Childhood cancer mortality in Europe, 1970-2007.

To update trends in childhood cancer mortality in Europe, we analysed mortality data derived from the World Health Organization for all childhood neoplasms, bone and kidney cancers, non-Hodgkin's lymphomas (NHL) and leukaemias, in 30 European countries up to 2007. Between 1990-1994 and 2005-2007, mortality from all neoplasms steadily declined in most European countries (from 5.2 to 3.5/100,000 boys and from 4.3 to 2.8/100,000 girls in the European Union, EU). In 2005-2007, however, mortality rates from childhood cancers were still higher in countries from Eastern (4.9/100,000 boys and 3.9/100,000 girls) and Southern (4.0/100,000 boys and 3.1/100,000 girls) Europe than in those from Western (3.1/100,000 boys and 2.5/100,000 girls) and Northern (3.2/100,000 boys and 2.5/100,000 girls) Europe. Similar temporal trends and geographic patterns were observed for leukaemias, with declines from 1.7 to 0.9/100,000 boys and from 1.3 to 0.7/100,000 girls between 1990-1994 and 2005-2007 in the EU. For kidney cancer and NHL mortality rates were low and have been declining in larger European countries over the last 15years. The pattern of trends was less clear for bone cancer, with no systematic downward trends at age 0-14, though some fall was evident at age 15-19. Thus, mortality from childhood cancer continued to decline over more recent years in most European countries. However, the mortality rates in Eastern - but also Southern - European countries in the mid 2000's were similar to those in the Western and Northern European ones in the early 1990's. Some further improvement in childhood cancer mortality is therefore achievable through more widespread and better adoption of currently available treatments.

A polymorphism in the leptin gene promoter is associated with anemia in patients with HIV disease.

To study factors associated with anemia and its effect on survival in HIV-infected persons treated with modern combined antiretroviral therapy (cART), we characterized the prevalence of anemia in the Veterans Aging Cohort Study (VACS) and used a candidate gene approach to identify proinflammatory gene single nucleotide polymorphisms (SNPs) associated with anemia in HIV disease. The study comprised 1597 HIV(+) and 865 HIV(-) VACS subjects with DNA, blood, and annotated clinical data available for analysis. Anemia was defined according to World Health Organization criteria (hemoglobin < 13 g/dL and < 12 g/dL in men and women, respectively). The prevalence of anemia in HIV(+) and HIV(-) subjects was 23.1% and 12.9%, respectively. Independent of HIV status, anemia was present in 23.4% and 8% in blacks and whites, respectively. Analysis of our candidate genes revealed that the leptin -2548 G/A SNP was associated with anemia in HIV(+), but not HIV(-), patients, with the AA and AG genotypes significantly predicting anemia (P < .003 and P < .039, respectively, logistic regression). This association was replicated in an independent cohort of HIV(+) women. Our study provides novel insight into the association between genetic variability in the leptin gene and anemia in HIV(+) individuals.

Correlação entre qualidade de vida e morbidade do cuidador de idoso com acidente vascular encefálico

Este estudo objetivou descrever as características sociodemográficas e a qualidade de vida dos cuidadores de idosos com histórico de acidente vascular cerebral e correlacionar o número de morbidades com os escores de qualidade de vida do cuidador. Inquérito domiciliar transversal que entrevistou cuidadores de idosos utilizando-se de instrumentos: semi-estruturado; World Health Organization Quality of Life-abreviado e Brazilian Multidimensional Functional Assessment Questionnaire. Foi realizada análise descritiva e correlação de Pearson (p<0,05). Prevaleceu o sexo feminino (93,5%), idade média de 55,4±14,17 anos, casados ou moram com companheiro (58,7%), com 4| - 8 anos de estudo (28,3%) e renda de 1 salário mínimo (34,8%). O maior escore de qualidade de vida foi no domínio relações sociais (67,57) e, menor no meio ambiente (54,82). O maior número de morbidades do cuidador correlacionou-se com menores escores em todos os domínios de qualidade de vida.

Fatores associados com a qualidade de vida de homens idosos

Inquérito domiciliário, transversal e analítico que objetivou descrever as características sociodemográficas, de saúde e a qualidade de vida de homens idosos e verificar os fatores socioeconômicos e de saúde associados à qualidade de vida. Participaram 804 homens idosos. Os dados foram coletados pelos instrumentos: Older Americans Resources and Services(OARS), World Health Organization Quality of Life - Bref (WHOQOL-BREF) e Health Organization Quality of Life Assessment for Older Adults(WHOQOL-OLD). Foram realizados análise descritiva, teste t-Student, correlação de Pearson e regressão linear múltipla (p <0,05). Predominaram idosos com 60├ 70 anos, casados, 4├ 8 anos de estudo e renda de um salário mínimo. Os menores escores de qualidade de vida foram no domínio físico e na faceta autonomia e estiveram associados a ausência de companheira e de escolaridade, baixa renda, maior número de morbidades e incapacidade funcional. A incapacidade funcional foi o que mais influenciou a qualidade de vida, excetuando-se o domínio físico e a faceta intimidade.

