Use of closed systems in the Hospital Pharmacy

Objective: In the setting of the increasing use of closed systems for reconstitution and preparation of these drugs, we intend to analyze the correct use of these systems in the Hospital Pharmacy, with the objective to minimize the risks of exposure not only for those professionals directly involved, but also for all the staff in the unit, taking also into account efficiency criteria. Method: Since some systems protect against aerosol formation but not from vapours, we decided to review which cytostatics should be prepared using an awl with an air inlet valve, in order to implement a new working procedure. We reviewed the formulations available in our hospital, with the following criteria: method of administration, excipients, and potential hazard for the staff handling them. We measured the diameters of the vials. We selected drugs with Level 1 Risk and also those including alcohol-based excipients, which could generate vapours. Outcomes: Out of the 66 reviewed formulations, we concluded that 11 drugs should be reconstituted with this type of awl: busulfan, cabazitaxel, carmustine, cyclophosphamide, eribulin, etoposide, fotemustine, melphalan, paclitaxel, temsirolimus and thiotepa; these represented an 18% of the total volume of formulations. Conclusions: The selection of healthcare products must be done at the Hospital Pharmacy, because the use of a system with an air valve inlet only for those drugs selected led to an outcome of savings and a more efficient use of materials. In our experience, we confirmed that the use of the needle could only be avoided when the awl could adapt to the different formulations of cytostatics, and this is only possible when different types of awls are available. Besides, connections were only really closed when a single awl was used for each vial. The change in working methodology when handling these drugs, as a result of this study, will allow us to start different studies about environmental contamination as a future line of work.

Development of gene expression-based biomarkers of exposure to metals and pesticides in the freshwater amphipod Hyalella azteca

Ecological risk assessment (ERA) is a framework for monitoring risks of exposure and adverse effects of environmental stressors to populations or communities of interest. One tool of ERA is the biomarker, which is a characteristic of an organism that reliably indicates exposure to or effects of a stressor like chemical pollution. Traditional biomarkers which rely on characteristics at the tissue level and higher often detect only acute exposures to stressors. Sensitive molecular biomarkers may detect lower stressor levels than traditional biomarkers, which helps inform risk mitigation and restoration efforts before populations and communities are irreversibly affected. In this study I developed gene expression-based molecular biomarkers of exposure to metals and insecticides in the model toxicological freshwater amphipod Hyalella azteca. My goals were to not only create sensitive molecular biomarkers for these chemicals, but also to show the utility and versatility of H. azteca in molecular studies for toxicology and risk assessment. I sequenced and assembled the H. azteca transcriptome to identify reference and stress-response gene transcripts suitable for expression monitoring. I exposed H. azteca to sub-lethal concentrations of metals (cadmium and copper) and insecticides (DDT, permethrin, and imidacloprid). Reference genes used to create normalization factors were determined for each exposure using the programs BestKeeper, GeNorm, and NormFinder. Both metals increased expression of a nuclear transcription factor (Cnc), an ABC transporter (Mrp4), and a heat shock protein (Hsp90), giving evidence of general metal exposure signature. Cadmium uniquely increased expression of a DNA repair protein (Rad51) and increased Mrp4 expression more than copper (7-fold increase compared to 2-fold increase). Together these may be unique biomarkers distinguishing cadmium and copper exposures. DDT increased expression of Hsp90, Mrp4, and the immune response gene Lgbp. Permethrin increased expression of a cytochrome P450 (Cyp2j2) and decreased expression of the immune response gene Lectin-1. Imidacloprid did not affect gene expression. Unique biomarkers were seen for DDT and permethrin, but the genes studied were not sensitive enough to detect imidacloprid at the levels used here. I demonstrated that gene expression in H. azteca detects specific chemical exposures at sub-lethal concentrations, making expression monitoring using this amphipod a useful and sensitive biomarker for risk assessment of chemical exposure.

