cell-sorting and analyzed by DNA microarray. Dataset analysis was used to compare gene expression between histologically normal and tumor-associated stromal cells. For comparison, stromal cells were also isolated and analyzed from the urinary bladder. Results The tumor-associated stromal cells were found to have decreased expression of genes involved in smooth muscle differentiation, and those detected in prostate but not bladder. Other differential expression between the stromal cell types included that of the CXC-chemokine genes. Conclusion CD90+ prostate tumor-associated stromal cells differed from their normal counterpart in expression of multiple genes, some of which are potentially involved in organ development.

Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917

Sustentabilidade nas organizações: a internalização dos gastos com o descarte do produto e/ou embalagem aos custos de produção

Neste estudo, tem-se como objetivo analisar e discutir crenças, valores e aspectos práticos, considerando que a internalização dos gastos decorrentes do descarte do produto e/ou embalagens deve nortear a gestão de custos de produção de uma empresa. Por tratar-se de área do conhecimento ainda carente de estudos e sem solução consensual por parte de agentes do mercado, realizou-se um ensaio teórico em que são apresentados e discutidos posicionamentos, práticas e ações com potencial para mitigar os efeitos da degradação ambiental decorrentes de descartes inapropriados. Para isso são propostas ações por parte de empresas e de iniciativas voluntárias em negociações de títulos financeiros de compensação das externalidades, os quais foram denominados de créditos de internalização de custos privados (CICPs). Considera-se que o desenvolvimento com sustentabilidade é um processo que envolve negociações entre empresas, governos e sociedade civil, pois as políticas e metas não devem ser apenas economicamente viáveis, mas socialmente justas, ambientalmente corretas e culturalmente compartilhadas.

Climate Change and "historical responsibilities"

The historical responsibility of countries listed in the Annex I of the Convention on Climate Change has been used extensively as a justification for the lack of action of countries not included in Annex I to reduce their greenhouse gas emissions. We analyzed the contribution of non-Annex I countries to the CO2 emissions in the period 1850 - 2006 to assess their relative contribution to total CO2 emissions. In the period 1980 - 2006 non-Annex I countries represented 44% of the total but this contribution increased in the period 1990 - 2006 to 48%. If we extrapolate present trends to 2020 they will represent 56% in the period 1990 - 2020. The "historical responsibility" of Annex I countries is therefore decreasing. If we take 1990 as the starting year in which the Climate Convention recognized clearly that greenhouse gases are interfering dangerously with the climate system, it becomes very difficult to attribute "blame" and "guilt" to Annex I for their historical contributions. It becomes also quite clear the need of non-Annex I countries to engage with Annex I countries in the effort to reduce emissions. The Copenhagen Accord has no mention of "historical responsibilities".