Critical analysis of the regulations regarding the disposal of medication waste

Expired or unused medication at people's homes is normally disposed of in normal garbage, sewage system or, in certain cases, returned to the public health system. There is still no specific legislation regarding this leftover medication to regulate and orient the handling and correct disposal of medication waste. However, there is defined regulation regarding health services' solid waste. This article has the objective of discussing management models for the disposal of medication waste and the recommendations made by pertinent national and international legislation. By means of literature reviews, the management structure for medication waste of international legislation and the regulations regarding the environment, as well as the national legislation for the solid waste from health services was analyzed. Through the analysis it was possible to present better clarifications as to the possible impacts to the environment, to the public's health and alternatives in order to obtain the efficient disposal of medication, reducing and/or avoiding sanitary risk, guaranteeing the quality and safety of public health.

Determination of the critical coupling of explosive synchronization transitions in scale-free networks by mean-field approximations

An explosive synchronization can be observed in scale-free networks when Kuramoto oscillators have natural frequencies equal to their number of connections. The present paper reports on mean-field approximations to determine the critical coupling of such explosive synchronization. It has been verified that the equation obtained for the critical coupling has an inverse dependence on the network average degree. This expression differs from those whose frequency distributions are unimodal and even. In this case, the critical coupling depends on the ratio between the first and second statistical moments of the degree distribution. Numerical simulations were also conducted to verify our analytical results.

HER-2, p53, p21 and hormonal receptors proteins expression as predictive factors of response and prognosis in locally advanced breast cancer treated with neoadjuvant docetaxel plus epirubicin combination

Abstract Background Neoadjuvant chemotherapy has been considered the standard care in locally advanced breast cancer. However, about 20% of the patients do not benefit from this clinical treatment and, predictive factors of response were not defined yet. This study was designed to evaluate the importance of biological markers to predict response and prognosis in stage II and III breast cancer patients treated with taxane and anthracycline combination as neoadjuvant setting. Methods Sixty patients received preoperative docetaxel (75 mg/m2) in combination with epirubicin (50 mg/m2) in i.v. infusion in D1 every 3 weeks after incisional biopsy. They received adjuvant chemotherapy with CMF or FEC, attaining axillary status following definitive breast surgery. Clinical and pathologic response rates were measured after preoperative therapy. We evaluated the response rate to neoadjuvant chemotherapy and the prognostic significance of clinicopathological and immunohistochemical parameters (ER, PR, p51, p21 and HER-2 protein expression). The median patient age was 50.5 years with a median follow up time 48 months after the time of diagnosis. Results Preoperative treatment achieved clinical response in 76.6% of patients and complete pathologic response in 5%. The clinical, pathological and immunohistochemical parameters were not able to predict response to therapy and, only HER2 protein overexpression was associated with a decrease in disease free and overall survival (P = 0.0007 and P = 0.003) as shown by multivariate analysis. Conclusion Immunohistochemical phenotypes were not able to predict response to neoadjuvant chemotherapy. Clinical response is inversely correlated with a risk of death in patients submitted to neoadjuvant chemotherapy and HER2 overexpression is the major prognostic factor in stage II and III breast cancer patients treated with a neoadjuvant docetaxel and epirubicin combination.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Precipitating factors of porphyria cutanea tarda in Brazil with emphasis on hemochromatosis gene (HFE) mutations. Study of 60 patients

