Systematic Assessment of Factors Influencing Preferences of Crohn's Disease Patients in Selecting an Anti-TNF agent (CHOOSE TNF TRIAL)

Background a nd A ims: I nfliximab (IFX), adalimumab (ADA)and certolizumab pegol (CZP) have similar efficacy for inductionand maintenance of clinical response and remission in Crohn'sdisease (CD). Given the comparable nature of t hese drugs,patients' p references m ay i nfluence the choice o f the product.Goal: to identify factors contributing to CD patients' decision inselecting one anti-TNF agent over the others.Methods: A p rospectdive s urvey was performed a mong a nti-TNF-naïve CD patients. Prior to completion of a questionnaire,patients were provided with a description of the three anti-TNFagents f ocusing on indications, route of administration, s ideeffects, and scientific evidence of efficacy and safety.Results: One hundred patients (47f/53m, mean age 45±16yrs)completed the questionnaire. Disease location was ileal, colonicand ileocolonic in 33%, 40% and 27% of patients, respectively.Thirty-six percent preferred ADA as medication of choice, while28% and 2 5% p referred CZP and IFX; 11% were u ndecided.Patients' decision in selecting an anti-TNF drug was influencedby t he following f actors: side effects ( 76%), p hysician'srecommendation (66%), route of administration (54%), efficacydata (52%), time required for therapy administration (27%),recommendations by other CD patients (21%) and interactionswith other medications (12%).Conclusions: T he majority of p atients p referred anti-TNFmedications t hat were a dministered by s ubcutaneous i njectionrather t han b y intravenous i nfusion. Side effect profile andphysicians' r ecommendation are t wo m ajor factors influencingthe patients' s election of a specific anti-TNF d rug. Patients'concerns about safety and lifestyle habits should be taken intoaccount when prescribing anti-TNF drugs.

Estudio Línea Base – ELBA Callao, primavera 2011

Estudio Línea Base – ELBA Callao, primavera 2011. Inf Inst Mar Perú. 39(3-4): 149-198.- El ELBA se efectuó en el área delimitada por las islas San Lorenzo y El Frontón y la Península de La Punta, del 21 al 30 de noviembre 2011, para a) caracterizar biológica y oceanográficamente el área de estudio y b) obtener bases técnicas para el ordenamiento pesquero y acuícola. En el área predominaron sedimentos arenosos y grava de origen terrígeno. Presentó características térmicas frías al interior y cálidas al sur, con influencia de aguas costeras. La comunidad fitoplanctónica presentó abundancia de diatomeas. Se identificó zonas con alta biomasa de bentos y con altos valores de stress. Los sólidos suspendidos totales, cadmio y coliformes totales y termotolerantes sobrepasaron los límites de los estándares de calidad acuática en el Perú. Las comunidades de invertebrados más importantes fueron: concha de abanico Argopecten purpuratus, cangrejos Cancer setosus (ahora Romaleon polyodon) y C. porteri, almeja Semele spp., pulpo Octopus mimus y macroalga Macrocystis sp.; el calamar Loligo gahi usa el área para desovar.

Calidad ambiental del humedal poza La Arenilla, Callao 2008

El presente informe da a conocer los resultados analíticos de la evaluación de parámetros físico-químicos, microbiológicos y contaminación de tipo orgánico de la calidad acuática del Humedal poza La Arenilla, La Punta, Provincia Constitucional del Callao en junio del 2008.

Inpatient diabetes care in a Swiss multi-site hospital: is there room for improvement?

