Prescription, dispensation and marketing patterns of methylphenidate

OBJECTIVE To analyze the patterns and legal requirements of methylphenidate consumption. METHODS We conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve. RESULTS The balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment. CONCLUSIONS Methylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting.METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test.RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions.CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

Functional domains of Bacillus subtilis transcription factor AraR and identification of aminoacids important for nucleoprotein complex assembly and effector-binding.

Journal of Bacteriology (Apr 2006) 3024-3036

A questão visual na oftalmologia pediátrica da região de Lisboa

RESUMO: Na parte inicial incluem-se algumas notas sucintas com base no panorama científico,histórico e cultural da visão considerada segundo três abordagens - o olho (o olho humano na especificidade da sua posição filogenética, elemento anátomo-funcional básico do sistema visual ao qual o cérebro pertence), os olhos (unidades gémeas essenciais do rosto na sua actividade consensual e conjugada da binocularidade), o olhar (carregado de expressão psicológica e o seu efeito sobre o observador, sinal para o comportamento e criador de sentimentos, sedimentado em obras de arte e em formas de superstição dos povos). Segue-se a apresentação de um estudo descritivo transversal, como contribuição para o conhecimento do estado de saúde visual da população infantil da região de Lisboa e determinar factores que o influenciam. Entre Outubro de 2005 e Agosto de 2006 examinaram-se 649 crianças com idade inferior a 10 anos da Consulta de Oftalmologia Pediátrica dos Serviços de Assistência Médico-Social do Sindicato dos Bancários do Sul e Ilhas (SAMS). Colheram-se dados respeitantes a mais de 250 variáveis primárias que cobriram a maior parte dos itens do exame oftalmológico habitual. Na análise dos dados teve-se especialmente em conta a idade, com um papel decisivo nas principais fases de desenvolvimento do sistema visual. No caso das crianças de 6 a 7 anos de idade põem-se lado a lado resultados dos SAMS e das Escolas. A profusão de dados numéricos ditou a necessidade da determinação frequente da significância estatística dos resultados de subgrupos. Alguns resultados do estudo, na sua maioria do grupo SAMS: Crianças de 6-7 anos, 71,1% (SAMS) e 91,5% (Escolas) não tinham sido examinadas com menos de 4 anos. Frequência global de alterações miópicas 9,4%, de alterações hipermetrópicas 25,3%, umas e outras com variações acentuadas com a idade. Estrabismo convergente 3,9%. Ambliopia 2,6% (13/491 crianças >=4 anos de idade), mais frequente no sexo feminino, naquelas que tiveram a sua 1ª observação depois dos 4 anos e em que os pais não aderiam à terapêutica prescrita. Objectivos específicos ocuparam-se da acuidade visual e da refracção ocular. O estudo comparativo da refractometria automática sem e com cicloplegia permitiu evidenciar que o teste da acuidade visual é insuficiente, por si só, para fazer o diagnóstico correcto. A análise dos antecedentes familiares oftalmológicos demonstrou a importância do seu conhecimento e pôs em evidência, entre outras, as seguintes relações: 10 pag1.qxp 27-11-2001 18:28 Page 10 Índice Geral 11 Crianças com antecedentes de alterações miópicas têm maior frequência de diagnóstico de alterações miópicas e de refracção negativa, uma taxa mais elevada de correspondência quantitativa diagnóstico/refracção nas alterações miópicas. Estas crianças também têm, em geral, características inversas no que diz respeito a alterações hipermetrópicas. Crianças com antecedentes de alterações hipermetrópicas têm maior frequência de diagnóstico de alterações hipermetrópicas. Crianças com antecedentes de estrabismo têm maior frequência de diagnóstico de estrabismo convergente manifesto e de esodesvios no seu todo. Crianças com antecedentes familiares de astigmatismo têm maior frequência de diagnóstico de astigmatismo. Traçam-se alguns perfis oftalmológicos infantis que permitem apreciar de forma sinóptica um conjunto de parâmetros da saúde da visão. Os dados colhidos sobre a aderência dos pais à terapêutica prescrita e sobre a atitude em relação ao uso de óculos assim como os dados sobre o comportamento da criança na sala de aula e dificuldades de aprendizagem foram em geral escassos para permitirem tirar conclusões, embora mostrem indícios a investigar futuramente. Paralelamente ortoptistas e enfermeiras efectuaram um rastreio escolar da acuidade visual <0,8 e de alterações da motilidade ocular extrínseca que abrangeu 520 alunos do 1º ano do 1º ciclo do ensino básico (2005/2006) das escolas públicas da cidade de Lisboa. 