Learning to live together: an exploration and analysis of managing cultural diversity in ten early childhood development centres in South Africa

This study explores how South African Early Childhood Development (ECD) Practitioners and families meet the needs of the increasing number of children from diverse cultural backgrounds in their care. Research participants were identified through ten ECD centres located in two urban communities in the Eastern and Western Cape Provinces of South Africa. The values and attitudes held by Practitioners and families vis-à-vis cultural diversity was investigated, along with the knowledge and strategies they employ to manage cultural diversity in ECD programmes. The intercultural education model provides the necessary tools to address the challenges identified.

Canakinumab Reduces The Risk Of Acute Gouty Arthritis Flares During Initiation Of Allopurinol Therapy: Results Of A Double-blind, Randomised Study

RATIONALE: This study assessed the efficacy and safety of canakinumab, a fully human anti-interleukin-1beta monoclonal antibody, for prophylaxis against acute gouty arthritis flares in patients initiating uratelowering therapy.METHODS: In this double-blind, double-dummy, dose-ranging study, 432 patients with gouty arthritis initiating allopurinol therapy were randomised 1:1:1:1:1:1:2 to receive: a single dose of canakinumab, 25, 50, 100, 200, or 300 mg subcutaneously (sc); four 4-weekly doses of canakinumab (50150125125 mg sc); or daily colchicine 0.5 mg orally for 16 weeks. Patients recorded details of flares in diaries. The study aimed to determine the canakinumab dose having equivalent efficacy to colchicine 0.5 mg at 16 weeks.RESULTS: A dose-response for canakinumab was not apparent with any of the four pre-defined dose-responsemodels. The estimated canakinumab dose with equivalent efficacy to colchicinewas belowthe range of doses tested.At 16 weeks, therewas a 62-72% reduction in themean number of flares per patient for canakinumab doses >50 mg vs colchicine based on a negative binomial model (rate ratio: 0.28-0.38, p50.0083), and the percentage of patients experiencing >1 flarewas significantly lower for all canakinumab doses (15- 27%) vs colchicine (44%, p<0.05). Therewas a 64-72%reduction in the risk of experiencing >1 flare for canakinumab doses >50 mg vs colchicine at 16 weeks (hazard ratio: 0.28-0.36, p50.05). The incidence of adverse events was similar across treatment groups.CONCLUSIONS: Single canakinumab doses >50 mg or four 4-weekly doses provided superior prophylaxis against flares compared with daily colchicine 0.5 mg.

Reproducibility and feasibility of a 22 joints ultrasound score in rheumatoid arthritis: a study among rheumatologists with diverse expertise in musculoskeletal ultrasound

Objective: To assess reproducibility and feasibility of amusculoskeletal ultrasound (US) score for rheumatoid arthritis amongrheumatologist with diverse expertise in US, working in private orhospital practice.Methods: The Swiss Sonography in Arthritis and Rheumatism(SONAR) group has developed a semi-quantitative score for RA usingOMERACT criteria for synovitis and erosion. The score was taught torheumatologists trained in US through two workshops. Subsequently,they were encouraged to practice in their office. For the study, we used6 US machines of different quality, each with a different patient.19 readers randomly selected among rheumatologists who haveattended both workshops, were asked to score anonymously at leastone patient. To assess whether some factors influence the score, weasked each reader to answer questionnaire describing his experiencewith US.Results: 19 rheumatologists have performed 29 scans, each patienthaving been evaluated by 4 to 6 readers. Median time for examcompletion was 20 minutes (range 15 to 60 mn). 53% ofrheumatologists work in private practice. Graph 1 show the global greyscale score for each patient. Weighted kappa was calculated for eachpair of reader using stata11. Almost all kappa of poor agreement wereobtained with a low quality device or by an assessor who havepreviously performed less than 5 scores himself.Conclusions: This is the first study to show an US score for RAfeasible by rheumatologists with diverse expertise in US both in privateand hospital practice. Reproducibility seemed to be influenced by thequality of device and previous experience with the score.

Biologics in rheumatoid arthritis - recommendations for Swiss practice.

