Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial

Objectives: To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata). Design: Data from two international, double blind, placebo controlled, randomised efficacy trials of quadrivalent HPV vaccine (protocol 013 (FUTURE I) and protocol 015 (FUTURE II)). The trials were to be 4 years in length, and the results reported are from final study data of 42 months' follow-up. Setting: Primary care centres and university or hospital associated health centres in 24 countries and territories around the world. Participants: 17 622 women aged 16-26 years enrolled between December 2001 and May 2003. Major exclusion criteria were lifetime number of sexual partners (>4), history of abnormal cervical smear test results, and pregnancy. Intervention: Three doses of quadrivalent HPV vaccine (for serotypes 6, 11, 16, and 18) or placebo at day 1, month 2, and month 6. Main outcome measures: Vaccine efficacy against cervical, vulvar, and vaginal intraepithelial neoplasia grade I and condyloma in a per protocol susceptible population that included subjects who received all three vaccine doses, tested negative for the relevant vaccine HPV types at day 1 and remained negative through month 7, and had no major protocol violations. Intention to treat, generally HPV naive, and unrestricted susceptible populations were also studied. Results: In the per protocol susceptible population, vaccine efficacy against lesions related to the HPV types in the vaccine was 96% for cervical intraepithelial neoplasia grade I (95% confidence interval 91% to 98%), 100% for both vulvar and vaginal intraepithelial neoplasia grade I (95% CIs 74% to 100%, 64% to 100% respectively), and 99% for condyloma (96% to 100%). Vaccine efficacy against any lesion (regardless of HPV type) in the generally naive population was 30% (17% to 41%), 75% (22% to 94%), and 48% (10% to 71%) for cervical, vulvar, and vaginal intraepithelial neoplasia grade I, respectively, and 83% (74% to 89%) for condyloma. Conclusions: Quadrivalent HPV vaccine provided sustained protection against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up. Trial registrations: NCT00092521 and NCT00092534.

The Ergonomic Analysis and Back Injuries in Flexible Production System

Back injuries identification and diagnoses in the transition of the Taylor model to the flexiblemodel of production organization, demands a parallel intervention of prevention actors at work. This study uses simultaneously three intervention models (structured action analysis, muscle skeletal symptoms questionnaires and muscle skeletal assessment) for work activities in a packaging plant. In this study seventy and two (72) operative workers participated (28 workers with muscle skeletal evaluation). In an intervention period of 10 months, the physical, cognitive, organizational components and productive process dynamics were evaluated from the muscle skeletal demands issues. The differences established between objective exposure at risk, back injury risk perception, appreciation and a vertebral spine evaluation, in prior and post intervention, determines the structure for a muscle skeletal risk management system. This study explains that back injury symptoms can be more efficiently reduced among operative workers combining measures registered and the adjustment between dynamics, the changes at work and efficient gestures development. Relevance: the results of this study can be used to pre ent back injuries in workers of flexible production processes.

The political influence of the kurdish community in Syria and its possible transboundary Effects in the subregion of the Middle East, during the period 2011-2014

El interés de esta monografía es analizar las interacciones no-lineales con resultados emergentes que mantuvo la comunidad kurda en Siria, durante el periodo 2011-2014, y por las cuales se produjeron formas de auto-organización como resultado de la estructura compleja a la que pertenece. De esta forma, se explica cómo a raíz de la crisis política siria y los enfrentamientos con el Estado Islámico, se transformó el rol de los kurdos en Siria y se influenciaron las estructuras políticas del país y las naciones de la región con población kurda. Por lo tanto, esta investigación se propone analizar este fenómeno a través del enfoque de complejidad en Relaciones Internacionales y el concepto de Auto-Organización. A partir de ello, se indaga sobre las interacciones surgidas en estructuras más pequeñas, que habrían afectado un sistema mayor; estableciendo nuevas formas de organización que no pueden ser explicadas, únicamente, a partir de elementos causales.

Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study

Objective To model the overall and income specific effect of a 20% tax on sugar sweetened drinks on the prevalence of overweight and obesity in the UK. Design Econometric and comparative risk assessment modelling study. Setting United Kingdom. Population Adults aged 16 and over. Intervention A 20% tax on sugar sweetened drinks. Main outcome measures The primary outcomes were the overall and income specific changes in the number and percentage of overweight (body mass index ≥25) and obese (≥30) adults in the UK following the implementation of the tax. Secondary outcomes were the effect by age group (16-29, 30-49, and ≥50 years) and by UK constituent country. The revenue generated from the tax and the income specific changes in weekly expenditure on drinks were also estimated. Results A 20% tax on sugar sweetened drinks was estimated to reduce the number of obese adults in the UK by 1.3% (95% credible interval 0.8% to 1.7%) or 180 000 (110 000 to 247 000) people and the number who are overweight by 0.9% (0.6% to 1.1%) or 285 000 (201 000 to 364 000) people. The predicted reductions in prevalence of obesity for income thirds 1 (lowest income), 2, and 3 (highest income) were 1.3% (0.3% to 2.0%), 0.9% (0.1% to 1.6%), and 2.1% (1.3% to 2.9%). The effect on obesity declined with age. Predicted annual revenue was £276m (£272m to £279m), with estimated increases in total expenditure on drinks for income thirds 1, 2, and 3 of 2.1% (1.4% to 3.0%), 1.7% (1.2% to 2.2%), and 0.8% (0.4% to 1.2%). Conclusions A 20% tax on sugar sweetened drinks would lead to a reduction in the prevalence of obesity in the UK of 1.3% (around 180 000 people). The greatest effects may occur in young people, with no significant differences between income groups. Both effects warrant further exploration. Taxation of sugar sweetened drinks is a promising population measure to target population obesity, particularly among younger adults.

Dairy fat: perceptions and realities.

Milk provides many key nutrients but the saturated and trans fatty acids in milk fat are associated with perceived negative effects on human health, especially cardiovascular disease. Recent epidemiological studies and dietary intervention trials challenge this perception, however; available evidence does not support the concept that consumption of saturated fats or dairy products adversely affects the risk of coronary heart disease (although replacing some saturated fats with mono or polyunsaturated fats is likely to provide benefit). Furthermore, the trans fats found in dairy products are consumed in very low amounts and do not appear to have the negative health effects associated with the consumption of industrial sources of trans fat. Milk fat is an excellent source of oleic acid that originates mainly by endogenous synthesis from stearic acid, but increasing the milk fat content of unsaturated fatty acids requires dietary formulations that bypass rumen biohydrogenation. Recent research indicates that long-chain omega-3 fatty acids and conjugated linoleic acids have potential beneficial effects in health maintenance and the prevention of chronic diseases. Enhancing the milk fat content of these fatty acids offers exciting possibilities, but educating consumers about inaccurate and inappropriate generalisations about fat remains the primary challenge. Finally, individuals do not simply consume milk-fat-derived fatty acids on their own, but rather as components in dairy foods which are highly complex and may contain many beneficial ingredients. Overall, dairy products are critical in providing many of the essential nutrients in the human diet. Nevertheless, dairy products vary in their nutrient composition, including fat, and this needs to be considered in the context of dietary recommendations and our need to consume a balanced diet.

Criteria for validation and selection of cognitive tests for investigating the effects of foods and nutrients.

This review is an output of the International Life Sciences Institute (ILSI) Europe Marker Initiative, which aims to identify evidence-based criteria for selecting adequate measures of nutrient effects on health through comprehensive literature review. Experts in cognitive and nutrition sciences examined the applicability of these proposed criteria to the field of cognition with respect to the various cognitive domains usually assessed to reflect brain or neurological function. This review covers cognitive domains important in the assessment of neuronal integrity and function, commonly used tests and their state of validation, and the application of the measures to studies of nutrition and nutritional intervention trials. The aim is to identify domain-specific cognitive tests that are sensitive to nutrient interventions and from which guidance can be provided to aid the application of selection criteria for choosing the most suitable tests for proposed nutritional intervention studies using cognitive outcomes. The material in this review serves as a background and guidance document for nutritionists, neuropsychologists, psychiatrists, and neurologists interested in assessing mental health in terms of cognitive test performance and for scientists intending to test the effects of food or food components on cognitive function.