Background and objective: Optimal care of diabetic patients (DPs) decreases the risk of complications. Close blood glucose monitoring can improve patient outcomes and shorten hospital stay. The objective of this pilot study was to evaluate the treatment of hospitalized DPs according to the current standards, including their diabetic treatment and drugs to prevent diabetes related complications [=guardian drugs: angiotensin converting enzyme inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARB), antiplatelet drugs, statins]. Guidelines of the American Diabetes Association (ADA) [1] were used as reference as they were the most recent and exhaustive for hospital care. Design: Observational pilot study: analysis of the medical records of all DPs seen by the clinical pharmacists during medical rounds in different hospital units. An assessment was made by assigning points for fulfilling the different criteria according to ADA and then by dividing the total by the maximum achievable points (scale 0-1; 1 = all criteria fulfilled). Setting: Different Internal Medicine and Geriatric Units of the (multi-site) Ho^pital du Valais. Main outcome measures: - Completeness of diabetes-related information: type of diabetes, medical history, weight, albuminuria status, renal function, blood pressure, (recent) lipid profile. - Management of blood glucose: Hb1Ac, glycemic control, plan for treating hyper-/hypoglycaemia. - Presence of guardian drugs if indicated. Results: Medical records of 42 patients in 10 different units were analysed (18 women, 24 men, mean age 75.4 ± 11 years). 41 had type 2 diabetes. - Completeness of diabetes-related information: 0.8 ± 0.1. Information often missing: insulin-dependence (43%) and lipid profile (86%). - Management of blood glucose: 0.5 ± 0.2. 15 patients had suboptimal glycemic balance (target glycaemia 7.2-11.2 mmol/ l, with values[11.2 or\3.8 mmol/l, or Hb1Ac[7%), 10 patients had a deregulated balance (more than 10 values[11.2 mmol/l or \3.8 mmol/l and even values[15 mmol/l). - Presence of guardian drugs if indicated: ACEI/ARB: 19 of 23 patients (82.6%), statin: 16 of 40 patients (40%), antiplatelet drug: 16 of 39 patients (41%). Conclusions: Blood glucose control was insufficient in many DPs and prescription of statins and antiplatelet drugs was often missing. If confirmed by a larger study, these two points need to be optimised. As it is not always possible and appropriate to make those changes during hospital stay, a further project should assess and optimise diabetes care across both inpatient and outpatient settings.

Influência da qualidade da água de irrigação na dispersão da argila de Latossolos

O fenômeno de dispersão da argila do solo pode ser provocado pela qualidade da água de irrigação. Objetivou-se estudar o efeito da irrigação com água com diferentes condutividades elétricas (CE), combinadas com diferentes valores de Relação de Adsorção de Sódio (RAS), na dispersão da argila de solos, de diferentes mineralogias, do Estado de Minas Gerais. As amostras foram coletadas no horizonte B de solos das cidades de Viçosa, Belo Horizonte e Barroso, classificados como Latossolo Vermelho-Amarelo distrófico típico (LVA), Latossolo Vermelho perférrico típico (LV) e Latossolo Vermelho distroférrico típico (LVd) destacados, respectivamente, pela presença de argilominerais caulinita, hematita e gibbsita. Os tratamentos corresponderam à percolação, nos três solos, de soluções de NaCl e CaCl2 preparadas de forma a se obter seis diferentes valores de CE (20; 50; 100; 200; 400 e 800 mS m-1) e cinco de RAS (0, 5, 10, 20 e 40 mmol c L-1), em três repetições, dispostos em um delineamento em blocos casualizados. A aplicação das soluções foi feita em permeâmetros de coluna vertical e carga constante. A solução foi aplicada até o momento em que a CE do efluente se aproximou daquela da solução aplicada (C/C0 = 1,0). Para avaliar o efeito das soluções aplicadas na estrutura do solo, foram quantificados os teores de argila dispersa em água (ADA). Os valores de ADA nas amostras de solo submetido à percolação das diferentes soluções salino-sódicas (ADA-S) foram relacionados com a CE e a RAS da solução percolada, ajustando-se superfícies de resposta com este fim. O comportamento dos solos foi diferenciado, no que se refere à dispersividade da argila, o que estava associado à mineralogia, mas, também, ao grau de intemperismo do solo. O LVA apresentou comportamento não dispersivo em todos os tratamentos e, no geral, todas as soluções de percolação, notadamente as de maiores CE, independentemente dos valores de RAS, proporcionaram diminuição no teor de argila dispersa (ADA-S) nos solos LV e LVd.