ASSOCIATION OF BIRTH WEIGHT AND TIME OF BREASTFEEDING WITH CURRENT NUTRITIONAL STATUS OF CHILDREN

Objetivo: Analisar a relação entre o peso ao nascer (PN) e o tempo de aleitamento materno (AM) com o atual estado nutricional de crianças de dois a seis anos de idade. Métodos: Estudo observacional, quantitativo e do tipo transversal, realizado com crianças, independentemente do sexo, com idades entre dois a seis anos, matriculadas em sete escolas de educação infantil da rede municipal de um município do interior do Rio Grande do Sul (RS), no período de junho a agosto de 2014. Participaram 353 crianças, aferindo-se peso e altura, após os pais terem respondido a um questionário de Peso ao Nascer (PN) e tempo de aleitamento materno. Resultados: A média de aleitamento materno exclusivo foi de 3,47 ± 2,81 meses. A maioria das crianças (50,7%, n=179) encontrou-se em risco de sobrepeso ou sobrepeso para a idade, conforme o Índice de Massa Corporal (IMC). O PN apresentou correlação positiva com a altura atual (r=0,164, p=0,002) e com o peso atual (r=0,180, p=0,001). O PN foi significativamente maior entre os meninos (p=0,003), e o tempo de AM associado à alimentação complementar foi significativamente maior entre as meninas (p=0,024). Conclusão: Os resultados sugerem que o peso ao nascer influencia o ganho de peso nos seis primeiros anos de vida, com maior destaque para os meninos; e o tempo de amamentação associado à alimentação complementar foi maior entre as meninas.

Expertise and forms of knowledge in the government of families

This paper examines the relationship between the state and the individual in relation to an aspect of mundane family life – the feeding of babies and young children. The nutritional status of children has long been a matter of national concern and infant feeding is an aspect of family life that has been subjected to substantial state intervention. It exemplifies the imposition upon women the ‘biologico-moral responsibility’ for the welfare of children (Foucault 1991b). The state’s attempts to influence mothers’ feeding practices operate largely through education and persuasion. Through an elaborate state-sponsored apparatus, a strongly medicalised expert discourse is disseminated to mothers. This discourse warns mothers of the risks of certain feeding practices and the benefits of others. It constrains mothers through a series of ‘quiet coercions’ (Foucault 1991c) which seek to render them self-regulating subjects. Using data from a longitudinal interview study, this paper explores how mothers who are made responsible in these medical discourses around child nutrition, engage with, resist and refuse expert advice. It examines, in particular, the rhetorical strategies which mothers use to defend themselves against the charges of maternal irresponsibility that arise when their practices do not conform to expert medical recommendations.

Exclusive breastfeeding practices in the Coast region, Tanzania.

Background: Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare. Objective: To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania. Methods: A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses. Results: The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding. Conclusion: The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

THE HYDROSOCIAL COSTS OF HIGH-VOLUME HYDRAULIC FRACTURING: A TALE OF TWO COUNTIES IN MICHIGAN

Although natural gas has been praised as a clean and abundant energy source, the varying impacts and uncertainties surrounding the process of extracting natural gas from unconventional sources, known as horizontal high-volume hydraulic fracturing (HVHF) or “fracking,” have raised important concerns. The practice of HVHF is expanding so quickly that the full impacts are not yet known. This thesis project, using a grounded theory methodological approach, explores the risks and benefits associated with HVHF as recognized by the residents of two Michigan counties, one that currently produces natural gas by HVHF (Crawford County) and one that does not (Barry County). Through an analysis of media content related to HVHF in each case study site and interviews with stakeholders in both counties, this study examines perceptions of risks and benefits by comparing two communities that differ in their level of experience with HVHF operations, contributing to our understanding of how perceptions of risks and benefits are shaped by natural gas development. The comparative analysis of the case study counties revealed similarities and differences between the case study counties. Overall, Barry County residents identified fewer benefits and more risks, and had stronger negative perceptions than Crawford County residents. This study contributes to the social science literature by developing a richer theoretical frame for understanding perceptions of HVHF and also shares recommendations for industry, organizations, regulators, and government leaders interested in effectively communicating with community stakeholders about the benefits and risks of HVHF.