The new paradigm of therapy in rheumatoid arthritis is to aim toward early and complete remission, using a larger use of conventional DMARDs and biologic agents. The present recommendations were established through a consensus to help practitioners in their daily use of those agents, to reflect the current "best practice" in Switzerland.

Rhumatologie. Polyarthrite rhumatoide et spondylarthrite ankylosante [Rheumatoid arthritis and ankylosing spondylitis: rheumatologic highlights 2007]

L'utilisation des traitements biologiques est maintenant solidement ancrée dans la prise en charge des rhumatismes inflammatoires. Les anti-TNFa sont à juste titre devenus des agents de choix ces dix dernières années, et la littérature récente nous rappelle leurs places et indications dans la spondylarthrite ankylosante. Toutefois, tous les patients n'y répondent pas et la disponibilité de nouveaux traitements est certainement une addition bienvenue. L'abatacept est un nouveau traitement de la polyarthrite rhumatoïde avec un mode d’action innovateur, qui paraît efficace et adéquatement sûr et pour lequel quelques données et aspects pratiques d'utilisation sont présentés. Nous devons néanmoins encore apprendre à l'intégrer dans des stratégies thérapeutiques, comme nous sommes en train de le faire avec le rituximab. The use of biological therapy is now firmly established in the management of inflammatory rheumatism. The anti-TNFalpha have rightly become agents of choice over the last 10 years, and the recent literature reminds us of their places and indications in ankylosing spondylitis. However, not all patients respond, and the availability of new treatments is certainly a welcome addition. Abatacept is a new treatment for rheumatoid arthritis with an innovative mode of action. It appears effective and safe, and some data as well as practical aspects on its use are presented. Nevertheless, we must still learn to integrate it into our therapeutic strategies, as we are presently doing with rituximab

Recommandations pour la prise en charge des formes oligoarticulaire et polyarticulaires (en dehors de la polyarthrite rhumatoïde) d'arthrite juvénile idiopathique [Guidelines for diagnosis and treatment of oligoarticular and polyarticular juvenile idiopathic arthritis].

A guideline group of pediatric rheumatologist experts elaborated guidelines related to the management of idiopathic juvenile arthritis in association with the Haute Autorité de santé (HAS). A systematic search of the literature published between 1998 and August 2008 and indexed in Pubmed was undertaken. Here, we present the guidelines for diagnosis and treatment in oligoarticular and polyarticular juvenile idiopathic arthritis (except for spondylarthropathy and rheumatoid arthritis).

HSS (F) 40-08 Managing Public Money Northern Ireland (PDF 221KB)

Managing Public Money Northern Ireland

Apoptosis as a target for gene therapy in rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovial joints resulting from hyperplasia of synovial fibroblasts and infiltration of lymphocytes, macrophages and plasma cells, all of which manifest signs of activation. All these cells proliferate abnormally, invade bone and cartilage, produce an elevated amount of pro-inflammatory cytokines, metalloproteinases and trigger osteoclast formation and activation. Some of the pathophysiological consequences of the disease may be explained by the inadequate apoptosis, which may promote the survival of autoreactive T cells, macrophages or synovial fibroblasts. Although RA does not result from single genetic mutations, elucidation of the molecular mechanisms implicated in joint destruction has revealed novel targets for gene therapy. Gene transfer strategies include inhibition of pro-inflammatory cytokines, blockade of cartilage-degrading metalloproteinases, inhibition of synovial cell activation and manipulation of the Th1-Th2 cytokine balance. Recent findings have iluminated the idea that induction of apoptosis in the rheumatoid joint can be also used to gain therapeutic advantage in the disease. In the present review we will discuss different strategies used for gene transfer in RA and chronic inflammation. Particularly, we will highlight the importance of programmed cell death as a novel target for gene therapy using endogenous biological mediators, such as galectin-1, a beta-galactoside-binding protein that induces apoptosis of activated T cells and immature thymocytes.

Sexual Offending in Northern Ireland - Managing the Risk

Sexual Offending in Northern Ireland - Managing the Risk

Managing Your Cancer Pain in Hospital and at Home (PDF 32 KB)

The purpose of this booklet is to give you information about pain. It will help you understand how to describe pain, and how the pain may be treated.