Relações solo-paisagem em uma topossequência sobre substrato granítico em Santo Antônio do Matupi, Manicoré (AM)

Considerando as dimensões da região amazônica e a necessidade de estudos que estabeleçam conexões entre os solos e a expressão da paisagem, o objetivo deste trabalho foi estudar as relações solo-paisagem em uma topossequência sobre substrato granítico em Santo Antônio do Matupi, Manicoré, AM. Foi estabelecido um caminhamento de 3.000 m a partir do "espigão" da vertente, no seu sentido mais suave, com identificação dos segmentos da vertente com base na "quebra" do declive do terreno. Foram abertas trincheiras nos segmentos de vertente mapeados, e perfis foram caracterizados morfologicamente, coletando-se amostras de seus horizontes. Foram realizadas análises físicas (textura, ADA e GF, Ds e Dp, Pt e CHSS), químicas (pH em água e KCl, Ca, Mg, K, Na e Al trocáveis, P disponível, H + Al e C orgânico; SiO2, Al2O3 e Fe2O3 (método do H2SO4) e óxidos de Fe "livres" extraído com ditionito-citrato-bicarbonato e o Fe mal cristalizado extraído com oxalato de amônio) e mineralógicas (frações areia, silte e argila), usando difratometria de raios X. As variações do relevo favoreceram a presença de solos distróficos nos topos e solos eutróficos no sopé de transporte. As variáveis ΔpH, relação silte/argila, V % e relação Fed/Fet indicaram a presença de solos mais intemperizados nas áreas de topo da paisagem e solos com menor grau de evolução na encosta e no sopé de transporte. A composição mineralógica da fração argila mostrou-se relativamente homogênea, com predominância de caulinita e gibbsita e menor proporção de mica e quartzo.

Systematic assessment of items influencing Crohn's disease patient's preferences in selecting an anti-TNF agent (Choose TNF trial)

Background and Aims: The three anti-TNF agents infliximab (IFX), adalimumab (ADA) andcertolizumab pegol (CZP) have demonstrated similar efficacy in induction and maintenanceof response and remission in Crohn's disease (CD) treatment. Given the comparability ofthese drugs, patient's preferences may influence the choice of the product. However, dataon patient's preferences for choosing anti-TNF agents are lacking. We therefore aimed toassess the CD patient's appraisal to select the drug of his choice and to identify factorsguiding this decision.Methods: A prospective survey among anti-TNF-naive CD patientswas performed. Patients were provided a description of the three anti-TNF agents focusingon indication, application mode (s.c. vs. i.v.), application time intervals, setting of application(hospital vs. private practice vs. patient's home), average time to apply the medication permonth, typical side effects, and the scientific evidence of efficacy and safety available for everydrug. Patients answered a questionnaire consisting of 17 questions, covering demographic,disease-specific, and medication data.Results: Hundred patients (47f/53m, mean age 45±16years) completed the questionnaire. Disease duration was <1year in 7%, 1-5 years in 31%,and >5 years in 62% of patients. Disease location was ileal in 33%, colonic in 40%, andileocolonic in 27%. Disease phenotype was inflammatory in 68%, stenosing in 29%, andinternally fistulizing in 3% of patients. Additionally, 20% had perianal fistulizing disease.Patients were already treated with the following drugs: mesalamines 61%, budesonide 44%,prednisone 97%, thiopurines 78%, methotrexate 16%. In total, 30% had already heardabout IFX, 20% about ADA, and 11% about CZP. Thirty-six percent voted for treatmentwith ADA, 28% for CZP, and 25% for IFX, whereas 11% were undecided. The followingfactors influenced the patient's decision for choosing a specific anti-TNF drug (severalanswers possible): side effects 76%, physician's recommendation 66%, application mode54%, efficacy experience 52%, time to spend for therapy 27%, patient's recommendations21%, interactions with other medications 12%. The single most important factor for choosinga specific anti-TNF was (1 answer): side effect profile 35%, physician's recommendation22%, efficacy experience 21%, application mode 13%, patient's recommendations 5%, timespent for therapy 3%, interaction with other medications 1%.Conclusions: The majority ofpatients preferred anti-TNF syringes to infusions. The safety profile of the drugs and thephysician's recommendation are major factors influencing the patient's choice for a specificanti-TNF drug. Patient's issues about safety and lifestyle habits should be taken into accountwhen prescribing specific anti-TNF formulations.