101 destas crianças foram observadas no consultório da autora, umas referidas a partir do rastreio, outras como controlo deste. Quanto à acuidade visual o valor preditivo do teste negativo foi de 91% mas o do teste positivo de apenas 67% (33% de falsos positivos, consequentemente uma alta taxa de sobrerreferenciação). A qualidade do rastreio efectuado por ortoptistas foi inferior à do efectuado por enfermeiras. O rastreio não teve qualidade aceitável. Foi feito um inquérito a médicos e enfermeiros de centros de saúde sobre conhecimentos, atitudes e práticas em relação com os cuidados de oftalmologia pediátrica. Discutem-se os resultados, tiram-se conclusões e fazem-se recomendações susceptíveis de contribuir para uma melhor saúde visual das crianças. ABSTRACT: Firstly some brief remarks are made based on the scientific, historical and cultural panorama of the human vision with regard to three approaches: the eye (the human eye in its specific filogenetic place, fundamental anatomofunctional element of the visual system in interaction with the brain), the eyes (essential twin units of the face with their consensual and conjugated binocular activity), the gaze (psychologicaly overloaded, a means to express oneself and to influence the observer, a guide to other persons' behaviour, consolidated in works of art and in people's traditional superstitious believes and ways of thinking). A report is made on a cross-sectional descriptive study whose goal is to contribute to the knowledge of the level of visual health of children in the Lisbon Region and to identify factors which determine it. Between October 2005 and August 2006 649 children under 10 years were observed at the pediatric ophthalmologic consultation in the SAMS (Serviços de Assistência Médico-Social do Sindicato dos Bancários do Sul e Ilhas). Data were collected concerning more than 250 primary variables covering most itens of the usual ophthalmological examination. Special attention was paid to children's age since it plays a crucial role in main stages of visual system development. In the case of children age 6 to 7 SAMS and school results are often put side by side. On account of the great number of numerical data it was often necessary to look at the degree of statistical significancy of differencies between subgroups. Some of the study's results (mostly SAMS): Children age 6 to 7 - 71,1% (SAMS) and 91,5% (Schools) had not an ophthalmologic examination before 4 years old. Total frequency of myopic disorders 9,4%, of hypermetropic disorders 25,3%, both showing great differences between age groups; convergent strabismus 3,9%; amblyopia 2,6% (13/491 children over 3 years old), more frequent among little girls, in those with 1st examination after 4 years old and in those whose parents didn´t complied to the therapy ordered for the child. Specific objectives dealt with visual acuity and ocular refraction. The comparison of automatic refractometry without and with cycloplegy showed that visual acuity testing is often not enough for a correct diagnosis. Eye disorders in the family history proved to be a very important information. Analysis of corresponding data disclosed a lot of relationships among others: 12 pag1.qxp 27-11-2001 18:28 Page 12 Índice Geral 13 Children with a family history of myopic disorders have more frequently a diagnosis of myopic disorders and a negative refraction, a higher rate of quantitative diagnosis/refraction matching concerning myopic disorders. Those children have in general inverse characteristics regarding hypermetropic disorders. Children with a family history of hypermetropic disorders have more frequently a diagnosis of hypermetropic disorders. Children with a family history of strabismus have more frequently a diagnosis of manifest convergent strabismus and all forms of esodeviations. Children with a family history of astigmatism have more frequently a diagnosis of astigmatism. Ophthalmologic profiles are drawn allowing to take into account in a synoptic way a set of visual health parameters. Data on parents' compliance with therapy ordered for the child, and attitudes regarding child's glass wearing, as well as data on child's behaviour in the classroom and learning difficulties were as a rule too few to allow conclusions but still need more studies in the future. Orthoptists and nurses performed in the same study period a screening of visual acuity <0,8 and of ocular motility disorders addressed to children of 1srt degree of public schools (term 2005/2006) in the town of Lisbon. 520 of such children were screened. 101 of them were examined by the author in her medical office; some were refered, the others taken as a control. Regarding visual acuity the predictive value of a negative test was 91% but the predictive value of a positive test was only 67% (33% of false positive results, consequently a too high rate of overreferal). Performed by orthoptists screening quality was inferior in comparison with screening done by nurses. On the whole this screening had not the required quality. A survey on physicians' and nurses' knowledge, attitudes and practices related to pediatric ophthalmologic care was carried out in health centers. Results are discussed, conclusions drawn. Some suggestions are made aiming at a better children's visual health.