Arthritis is linked to local and systemic activation of coagulation and fibrinolysis pathways.

BACKGROUND: Activation of coagulation and fibrinolysis play a role in the pathophysiology of experimental arthritis. Objective: To determine the extent of activation of the coagulation and fibrinolytic pathways in different joint diseases in humans and to ascertain the factors that may influence fibrin deposition within the joint. METHODS: Plasma from normal subjects (controls, n= 21) and plasma and synovial fluid samples from patients with rheumatoid arthritis (RA; n = 64), osteoarthritis (OA; n = 29), spondyloarthropathy (SpA; n = 22) and crystal arthritis (CA; n = 25) were analyzed for the levels of TF (tissue factor) and tissue factor pathway inhibitor (TFPI) activities, thrombin-antithrombin III (TAT) complexes, and F1 + 2 (thrombin fragment), fibrin d-dimer and thrombin-activated fibrinolysis inhibitor (TAFI) antigenic levels. The measurements were analyzed by pairwise correlation with each other as well as with standard parameters of inflammation [C-reactive protein (CRP), joint leukocyte count]. Inter-group comparisons were performed to look for disease-specific differences. RESULTS: Compared with healthy controls, patients with joint diseases had higher levels of TAT, F1 + 2 and d-dimers in their plasma. In the synovial fluid, TF activity, TAT, d-dimers, and TAFI were significantly higher in inflammatory arthritides than in OA. The levels were highest in RA patients. In the plasma, TF activity was correlated with TAT and d-dimer levels with CRP, TFPI, and TAT. In the synovial fluid, TF activity correlated with plasma CRP levels, synovial fluid leukocyte count, and synovial TAT and TAFI levels. In addition, synovial d-dimers correlated with CRP, and synovial TAFI levels were correlated with synovial F1 + 2 and TAT. CONCLUSIONS: Activation of the coagulation and fibrinolytic cascades in the joint and in the circulation is evident in both inflammatory and degenerative joint diseases. Within the joint, inflammatory mechanisms leading to TF-mediated activation of the coagulation pathway and subsequent fibrin deposition is the most likely explanation for the observed findings. In the plasma, the link between inflammation (CRP increase) and TF activation is weak, and a non-TF-mediated mechanism of coagulation activation could explain these findings. RA is characterized by significantly higher levels of TAT in the synovial fluid and plasma than other arthritides. Although fibrinolytic activity is linked to inflammation, the increased amounts of TAFI in the joint, particularly in RA, may explain why fibrin formation is so prominent in this condition compared with other joint diseases.

Managing the size of the Olympic Games

The last two decades have seen dramatic increases in the size and scope of the Summer Olympic Games. In many ways, London 2012 reached even higher summits than the Beijing Games in 2008. This growth is a major challenge for the Olympics and its future organizers, as it is making the Games increasingly difficult to stage and has greatly reduced the number of cities capable of hosting them. This study shows how various participation and organization indicators have expanded over six Olympiads, from Barcelona 1992 to London 2012, and examines the reasons for this growth. It suggests ways of reducing the size of the Summer Olympic Games in order to make them more manageable and to encourage candidatures from smaller cities and countries.

Managing health and increasing well-being

The Building the Community-Pharmacy Partnership has worked to improve local health outcomes by encouraging members of the community to develop skills relating to managing their own health, and providing accessible information on the availability of services of which they can avail of. The aim is to facilitate local people to gain knowledge on various health issues through books, videos, leaflets and enable the most vulnerable and in need to access additional support through the pharmacy to complementary therapy. Outcome: A room in the pharmacy has been renovated and offers access to other support services. Funding has allowed the pharmacist to equip the room with videos, leaflets, books etc. There has been an increase in partnership working between the community group, pharmacist and more contact has been made with primary care. Further funding has allowed for the development of a subsidised support referral service for counselling and complementary therapies. As well as this, the pharmacist has worked with local groups to provide information sessions on lifestyle and on health issues identified by the local groups