Validation of the NANA (Novel Assessment of Nutrition and Ageing) touch screen system for use at home by older adults

Prospective measurement of nutrition, cognition, and physical activity in later life would facilitate early detection of detrimental change and early intervention but is hard to achieve in community settings. Technology can simplify the task and facilitate daily data collection. The Novel Assessment of Nutrition and Ageing (NANA) toolkit was developed to provide a holistic picture of an individual's function including diet, cognition and activity levels. This study aimed to validate the NANA toolkit for data collection in the community. Forty participants aged 65 years and over trialled the NANA toolkit in their homes for three 7-day periods at four-week intervals. Data collected using the NANA toolkit were compared with standard measures of diet (four-day food diary), cognitive ability (processing speed) and physical activity (self-report). Bland–Altman analysis of dietary intake (energy, carbohydrates, protein fat) found a good relationship with the food diary and cognitive processing speed and physical activity (hours) were significantly correlated with their standard counterparts. The NANA toolkit enables daily reporting of data that would otherwise be collected sporadically while reducing demands on participants; older adults can complete the daily reporting at home without a researcher being present; and it enables prospective investigation of several domains at once

Apples and cardiovascular health: is the gut microbiota a core consideration?

There is now considerable scientific evidence that a diet rich in fruits and vegetables can improve human health and protect against chronic diseases. However, it is not clear whether different fruits and vegetables have distinct beneficial effects. Apples are among the most frequently consumed fruits and a rich source of polyphenols and fiber. A major proportion of the bioactive components in apples, including the high molecular weight polyphenols, escape absorption in the upper gastrointestinal tract and reach the large intestine relatively intact. There, they can be converted by the colonic microbiota to bioavailable and biologically active compounds with systemic effects, in addition to modulating microbial composition. Epidemiological studies have identified associations between frequent apple consumption and reduced risk of chronic diseases such as cardiovascular disease. Human and animal intervention studies demonstrate beneficial effects on lipid metabolism, vascular function and inflammation but only a few studies have attempted to link these mechanistically with the gut microbiota. This review will focus on the reciprocal interaction between apple components and the gut microbiota, the potential link to cardiovascular health and the possible mechanisms of action.

Urinary metabolomic profiling to identify biomarkers of a flavonoid-rich and flavonoid-poor fruits and vegetables diet: the FLAVURS trial in adults: the FLAVURS trial

The present study aims to investigate the dose dependent effects of consuming diets enriched in flavonoid-rich and flavonoid-poor fruits and vegetables on the urine metabolome of adults who had a C1.5 fold increased risk of cardiovascular diseases. A single-blind, dose-dependent, parallel randomized controlled dietary intervention was conducted where volunteers (n = 126) were randomly assigned to one of three diets: high flavonoid diet, low flavonoid diet or habitual diet as a control for 18 weeks. High resolution LC– MS untargeted metabolomics with minimal sample cleanup was performed using an Orbitrap mass spectrometer. Putative biomarkers which characterize diets with high and low flavonoid content were selected by state-of-the-art data analysis strategies and identified by HR-MS and HR-MS/MS assays. Discrimination between diets was observed by application of two linear mixedmodels: one including a diet-time interaction effect and the second containing only a time effect. Valerolactones, phenolic acids and their derivatives were among sixteen biomarkers related to the high flavonoid dietary exposure. Four biomarkers related to the low flavonoid diet belonged to the family of phenolic acids. For the first time abscisic acid glucuronide was reported as a biomarker after a dietary intake, however its origins have to be examined by future hypothesis driven experiments using a more targeted approach. This metabolomic analysis has identified a number of dose dependent urinary biomarkers (i.e. proline betaine or iberin-N-acetyl cysteine), which can be used in future observation and intervention studies to assess flavonoids and nonflavonoid phenolic intakes and compliance to fruit and vegetable intervention.

Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Transfer function-noise modeling and spatial interpolation to evaluate the risk of extreme (shallow) water-table levels in the Brazilian Cerrados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Educação inclusiva e formação continuada: contribuições dos casos de ensino para os processos de aprendizagem e desenvolvimento profissional de professores

This study focuses on processes of learning and professional development experienced by elementary school teachers who have students with special educational needs in their classrooms. Cases and case methods can be used as methodological resource to articulate the continued training of teachers in an inclusive perspective. This research-intervention adopted a constructive-collaborative model for continued teachers formation. The main objective was to investigate the possible contributions of teaching cases, while investigative and formative strategies, for the processes of learning and professional development of teachers who work in the regular school. The data were collected by means of analytical activities, drafting collective discussion and teaching cases, having eight teachers as participants in a regular public school, located in the municipality of Natal/RN, Brasil. The theoretical reference covers the inclusive education, teaching learning, teachers professional development, the knowledge base for teaching and teaching cases as a resource for continued teachers formation in an inclusive perspective. The results indicated that teaching cases allowed description and analysis of educational practices developed by regular education teachers and adoption of reflective processes about situations reported and on their own pedagogical actuation, achieving indications of changes. It also indicates the contribution of cases for the clarification, systematization and extension of professional knowledge about inclusive education process as well as for involvement by the teachers of the study in a pedagogical thinking process. The lessons learned are related mainly to own role as teachers of regular education, to the role of professional support and specialized institutions faced to school inclusion. The analyses showed the methodological option was suitable to develop a schoolcentric training process, allowing teachers to seek in their actual environment alternatives for construction of a new logic of teaching that encloses diversity. The conclusion is that the cases, while bringing educational situations closer to the reality experienced by teachers in their daily professional role, causes relevant improvement on teachers education, because it offers training in conjunction with the experience and knowledge that teachers already have

Educação inclusiva e formação continuada: contribuições dos casos de ensino para os processos de aprendizagem e desenvolvimento profissional de professores

This study focuses on processes of learning and professional development experienced by elementary school teachers who have students with special educational needs in their classrooms. Cases and case methods can be used as methodological resource to articulate the continued training of teachers in an inclusive perspective. This research-intervention adopted a constructive-collaborative model for continued teachers formation. The main objective was to investigate the possible contributions of teaching cases, while investigative and formative strategies, for the processes of learning and professional development of teachers who work in the regular school. The data were collected by means of analytical activities, drafting collective discussion and teaching cases, having eight teachers as participants in a regular public school, located in the municipality of Natal/RN, Brasil. The theoretical reference covers the inclusive education, teaching learning, teachers professional development, the knowledge base for teaching and teaching cases as a resource for continued teachers formation in an inclusive perspective. The results indicated that teaching cases allowed description and analysis of educational practices developed by regular education teachers and adoption of reflective processes about situations reported and on their own pedagogical actuation, achieving indications of changes. It also indicates the contribution of cases for the clarification, systematization and extension of professional knowledge about inclusive education process as well as for involvement by the teachers of the study in a pedagogical thinking process. The lessons learned are related mainly to own role as teachers of regular education, to the role of professional support and specialized institutions faced to school inclusion. The analyses showed the methodological option was suitable to develop a schoolcentric training process, allowing teachers to seek in their actual environment alternatives for construction of a new logic of teaching that encloses diversity. The conclusion is that the cases, while bringing educational situations closer to the reality experienced by teachers in their daily professional role, causes relevant improvement on teachers education, because it offers training in conjunction with the experience and knowledge that teachers already have

Saberes pedagógicos/comunicacionais, pesquisa/formação: reflexões sobre as experiências formativas das professoras online