BACKGROUND: Porphyria cutanea tarda is the most common form of porphyria, characterized by the decreased activity of the uroporphyrinogen decarboxylase enzyme. Several reports associated HFE gene mutations of hereditary hemochromatosis with porphyria cutanea tarda worldwide, although up to date only one study has been conducted in Brazil. OBJECTIVES: Investigation of porphyria cutanea tarda association with C282Y and H63D mutations in the HFE gene. Identification of precipitating factors (hepatitis C, HIV, alcoholism and estrogen) and their link with HFE mutations. METHODS: An ambispective study of 60 patients with PCT was conducted during the period from 2003 to 2012. Serological tests for hepatitis C and HIV were performed and histories of alcohol abuse and estrogen intake were investigated. HFE mutations were identified with real-time PCR. RESULTS: Porphyria cutanea tarda predominated in males and alcohol abuse was the main precipitating factor. Estrogen intake was the sole precipitating factor present in 25% of female patients. Hepatitis C was present in 41.7%. All HIV-positive patients (15.3%) had a history of alcohol abuse. Allele frequency for HFE mutations, i.e., C282Y (p = 0.0001) and H63D (p = 0.0004), were significantly higher in porphyria cutanea tarda patients, compared to control group. HFE mutations had no association with the other precipitating factors. CONCLUSIONS: Alcohol abuse, hepatitis C and estrogen intake are prevalent precipitating factors in our porphyria cutanea tarda population; however, hemochromatosis in itself can also contribute to the outbreak of porphyria cutanea tarda, which makes the research for HFE mutations necessary in these patients

Ports in short sea shipping: a critical assessment of the European maritime transport policy

Programa de doctorado: Perspectivas Científicas sobre el turismo y la Dirección de Empresas Turísticas

Kinematic interaction factors of deep foundations with inclined piles.

[EN]The beneficial or detrimental role of battered piles on the dynamic response of piled foundations has not been yet fully elucidated. In order to shed more light on this aspect, kinematic interaction factors of deep foundations with inclined piles, are provided for single battered piles, as well as for 2X2 and 3X3 groups of piles subjected to vertically incident plane shear S waves.

Formazione, apprendimento e nuove prospettive e-learning. Lo sviluppo delle nuove tecnologie didattiche e la creazione di sistemi di apprendimento lungo l’intero arco della vita

The thesis of this paper is based on the assumption that the socio-economic system in which we are living is characterised by three great trends: growing attention to the promotion of human capital; extremely rapid technological progress, based above all on the information and communication technologies (ICT); the establishment of new production and organizational set-ups. These transformation processes pose a concrete challenge to the training sector, which is called to satisfy the demand for new skills that need to be developed and disseminated. Hence the growing interest that the various training sub-systems devote to the issues of lifelong learning and distance learning. In such a context, the so-called e-learning acquires a central role. The first chapter proposes a reference theoretical framework for the transformations that are shaping post-industrial society. It analyzes some key issues such as: how work is changing, the evolution of organizational set-ups and the introduction of learning organization, the advent of the knowledge society and of knowledge companies, the innovation of training processes, and the key role of ICT in the new training and learning systems. The second chapter focuses on the topic of e-learning as an effective training model in response to the need for constant learning that is emerging in the knowledge society. This chapter starts with a reflection on the importance of lifelong learning and introduces the key arguments of this thesis, i.e. distance learning (DL) and the didactic methodology called e-learning. It goes on with an analysis of the various theoretic and technical aspects of e-learning. In particular, it delves into the theme of e-learning as an integrated and constant training environment, characterized by customized programmes and collaborative learning, didactic assistance and constant monitoring of the results. Thus, all the aspects of e-learning are taken into exam: the actors and the new professionals, the virtual communities as learning subjects, the organization of contents in learning objects, the conformity to international standards, the integrated platforms and so on. The third chapter, which concludes the theoretic-interpretative part, starts with a short presentation of the state-of-the-art e-learning international market that aims to understand its peculiarities and its current trends. Finally, we focus on some important regulation aspects related to the strong impulse given by the European Commission first, and by the Italian governments secondly, to the development and diffusion of e-learning. The second part of the thesis (chapters 4, 5 and 6) focus on field research, which aims to define the Italian scenario for e-learning. In particular, we have examined some key topics such as: the challenges of training and the instruments to face such challenges; the new didactic methods and technologies for lifelong learning; the level of diffusion of e-learning in Italy; the relation between classroom training and online training; the main factors of success as well as the most critical aspects of the introduction of e-learning in the various learning environments. As far as the methodological aspects are concerned, we have favoured a qualitative and quantitative analysis. A background analysis has been done to collect the statistical data available on this topic, as well as the research previously carried out in this area. The main source of data is constituted by the results of the Observatory on e-learning of Aitech-Assinform, which covers the 2000s and four areas of implementation (firms, public administration, universities, school): the thesis has reviewed the results of the last three available surveys, offering a comparative interpretation of them. We have then carried out an in-depth empirical examination of two case studies, which have been selected by virtue of the excellence they have achieved and can therefore be considered advanced and emblematic experiences (a large firm and a Graduate School).