Entre a história e a memória, o estudo psicossocial das memórias históricas

O artigo aborda a noção de "memórias históricas", a qual, como uma instância conceitual do fenômeno da memória social, designa as "memórias da história" construídas por populações que estiveram implicadas em fatos que se tornaram "históricos". Este estudo é da alçada da psicologia social, não tendo qualquer implicação para a produção científica da história. Assim, busca-se distingui-las das "histórias memoriais", que constituem um tipo alternativo de história, a partir das lembranças de participantes de determinados eventos, sem submetê-los nem aos critérios clássicos da pesquisa histórica nem a uma rigorosa análise psicossocial. Conclui-se que, entendidas como um empreendimento acadêmico na tradição da psicologia social, as "memórias históricas" não advogam qualquer relação com a verdade histórica. Elas são concebidas como memórias, não como história, cujos produtos não dão conta exclusiva da sua determinação, visto haver mais na memória histórica do que a história seria capaz de suprir.

Informação tecnológica e para negócios no Brasil: introdução a uma discussão conceitual

Discorre-se que, apesar do valor estratégico da informação, sua utilização de forma eficiente e eficaz não está plenamente consolidada no Brasil. Refere-se à falta de consenso no uso de conceitos e terminologias relacionados com a informação para indústria/empresas, focalizando, principalmente, a informação tecnológica e informação para negócios. Apresentam-se termos e conceitos referentes à indústria, tecnologia e negócios recuperados na literatura. Trata-se de uma contribuição para os estudos conceituais da área de informação tecnológica e para negócios no Brasil.

Pieces of Iowa’s Past, March 13, 2013

Pieces of Iowa’s Past, published by the Iowa State Capitol Tour Guides weekly during the legislative session, features historical facts about Iowa, the Capitol, and the early workings of state government. All historical publications are reproduced here with the actual spelling, punctuation, and grammar retained. THIS WEEK: Judge Reuben Noble Praises the Iowa State Building at the 1893 World’s Columbian Exposition BACKGROUND: REUBEN NOBLE REUBEN NOBLE was born on the 14th of April, 1821, in Ada County, Mississippi, where his father was a farmer. When he was eighteen years of age, Noble began to study law and was admitted to the bar at twenty-one. In 1843, he came to Iowa, making his home at Garnavillo, in Clayton County. In 1854, Noble was elected to the legislature as a free soil Whig and upon the organization of the House was chosen Speaker, serving in the regular session of 1854 and extraordinary session of 1855. At the first Republican State Convention of 1856, he was placed at the head of the ticket for presidential elector. Four years later, he was a delegate to the National Convention that nominated Abraham Lincoln for president. Up to the time of the attempt of the Republicans to remove President Johnson by impeachment, Noble had been a prominent leader of that party. But approving of the policies of the President, he left the Republicans and from that time became a Democrat. In 1866, Noble was nominated by the Democrats for Representative in Congress but was defeated by William B. Allison. In 1886, he was one of the organizers of the Pioneer Lawmakers’ Association and was its first president, never missing a session during the remainder of his life. Noble was the leader of the bar of northeastern Iowa beginning in 1850. As a compliment to his high standing and eminent qualifications as a jurist, the citizens of the Tenth Judicial District elected him to tthe office of district judge in the fall of 1874. (History of Iowa from the Earliest Times to the Beginning of the Twentieth Century/Volume 4)

The efficacy and safety of a third anti-TNF monoclonal antibody in Crohn's disease after failure of two other anti-TNF antibodies.