The thesis, entitled, Pedagogical/comunication knowledge, research/formation: Reflections on the formative experiences of teachers online , developed dialogues on the pedagogical/communication knowledge, research-formation and the formative experiences of teachers online, for the purpose of understanding how pedagogical/communication knowledge is establishing/established from the formative experience of teachers online. For this reason we began with the following question: how does pedagogical/communication knowledge become estabilishing/established beginning with the formative experience of teachers online? The methodological approach for the selected research was research/formation, based on Ethnoresearch of critical formation. This became a rich route for reflections on pedagogical/communication knowledge and formative experiences, making a contribution for formation and autoformation of the teacher/researcher and the teachers online. This provided moments of formation, of reflection-in-action and on the action, potentialized/structured the process of comprehending, analyzing, interpreting, reflecting on the formative experiences and contributing for reflections on pedagogical/communication knowledge of the teacher online. The theoretical referential dialogue was based on concepts such as: education online, interactivity Silva (2002), Santos (2005), Moran (2003), teaching, Veiga (2005), Pimenta (2002), Freire (2005), Tardif (2002), teaching online Sacramento (2006), teaching knowledge Tardif (2002), Charlot (2000), Porlán (1997), García (1992), Freire (2005), Ethnoresearch-formation Macedo (2000), formation Macedo (2010), Josso (2010). The discoveries revealed that the pedagogical/communication knowledged becomes establishing/established beginning with formative experience of the teachers online, from the emergency of a collective communicative dialogue, structuring and potentialized by the experiences of the context online, from the didactic pedagogical/communicational organization online, of the research, of the relation created by the expertise and the presents itself along the itinerary of the family , the school, academic and professional. From this we can conclude that of knowledge and plural experiences, which became broken down because they are parts that relate themselves with other parts, which become united in one whole, the singular/plural, the local/global, the text and the context, agregating principles a pedagogical- communication perspective that orients :the dialogue, the interactivity, the hypertextuality, themultivocallity, formative dispositions, formative experiences all of wich makes for the possibilities for researdh and the training of professors and teachers who accept their point of departure and enddind points as pedagogy and experience

A leitura de literatura na escola: por uma educação emocional de crianças na educação infantil

This dissertation examines the contributions of juvenile literature reading for the problematization of the emotional experiences and conflicts of children at infant education. Its importance consists in providing useful information for the pedagogic work orientated to literature reading at the initial series of basic education, in order to increase the teacher s ability to explore the literary text from its instigating and enriching nature in view of the child s emotional experiences and conflicts. It is methodologically based on the principles of the qualitative research, what characterizes it as a case study. The research focused a level V-infant education class with 28 students in 5-6 age group, at a public school of Natal, State of Rio Grande do Norte (Brazil). The used resources were: audio recording, field diary, and interviews. Seventeen classes were carried out and they consisted in reading sessions of classic and contemporaneous tales, fables, and legends which used different didactic strategies. These sessions were developed in accordance with the reading experience through scaffolding instructions as it was described by Graves & Graves. The theoretical references were the studies of Amarilha (1997/ 2006), Bettelheim (2004), Coelho (1987/2000), Damásio (2005), Del Nero (2003), Eco (1994/2006), Held (1980), Iser (1996), Jauss (2002), Stierle (2002), Wallon (2007), Telles (2006), Yunes (2003), and Zilberman (1987). The analyses showed that literary reading in class is a special environment for inclusion of the reader s subjectivity; as well as the inclusion of their emotional experiences and their conflicts within the story by way of helping children think and become suitable for dealing with their inner feelings. The literary reading is presented as an experiential and formative activity which helps children understand their emotions through a process of identification, exteriorization, and catharsis; what implies that the esthetic experience from the text makes possible the reader s self-knowledge and increases the perception of his inner feelings and objective reality so that this reader has emotional capital to deal with life difficulties. It is important to highlight that the discussions carried out in the class represented a field of sharing experiences through which each reader had the chance to present their experience of life to the others, including their sorrows and sufferings, in order to help them to develop best strategies to deal with the social environment