A conceptualisation of a governance model for biobanks in the digital society

Biobanks are key infrastructures in data-driven biomedical research. The counterpoint of this optimistic vision is the reality of biobank governance, which must address various ethical, legal and social issues, especially in terms of open consent, privacy and secondary uses which, if not sufficiently resolved, may undermine participants’ and society’s trust in biobanking. The effect of the digital paradigm on biomedical research has only accentuated these issues by adding new pressure for the data protection of biobank participants against the risks of covert discrimination, abuse of power against individuals and groups, and critical commercial uses. Moreover, the traditional research-ethics framework has been unable to keep pace with the transformative developments of the digital era, and has proven inadequate in protecting biobank participants and providing guidance for ethical practices. To this must be added the challenge of an increased tendency towards exploitation and the commercialisation of personal data in the field of biomedical research, which may undermine the altruistic and solidaristic values associated with biobank participation and risk losing alignment with societal interests in biobanking. My research critically analyses, from a bioethical perspective, the challenges and the goals of biobank governance in data-driven biomedical research in order to understand the conditions for the implementation of a governance model that can foster biomedical research and innovation, while ensuring adequate protection for biobank participants and an alignment of biobank procedures and policies with society’s interests and expectations. The main outcome is a conceptualisation of a socially-oriented and participatory model of biobanks by proposing a new ethical framework that relies on the principles of transparency, data protection and participation to tackle the key challenges of biobanks in the digital age and that is well-suited to foster these goals.

Impact of gentrification processes in rural landscapes: a methodology for landscape assessment towards sustainable rural development

With an increasing demand for rural resources and land, new challenges are approaching affecting and restructuring the European countryside. While creating opportunities for rural living, it has also opened a discussion on rural gentrification risks. The concept of rural gentrification encircles the influx of new residents leading to an economic upgrade of an area making it unaffordable for local inhabitants to stay in. Rural gentrification occurs in areas perceived as attractive. Paradoxically, in-migrants re-shape their surrounding landscape. Rural gentrification may not only cause displacement of people but also landscape values. Thus, this research aims to understand the twofold role of landscape in rural gentrification theory: as a possible driver to attract residents and as a product shaped by its residents. To understand the potential gentrifiers’ decision process, this research has provided a collection of drivers behind in-migration. Moreover, essential indicators of rural gentrification have been collected from previous studies. Yet, the available indicators do not contain measures to understand related landscape changes. To fill this gap, after analysing established landscape assessment methodologies, evaluating the relevance for assessing gentrification, a new Landscape Assessment approach is proposed. This method introduces a novel approach to capture landscape change caused by gentrification through a historical depth. The measures to study gentrification was applied on Gotland, Sweden. The study showed a population stagnating while the number of properties increased, and housing prices raised. These factors are not indicating positive growth but risks of gentrification. Then, the research applied the proposed Landscape Assessment method for areas exposed to gentrification. Results suggest that landscape change takes place on a local scale and could over time endanger key characteristics. The methodology contributes to a discussion on grasping nuances within the rural context. It has also proven useful for indicating accumulative changes, which is necessary in managing landscape values.

Preservation Of The External Jugular Vein In Bilateral Radical Neck Dissections: Technique In Two Cases And Review Of The Literature.

Context. The possibility of cephalic venous hypertension with the resultant facial edema and elevated cerebrospinal fluid pressure continues to challenge head and neck surgeons who perform bilateral radical neck dissections during simultaneous or staged procedures. Case Report. The staged procedure in patients who require bilateral neck dissections allows collateral venous drainage to develop, mainly through the internal and external vertebral plexuses, thereby minimizing the risks of deleterious consequences. Nevertheless, this procedure has disadvantages, such as a delay in definitive therapy, the need for a second hospitalization and anesthesia, and the risk of cutting lymphatic vessels and spreading viable cancer cells. In this paper, we discuss the rationale and feasibility of preserving the external jugular vein. Considering the limited number of similar reports in the literature, two cases in which this procedure was accomplished are described. The relevant anatomy and technique are reviewed and the patients' outcomes are discussed. Conclusion. Preservation of the EJV during bilateral neck dissections is technically feasible, fast, and safe, with clinically and radiologically demonstrated patency.

Assessment Of Sleep Bruxism, Orthodontic Treatment Need, Orofacial Dysfunctions And Salivary Biomarkers In Asthmatic Children.

To evaluate the sleep bruxism, malocclusions, orofacial dysfunctions and salivary levels of cortisol and alpha-amylase in asthmatic children. 108 7-9-yr-old children were selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthmatics, n=53) and from public schools (controls, n=55), Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds and the presence of shiny and polish facets on incisors and/or first permanent molars. The index of orthodontic treatment need was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the nordic orofacial test-screening (NOT-S). Salivary cortisol and alpha-amylase were expressed as awakening response (AR), calculated as the difference between levels immediately after awakening and 30min after waking, and diurnal decline (DD), calculated as the difference between levels at 30min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests. Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p<0.05). Asthmatics had higher scores of NOT-S total and interview (p<0.05). Dysfunctions on sensory function and chewing and swallowing were more frequent in asthmatics (p<0.05). Salivary cortisol AR on weekend was significantly higher for asthmatics (p<0.05). Salivary cortisol DD was significantly higher on weekday than weekend for controls (p<0.05). There were no significant differences in alpha-amylase values in and between groups. The presence of asthma in children was associated with sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend.