Social housing: interventions of densification in urban regeneration (1995-2010). Critical analysis of strategies adopted in Milan, London, São Paulo

The prospect of the continuous multiplication of life styles, the obsolescence of the traditional typological diagrams, the usability of spaces on different territorial scales, imposes on contemporary architecture the search for new models of living. Limited densities in urban development have produced the erosion of territory, the increase of the harmful emissions and energy consumption. High density housing cannot refuse the social emergency to ensure high quality and low cost dwellings, to a new people target: students, temporary workers, key workers, foreign, young couples without children, large families and, in general, people who carry out public services. Social housing strategies have become particularly relevant in regenerating high density urban outskirts. The choice of this research topic derives from the desire to deal with the recent accommodation emergency, according to different perspectives, with a view to give a contribution to the current literature, by proposing some tools for a correct design of the social housing, by ensuring good quality, cost-effective, and eco-sustainable solutions, from the concept phase, through management and maintenance, until the end of the building life cycle. The purpose of the thesis is defining a framework of guidelines that become effective instruments to be used in designing the social housing. They should also integrate the existing regulations and are mainly thought for those who work in this sector. They would aim at supporting students who have to cope with this particular residential theme, and also the users themselves. The scientific evidence of either the recent specialized literature or the solutions adopted in some case studies within the selected metropolitan areas of Milan, London and São Paulo, it is possible to identify the principles of this new design approach, in which the connection between typology, morphology and technology pursues the goal of a high living standard.

Students' knowledge of symptoms and risk factors of potential life-threatening medical conditions

In order to assess medical students' knowledge of Basic Life Support (BLS) principles, we defined a minimal knowledge (MK) of three life-threatening medical conditions that should be universally known: cardiac arrest, heart attack and stroke, and compared the results with those of laypersons.

Risk factors of mortality in different age groups after thoracic endovascular aortic repair

The aim of this study was to determine risk factors for mortality in different age groups after thoracic endovascular aortic repair (TEVAR).

Neurological outcome, working capacity and prognostic factors of patients with SCIWORA

STUDY DESIGN: Retrospective case review. OBJECTIVES: In the present study, the neurological outcome, retirement and prognostic factors of patients with spinal cord injury without radiographic abnormality (SCIWORA) were evaluated. SETTING: Swiss national work accident insurance database. METHODS: The medical histories of 32 patients who were insured by the Swiss Accident Insurance Fund (SUVA) and had SCIWORA between 1995 and 2004 were evaluated thoroughly. Moreover, all available magnetic resonance imaging (MRI) scans were evaluated. RESULTS: At the last follow-up, none of the patients had complete spinal cord injury, only 4 patients had severe deficits and 12 patients had normal motor and sensory function in the neurological examination. However, only 7 out of 32 patients had returned to full-time work and 10 out of 32 patients were fully retired. Both the presence of spinal cord change (ρ=0.51) and higher maximum spinal cord compression (ρ=0.57) in MRI scan correlated with the likelihood for retirement; older age (ρ=0.38) and physical load of work (ρ=0.4) correlated with retirement to a lesser extent. CONCLUSION: Although the neurological outcome of SCIWORA is mostly good, the retirement rate is high. Presence of spinal cord change and severity of cord compression are the best predictors for the degree of retirement.