Phototherapy in Childhood: a 17-Year Retrospective Study Regarding Effectiveness and Safety

Introduction: Skin diseases in paediatric age are often distressing conditions with significant impact in children’s psychosocial development. Additionally, systemic therapeutic options are often limited in childhood, due to its potential toxicity in this vulnerable group. Phototherapy is therefore an endorsed option for photo-responsive dermatological conditions. Objective and Methods:This observational retrospective study aims to access efficacy and safety of Phototherapy in our paediatric population. Relevant clinical data from 1996 to present concerning patients aged 18 years or less was collected. Results: 78 patients were included, of which64,1%was female. Mean age was 12,9 years (range 2-18). Distribution according to diagnosis was:47,4%psoriasis, 34,6% alopecia areata, 9,0% vitiligo, 9,0% other diagnosis. Mean number of cycles was 1,5 (range 1-7), with an average of 16,3 treatments per cycle and mean cumulative dose 134 J/cm2. 70,5% was treated with one single cycle. Topic and systemic PUVA were the first choice in 37,2% and 39,7%, respectively, while UVB TL01 and broadband UVB were used in 11,5% each. On the first cycle 67,5% improved, 14,3% showed no sustained clinical response and 19,5% were lost to follow-up. Psoriasis patients had the best response rates (81,8%), followed by alopecia areata (59,3%). Side effects occurred in 21%, being erythema the most common (12%). None led to therapeutic interruption. Discussion: Phototherapy is a safe and effective option in childhood, yet the withdraw rate might be an important limitation.

Mental Health and Quality of Life in Alcoholic Liver Disease Patients After Liver Transplantation: a Prospective Controlled Study

OBJECTIVE: Alcoholic liver disease (ALD) is one of the most important indications for liver transplantation. Discordant conclusions have been found concerning quality of life and mental health after transplantation in this particular group. The aim of this work was to investigate improvements in mental health and quality of life among transplanted patients for ALD. METHODS: We studied 45 consecutive transplant candidates with ALD, attending the outpatient clinics. Among these patients we transplanted 24 with the control candidates remaining in wait for transplantation. RESULTS: There was a significant improvement in all mental health and quality of life dimensions among the transplanted ALD group. We also observed a favorable evolution of coping mechanisms (CM) in this group. CONCLUSION: There is a favorable adjustment of ALD patients after transplantation as shown in CM evolution, which might explain the improved mental health and quality-of-life dimensions.

Atorvastatin versus Bezafibrate in Mixed Hyperlipidaemia : Randomised Clinical Trial of Efficacy and Safety (the ATOMIX Study)

OBJECTIVE: Combined hyperlipidaemia is a common and highly atherogenic lipid phenotype with multiple lipoprotein abnormalities that are difficult to normalise with single-drug therapy. The ATOMIX multicentre, controlled clinical trial compared the efficacy and safety of atorvastatin and bezafibrate in patients with diet-resistant combined hyperlipidaemia. PATIENTS AND STUDY DESIGN: Following a 6-week placebo run-in period, 138 patients received atorvastatin 10mg or bezafibrate 400mg once daily in a randomised, double-blind, placebo-controlled trial. To meet predefined low-density lipoprotein-cholesterol (LDL-C) target levels, atorvastatin dosages were increased to 20mg or 40mg once daily after 8 and 16 weeks, respectively. RESULTS: After 52 weeks, atorvastatin achieved greater reductions in LDL-C than bezafibrate (percentage decrease 35 vs 5; p < 0.0001), while bezafibrate achieved greater reductions in triglyceride than atorvastatin (percentage decrease 33 vs 21; p < 0.05) and greater increases in high-density lipoprotein-cholesterol (HDL-C) [percentage increase 28 vs 17; p < 0.01 ]. Target LDL-C levels (according to global risk) were attained in 62% of atorvastatin recipients and 6% of bezafibrate recipients, and triglyceride levels <200 mg/dL were achieved in 52% and 60% of patients, respectively. In patients with normal baseline HDL-C, bezafibrate was superior to atorvastatin for raising HDL-C, while in those with baseline HDL-C <35 mg/dL, the two drugs raised HDL-C to a similar extent after adjustment for baseline values. Both drugs were well tolerated. CONCLUSION: The results show that atorvastatin has an overall better efficacy than bezafibrate in concomitantly reaching LDL-C and triglyceride target levels in combined hyperlipidaemia, thus supporting its use as monotherapy in patients with this lipid phenotype.