BACKGROUND: Adalimumab (ADA) and certolizumab pegol (CZP) have demonstrated efficacy in Crohn's disease (CD) patients previously treated with infliximab (IFX). AIM: To assess the efficacy and tolerability of a third anti-TNF in CD after failure of and/or intolerance to two different anti-TNF antibodies. METHODS: Crohn's disease patients who received ADA or CZP after loss of response and/or intolerance to two anti-TNF agent were included in this retrospective study. Data were collected using a standardized questionnaire. Clinical response, duration, safety and reasons for discontinuation were assessed. RESULTS: Sixty-seven patients treated with CZP (n = 40) or ADA (n = 27) were included. A clinical response was observed in 41 (61%) at week 6 and 34 patients (51%) at week 20. The probability of remaining under treatment at 3 months, 6 months and 9 months was 68%, 60% and 45%, respectively. At the end of follow-up, the third anti-TNF had been stopped in 36 patients for intolerance (n = 13), or failure (n = 23). Two deaths were observed. CONCLUSIONS: The treatment with a third anti-TNF (CZP or ADA) agent of CD patients, who have experienced loss of response and/or intolerance to two anti-TNF antibodies, has favourable short-term and long-term efficacy. It is an option to be considered in patients with no other therapeutic options.

Enzyme polymorphism and clinical variability of diseases: a study of diabetes mellitus.

We investigated possible relations among four common neonatal manifestations of diabetic pregnancy (macrosomia, hypoglycemia, hypocalcemia, jaundice) and four enzyme polymorphisms (PGM1, ADA, AK1, ACP1 in a sample of infants born of diabetic mothers. The pattern of associations observed between the two sets of variables is consistent with known differences in enzymatic activity within phenotypes of each system, suggesting that low enzymatic activity may have unfavorable effects on fetal development and on adaptability of the neonate to the extrauterine environment, Some of the polymorphic enzymes studied influence fetal growth in normal pregnancy as well. Analysis of relations between genetic polymorphisms and the clinical pattern of common diseases may provide a better understanding of the genetic basis of the clinical variability of diseases within and between human populations.

Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight.

BACKGROUND: The evidence for a "diabesity" epidemic is accumulating worldwide but population-based data are still scarce in the African region. We assessed the prevalence, awareness and control of diabetes (DM) in the Seychelles, a rapidly developing country in the African region. We also examined the relationship between body mass index, fasting serum insulin and DM. METHODS: Examination survey in a sample representative of the entire population aged 25-64 of the Seychelles, attended by 1255 persons (participation rate of 80.2%). An oral glucose tolerance test (OGTT) was performed in individuals with fasting blood glucose between 5.6 and 6.9 mmol/l. Diabetes mellitus (DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were defined along criteria of the ADA. Prevalence estimates were standardized for age. RESULTS: The prevalence of DM was 11.5% and 54% of persons with DM were aware of having DM. Less than a quarter of all diabetic persons under treatment were well controlled for glycemia (HbA1c), blood pressure or LDL-cholesterol. The prevalence of IGT and IFG were respectively 10.4% and 24.2%. The prevalence of excess weight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2) was respectively 60.1% and 25.0%. Half of all DM cases in the population could be attributed to excess weight. CONCLUSION: We found a high prevalence of DM and pre-diabetes in a rapidly developing country in the African region. The strong association between overweight and DM emphasizes the importance of weight control measures to reduce the incidence of DM in the population. High rates of diabetic persons not aware of having DM in the population and insufficient cardiometabolic control among persons treated for DM stress the need for intensifying health care for diabetes.

Escenarios del impacto de la inmigración en la longevidad y dependencia de los mayores en la población española

Introduction: The composition of the Spanish population has recently changed due to immigration. The present study aimed to estimate the magnitude of change in the calculation of healthy life expectancy and life expectancy in disability, taking the population of foreign residents into account. For this population, there is no information on mortality or the prevalence of disability. Material and methods: Data were extracted from the 1999 Survey on Disabilities, Handicaps and Health Status to estimate healthy life expectancy and life expectancy in disability using the Sullivan method. Data were taken from the Spanish Statistical Institute and the World Health Organization, Sullivan's method was adapted to the case of two different populations, and possible scenarios were established. Results: The differences between the mortality table estimated for the foreign resident population and that estimated for the Spanish population were considerable and were more evident in women. At 65 years of age and in the worst scenario, which occurs when all the members of the foreign resident population are disabled, life expectancy in disability would be 2 more years for men and 3 more years for women than when the foreign population was not considered. Conclusions: Our scenarios reveal that the impact of immigration on the calculation of healthy life expectancy and life expectancy in disability is moderate.