Comparação dos indicadores funcionais e bioquimicos em homens de meia-idade submetidos a treinamento aerobio e corredores de longa distancia

Universidade Estadual de Campinas . Faculdade de Educação Física

Estado nutricional e desempenho motor de escolares = : Nutritional state and motor performance of scholl-age children

Universidade Estadual de Campinas . Faculdade de Educação Física

Storage stability of snacks with reduced saturated and trans fatty acids contents

A gordura vegetal parcialmente hidrogenada tem sido utilizada na aromatização de snacks. Entretanto, o risco à saúde ocasionado pelo elevado consumo de ácidos graxos saturados e trans (AGT) vem estimulando o desenvolvimento de abordagens alternativas a essa gordura. Substituímos a gordura vegetal parcialmente hidrogenada (F) por óleo de canola (O) na aromatização de snacks. Snacks com diferentes níveis de O foram produzidos, embalados e armazenados em temperatura ambiente durante vinte semanas. Monitoramos o perfil de ácidos graxos, o teor de substâncias reativas ao TBA (TBARS), a força de cisalhamento e a aceitabilidade sensorial. A substituição total reduziu o teor de ácidos graxos saturados em 72,5 por cento, em comparação aos snacks comerciais. Os snacks eram inicialmente isentos de AGT, porém, após 8 semanas, esses compostos surgiram, havendo aumento gradual durante o período de armazenamento. Entretanto, estes níveis mantiveram-se inferiores aos observados em snacks comercializados. Também foram observados baixos teores de TBARS e estabilidade da força de cisalhamento. Snacks aromatizados com F ou O foram igualmente bem aceitos durante as vinte semanas de armazenamento. É possível desenvolver snacks com teores reduzidos de ácidos graxos saturados e trans, estáveis durante o armazenamento, mantendo a elevada aceitabilidade sensorial típica deste tipo de produto

The Role of Black Rice (Oryza sativa L.) in the Control of Hypercholesterolemia in Rats

Cardiovascular disease is a serious public health problem; it is the first cause of death in Brazil and in developed countries. Thus, it is essential to search for alternative sources such as some functional foods to prevent and control the risks of this disease. The purpose of this study was to evaluate the lipidemic parameters in hypercholesterolemic rats fed diets containing black rice variety IAC 600 or unrefined rice. Adult male Wistar rats (Rattus norvegicus var. albinos) were used, weighing about 200-220 g. The animals were divided into four groups: the first received a control casein diet, the second received hypercholesterolemic diet, and the other two groups, after induction of hypercholesterolemia, received the test diets, the first containing 20% black rice and the second 20% unrefined, for 30 days. It was observed that diet containing black rice reduced the level of plasma cholesterol, triglycerides, and low-density lipoprotein. For high-density lipoprotein values, the diet that provided an increase in the levels was the black rice. The diet containing black rice was more effective in controlling the lipidemia in rats compared with the whole rice diet.

Breastfeeding, sleep and wake circadian rhythms show distinct temporal emerging patterns

The emerging patterns of breastfeeding, sleep and wake circadian rhythms in an infant and the breastfeeding emergence pattern of his elder sister are presented. Both children were raised under regular contact with photic and non-photic Zeitgebers. Data are related to the first four months of life of the infants, which correspond to the exclusive and ad libitum breastfeeding stage of their lives. Discrimination is made of fasting-associated-wakefulness (FAW) which is a wake state without feeding. Our data show that while FAW episodes are concentrated in the diurnal phase of the day since the first week of life, breastfeeding rhythm takes longer to show statistically significant circadian periodicity (four weeks) and to become monophasic, concentrated in the diurnal phase of the day (three/four months). This precedence of the consolidation of FAW rhythm indicates tight association between nocturnal sleep fragmentation and the drive to feed, in the first months of life of infants.