Long-Term Lamivudine Treatment of Children with Chronic Hepatitis B: Durability of Therapeutic Responses and Safety

Lamivudine has been demonstrated safe and efficacious in the short term in a large cohort of children with chronic hepatitis B (CHB), but optimal duration of treatment has not been elucidated and limited data on the safety of long-term lamivudine administration have been reported. In addition, the durability of favourable therapeutic outcomes after lamivudine therapy in children has not been well characterized. The aim of this study was to examine the safety of lamivudine and the durability of clinical responses in a group of children who received up to 3 years of treatment for CHB. One hundred and fifty-one children from centres in nine countries who had previously received lamivudine in a large prospective trial were enrolled. During the first year, children had been randomized to either lamivudine or placebo treatment. Subsequently, in a separate extension study, those who remained hepatitis B e antigen (HBeAg) positive were given lamivudine for up to 2 years and those who were HBeAg negative were observed for additional 2 years. Results of these studies have been previously reported. In this study, these children were followed for 2 additional years. Data gathered from medical record review included weight, height, signs and symptoms of hepatitis, alanine aminotransferase (ALT) levels, serologic markers, hepatitis B virus (HBV) DNA levels and serious adverse events (SAEs). Other pharmacological treatments for CHB were allowed according to the practices of individual investigators and were documented. Subjects were divided into two groups for analysis, those who had achieved virological response (VR), defined as HBeAg negative and undetectable HBV DNA by the bDNA assay by the end of the extension study at 3 years, and those who had not. In those who had achieved VR by the end of the extension study, long-term durability of HBeAg seroconversion was 82% and >90% in those who had received lamivudine for 52 weeks and at least 2 years respectively. This compares to 75% for those who had achieved seroconversion after placebo. In those who had not achieved VR by the end of the extension study, an additional 11% did so by the end of the study; they had all received lamivudine in the previous trial, and none had received further treatment during the study. Eight children lost hepatitis B surface antigen during the study and all had received lamivudine at some point during the previous trials. Evaluation of safety data revealed no SAEs related to lamivudine. There was no effect of treatment on weight or height z scores. Clinically benign ALT flares (>10 times normal) were seen in 2% of children. Favourable outcomes from lamivudine treatment of CHB in children are maintained for at least several years after completion of treatment. Up to 3 years of lamivudine treatment is safe in children.

Development and Characterization of bioactive, edible whey protein films and coatings to improve quality and safety of Food products

Dissertação para a obtenção de grau de doutor em Ciências da Engenharia e Tecnologia

The influence of the regional basic diet from northeast Brazil on health and nutritional conditions of mice infected with Schistosoma mansoni

Protein nutritionalstatus indicators were studied in weanling albino Swiss mice infected with S. mansoni andfed the Regional Basic Diet (RBD)from Northeast Brazil, a multideficient diet of low-protein content. Each mouse was infected percutaneously with 80 cercariae. The experiment lasted 63 days. The growth curve, food consumption, protein intake, weight gain, Protein Efficiency Ratio (PER) and Net Protein Ratio (NPR) were the parameters investigated. RBD-fed mice showed a marked weight loss, a lower food and protein intake, a slower body weight gain and lower rates of food protein utilization when compared to casein-fed animals. Differences between infected and non-infected mice were not consistent. The present results suggest that the effects of RBD-induced malnutrition on health and nutritional conditions of the mice are more severe than those of Manson's schistosomiasis, in the initial phase of the disease.