Welcome to the golden land: sexual and gender-based violence against women refugees from Burma

European Master’s Degree in Human Rights and Democratisation Academic Year 2005/2006

A proteomic approach toward the selection of proteins with enhanced intrinsic conformational stability

Journal of Proteome Research (2006)5: 2720-2726

Economias de escala em centros hospitalares

RESUMO - Perante o actual contexto de contenção de gastos no sector da saúde e consequente preocupação com a eficiência do sistema, tem‐se assistido a mudanças várias no modelo de gestão e organizacional do sistema de saúde. Destaca‐se a alteração da estrutura hospitalar, com vista à racionalização dos seus recursos internos, onde as fusões hospitalares têm assumido um papel determinante. Em Portugal, nos últimos 10 anos, assistiu‐se a uma significativa redução do número de hospitais (de sensivelmente 90 para 50 unidades), exclusivamente através das fusões e sem quaisquer alterações no número de estruturas físicas existentes. Não obstante os argumentos justificativos desta reforma, a avaliação dos objectivos implícitos é insuficiente. Neste âmbito, pretendeu‐se com este estudo contribuir para a análise do impacte da criação de centros hospitalares na redução de gastos, isto é, verificar se a consolidação e consequente reengenharia dos processos produtivos teve consequencias ao nível da obtenção de economias de escala. Para esta análise usou‐se uma base de dados em painel, onde se consideraram 75 hospitais durante 7 anos (2003‐2009), número que foi reduzindo ao longo do período em análise devido às inúmeras fusões já referidas. Para avaliar os ganhos relativos às fusões hospitalares, ao nível da eficiência técnica e das economias de escala, recorreu‐se à fronteira estocástica especificada função custo translog. Estimada a fronteira, foi possível analisar três centros hospitalares específicos, onde se comparou o período pré‐fusão (2005‐2006) com o período após a fusão (2008‐2009). Como variáveis explicativas, relativas à produção hospitalar, considerou‐se o número de casos tratados e os dias de internamento (Vita, 1990; Schuffham et al., 1996), o número de consultas e o número de urgências, sendo estas variáveis as mais comuns na literatura (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Quanto à variável dependente usou‐se o custo variável total, que compreende o total de custos anuais dos hospitais excepto de imobilizado. Como principais conclusões da investigação, em consequência da criação dos centros hospitalares, são de referir os ganhos de escala na fusão de hospitais de reduzida dimensão e com mais serviços complementares. --------ABSTRACT - Driven by the current pressure on resources induced by budgetary cuts, the Portuguese Ministry of Health is imposing changes in the management model and organization of NHS hospitals. The most recent change is based on the creation of Hospital Centres that are a result of administrative mergers of existing hospitals. In less than 10 years the number of hospitals passed from around 90 to around 50, only due to the mergers and without any change in the existing number of physical institutions. According to the political discourse, one of the main goals expected from this measure is the creation of synergies and more efficiency in the use of available resources. However, the merger of the hospitals has been a political decision without support or evaluation of the first experiments. The aim of this study is to measure the results of this policy by looking at economies of scale namely through reductions in the expenditures, as expected and sought by the MoH. Data used covers 7 years (2003‐2009) and 75 hospitals, number that has been reduced my the enoumerous mergers during the last decade. This work uses a stochastic frontier analysis through the translog cost function to examine the gains from mergers, which were decomposed into technical efficiency and economies of scale. It was analised these effects by the creation of three specific hospital centers, using a longitudinal approach to compare the period pre‐merger (2003‐2006) with the post‐merger period (2007‐09). To measure changes in inpatient hospital production volume and length of stay are going to be considered as done by Vita (1990) and Schuffham et al. (1996). For outpatient services the number of consultations and emergencies are going to be considered (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Total variable cost is considered as the dependent variable explained the aforementioned ones. After a review of the literature results expected point to benefits from the mergers, namely a reduction in total expenditures and in the number of duplicated services. Results extracted from our data point in the same direction, and thus for the existence of some economies of scale only for small hospitals.

The impact of SFAS 123R on CEO equity compensation

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Desigualdades de saúde no género na população adolescente : tabaco e obesidade

RESUMO - Introdução: Apesar de ocorrerem melhorias significativas na saúde das populações devido aos avanços tecnológicos continuam a surgir desigualdades de saúde no género, nomeadamente na população adolescente, quando estes não adotam comportamentos saudáveis. Objetivos: Analisar as desigualdades de saúde no género na população adolescente relativamente ao tabaco, obesidade e tipo de dieta. Métodos: Foi realizado um estudo analítico e descritivo, onde foram recolhidos dados acerca de fatores relacionados com comportamento, dos quais se destacam o tabagismo, obesidade, e tipo de dieta (consumo de sopa; salada/legumes cozidos; fruta e bolos, chocolates e sobremesa doce) por grupo etário. Dados pertencentes ao INS 2005/2006. Resultados: Verificou-se que a prevalência do tabagismo é estatisticamente significativa relativamente ao género apenas no grupo etário 17-19 anos (p=0). Demonstrou-se que havia associação estatisticamente significativa entre o género e obesidade apenas no grupo etário 10-13 anos (p=0). Quanta à variável tipo de dieta apenas no consumo de fruta existiu associação estatisticamente significativa no género no grupo etário 10-13 anos (p=0,036). Conclusões: Assim, com a realização do estudo verificou-se que o período crítico do consumo tabágico é no grupo etário 17-19 anos, já obesidade são os mais jovens pertencentes ao grupo etário 10-13 anos.

The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Mammals and birds of the Manu Biosphere Reserve, Peru / Bruce D. Patterson, Douglas F. Stotz, Sergio Solari.

n.s. no.110(2006)

Journal of Hymenoptera research.

v. 14, no. 2, 2005

Journal of Hymenoptera research.

v. 14, no. 1, 2005

Three new species of frogs and a new tadpole from eastern Thailand / B.L. Stuart ... [et al.]

n.s. no.111(2006)

The mammals of Mt. Kitanglad Nature Park, Mindanao, Philippines / Lawrence R. Heaney ... [et al.]

n.s. no.112(2006)