Feasibility study of the immunogenicity and safety of a novel DTPw/Hib (PRP-T) Brazilian combination compared to a licensed vaccine in healthy children at 2, 4, and 6 months of age

Vaccination of infants with conjugated Haemophilus influenzae type b (Hib) vaccines has been proven to reduce Hib meningitis by 95% and pneumoniae by 20%. The routine use of Hib vaccine is facilitated by the introduction of combination vaccines into the EPI (Expanded Plan of Immunization). The objective of this study was to compare the immunogenicity and reactogenicity of an extemporaneously mixed DTPw/Hib (diphtheria-tetanus-whole cell pertussis) combination, using the technology of two Brazilian manufacturers, against a licensed DTPw/Hib European combination in 108 infants vaccinated at 2, 4 and 6 months according to the local national schedule. The Brazilian combination was highly immunogenic with Hib seroprotection rates (anti-PRP > 0.15 mg /ml of 98% after 2 doses and 100% after 3). Also for tetanus and pertussis the new Brazilian combination was as immunogenic as the European counterpart, except the diphtheria seroprotection rates and titers were lower. There was also no clinically relevant difference in reactogenicity. If these feasibility results are confirmed, the Brazilian DTPw/Hib combination should help to boost the uptake of Hib vaccination in Brazil.

Mental health and the crisis: Evidence from share

Mental health constitutes a significant share of the global burden of disease. It is shaped to a great extent by socioeconomic factors and is vulnerable to external shocks. The recent financial crisis brought about stressors prone to trigger and aggravate mental illnesses. This project presents a micro analysis of the effect of the economic crisis on mental health in eleven European countries, through the estimation of individual health production functions accounting for socioeconomic controls and macroeconomic indicators. We find that mental health has deteriorated since 2007, even though the development of depression episodes is unchanged. Additionally, his variation can be partially attributed to economic recession and budgetary cuts in health spending.

Mental health and neuroscience. A perspective from the magazine market

Mental health awareness has been rising worldwide, motivated by its social and economic costs. Despite the investment in research in neuroscience in the recent years, little is known about the underlying mechanisms in the brain that are correlated with psychiatric conditions. This project, through two feature articles suitable to be published in magazines, provides perspectives onto mental health research. First it presents an example where psychiatry joins forces with neuroscience and computer science in an interdisciplinary effort to improve the life of those affected by mental disorders. The second article gathers opinions which claim that mental health research priorities should be set by patients themselves, or even that people with lived experience of mental health issues should have an active role in that research. This project was planned and researched while I was an Erasmus student at Nottingham Trent University, in the United Kingdom.

Breastfeeding: making the difference in the development, health and nutrition of term and preterm newborns

Breastfeeding is the natural and safe way of feeding small infants, providing nutritional, immunological, psychological and economic recognized and unquestionable advantages. These qualities are especially important in premature infants, because of their vulnerability. Despite highly desirable, there is, in general, little success in breastfeeding preterm infants, especially in special care neonatal units. There are evidences that a high supportive hospital environment, with an interdisciplinary team, makes possible to these infants to be breastfed. In this article, the authors present an up-to-date review about the components of human milk and its unique characteristics, as well as describes aspects that make the breast milk particularly suitable for feeding the premature newborn.

Os médicos do trabalho e a nova organização da saúde e segurança do trabalho : quais as consequências na prática profissional? António de Sousa Uv

RESUMO - Em 1994/1995 o modelo legal de organização de serviços de Medicina do Trabalho instituído na década de 1960 foi substituído por uma nova superestrutura de serviços de Segurança, Higiene e Saúde dos Trabalhadores (SHST) nos locais de trabalho. O presente estudo pretende descrever e analisar em que medida o novo enquadramento jurídico de SHST, iniciado em 1994/1995 e correspondente genericamente à fase da Nova Saúde Ocupacional, foi acompanhado de alterações: (1) na percepção do grau de satisfação dos médicos do trabalho quanto ao seu papel e estatuto profissionais e (2) nas repercussões na sua prática profissional. O presente estudo (empírico, descritivo e comparativo) abrangeu um grupo de médicos do trabalho diplomados pela Escola Nacional de Saúde Pública (n = 153), de quem se recolheu, através de um questionário aplicado em 1993 e 2000, a opinião sobre as mudanças organizacionais da SHST. O papel e funções dos médicos do trabalho e as garantias de exercício profissional não se alteraram de forma importante, tendo a prática profissional da medicina do trabalho na modalidade «medicina do trabalho de empresa» (serviços internos e externos) diminuído, apesar de continuar a ser a forma de exercício predominante dos médicos do trabalho. O tempo dedicado à sua actividade situou-se num valor médio próximo das 20 horas semanais, sem alterações importantes entre 1993 e 2000. Concluiu-se que, no essencial, a publicação da nova legislação sobre organização de cuidados de MT/SHST/SO em 1994 e 1995 não reforçou significativamente as condições gerais de exercício da medicina do trabalho.

Decision methods applied to solve a safety problem on a waste treatment facility

To solve a health and safety problem on a waste treatment facility, different multicriteria decision methods were used, including the PROV Exponential decision method. Four alternatives and ten attributes were considered. We found a congruent solution, validated by the different methods. The AHP and the PROV Exponential decision method led us to the same options ordering, but the last method reinforced one of the options as being the best performing one, and detached the least performing option. Also, the ELECTRE I method results led to the same ordering which allowed to point the best solution with reasonable confidence. This paper demonstrates the potential of using multicriteria decision methods to support decision making on complex problems such as risk control and accidents prevention.

Occupational Ergonomics and Safety, Part 2

[Excerpt] This section is the second part of a special issue on Occupational Ergonomics and Safety, which was organized for WORK: A Journal of Prevention, Assessment and Rehabilitation. As in the first part of this thematic issue, this one comprises thirteen papers that were peer-reviewed and, finally, accepted for publication. This issue includes the work of authors from eleven countries all over the world. The variety of the presented works is not limited to their geographical origin, but it is also visible on the topics that are addressed, ranging from typical studies on ergonomics to safety management studies, as well as occupational hygiene topics.

Economic evaluation of occupational safety preventive measures in a hospital

BACKGROUND: When an organization performs an integrated analysis of risks through its Occupational Health and Safety Management System, several steps are suggested to address the implications of the identified risks. Namely, the organization should make a detailed analysis of the monetary impact for the organization of each of the preventive measures considered. However, it is also important to perform an analysis of the impact of each measure on society (externalities). OBJECTIVE: The aim of this paper is to present a case study related to the application of the proposed economic evaluation methodology. METHODS: An analysis of the work accidents in a hospital has been made. Three of the major types of accidents have been selected: needle stings, falls and excessive strain. Following the risk assessment, some preventive measures have been designed. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organization’s perspective) and in economic terms (including the benefits for the worker and for the Society). RESULTS: While the financial ratio is only advantageous in some cases, when the externalities are taken into account, the B/C ratio increases significantly. CONCLUSIONS: It is important to consider external

The quantified-Self and wearable technologies in the workplace: implications and challenges for their implementations

Introduction of technologies in the workplace have led to a dramatic change. These changes have come with an increased capacity to gather data about one’s working performance (i.e. productivity), as well as the capacity to track one’s personal responses (i.e. emotional, physiological, etc.) to this changing workplace environment. This movement of self-monitoring or self-sensing using diverse types of wearable sensors combined with the use of computing has been identified as the Quantified-Self. Miniaturization of sensors, reduction in cost and a non-stop increase in the computer power capacity has led to a panacea of wearables and sensors to track and analyze all types of information. Utilized in the personal sphere to track information, a looming question remains, should employers use the information from the Quantified-Self to track their employees’ performance or well-being in the workplace and will this benefit employees? The aim of the present work is to layout the implications and challenges associated with the use of Quantified-Self information in the workplace. The Quantified-Self movement has enabled people to understand their personal life better by tracking multiple information and signals; such an approach could allow companies to gather knowledge on what drives productivity for their business and/or well-being of their employees. A discussion about the implications of this approach will cover 1) Monitoring health and well-being, 2) Oversight and safety, and 3) Mentoring and training. Challenges will address the question of 1) Privacy and Acceptability, 2) Scalability and 3) Creativity. Even though many questions remain regarding their use in the workplace, wearable technologies and Quantified-Self data in the workplace represent an exciting opportunity for the industry and health and safety practitioners who will be using them.