A tumor-specific cellular environment at the brain invasion border of adamantinomatous craniopharyngiomas.

Craniopharyngiomas (CP) are benign epithelial tumors of the sellar region and can be clinicopathologically distinguished into adamantinomatous (adaCP) and papillary (papCP) variants. Both subtypes are classified according to the World Health Organization grade I, but their irregular digitate brain infiltration makes any complete surgical resection difficult to obtain. Herein, we characterized the cellular interface between the tumor and the surrounding brain tissue in 48 CP (41 adaCP and seven papCP) compared to non-neuroepithelial tumors, i.e., 12 cavernous hemangiomas, 10 meningiomas, and 14 metastases using antibodies directed against glial fibrillary acid protein (GFAP), vimentin, nestin, microtubule-associated protein 2 (MAP2) splice variants, and tenascin-C. We identified a specific cell population characterized by the coexpression of nestin, MAP2, and GFAP within the invasion niche of the adamantinomatous subtype. This was especially prominent along the finger-like protrusions. A similar population of presumably astroglial precursors was not visible in other lesions under study, which characterize them as distinct histopathological feature of adaCP. Furthermore, the outer tumor cell layer of adaCP showed a distinct expression of MAP2, a novel finding helpful in the differential diagnosis of epithelial tumors in the sellar region. Our data support the hypothesis that adaCP, unlike other non-neuroepithelial tumors of the central nervous system, create a tumor-specific cellular environment at the tumor-brain junction. Whether this facilitates the characteristic infiltrative growth pattern or is the consequence of an activated Wnt signaling pathway, detectable in 90% of these tumors, will need further consideration.

Metodologia de Análise de Investimentos em Sistemas e Tecnologias da Informação, pelas empresas caboverdeanas

O aumento da competitividade das empresas caboverdeanas impõe-se sobretudo por causa do momento histórico que particularmente o país atravessa. A graduação para país de rendimento médio, a adesão à Organização Mundial de Comércio e o estatuto de parceria especial com a União Europeia constituem razões de grande vulto para as empresas nacionais e outras que empreendem no mercado caboverdeano, definirem eficazmente e eficientemente os seus processos organizacionais de forma a atingirem patamares de produtividade e performance aos níveis internacionais. A envolvente externa às empresas caboverdeanas tem sido alvo de alterações profundas com a globalização dos mercados e o novo paradigma de economia baseada no conhecimento. Para que as empresas mantenham posições competitivas são muitos os desafios que terão que superar. Inexoravelmente, terão que reorganizar e redefinir os seus processos de negócio e suas estratégias de forma coerente. Os SI/TI constituem o factor potencial de reorganização e modernização, a alavanca de diferenciação competitiva e da concretização de negócios e resultados adicionais. O objectivo deste trabalho é o desenvolvimento e a validação de uma metodologia de enquadramento, análise e avaliação de investimentos em SI/TI. O procedimento proposto é fundamentado pela literatura e nas práticas das empresas cabo-verdianas e visa apoiar as empresas a atingirem estágios de performance e produtividade elevados, decorrentes da utilização optimizada dos recursos oferecidos pelos SI/TI. Porque elevadas somas de recursos financeiros são investidos em Sistemas e Tecnologias de Informação e nem todos os benefícios associados são quantificáveis e dado que os riscos associados são elevados, propõe-se com este trabalho um procedimento metodológico de apoio às empresas. Esta metodologia simplificada de análise de investimentos em Sistemas e Tecnologias da Informação propõe uma abordagem científica, sólida e objectiva de avaliação de investimentos em SI/TI, visando propiciar incremento do valor acrescentado dos produtos e/ou serviços das empresas. Os resultados obtidos a partir das análises quantitativas e qualitativas elaboradas permitem retratar a prática das empresas caboverdeanas no domínio de análise e avaliação de investimentos em SI/TI e gerar inferências importantes sobre o comportamento dos responsáveis empresariais e de SI/TI. The increase in competition by the Capeverdean companies is taking place mainly because of the historic moment the country is going through. The recent nomination of Cape Verde as a medium development country, the adhesion to the WCO (World Commerce Organization) and the special partnership with the European Union are relevant reasons for the national companies and others that operate in the Capeverdean market to define efficiently their organizational processes in order to reach levels of productivity and performance comparable to the international ones. The external component of the Capeverdean companies has been undergoing deep changes with market globalization and with the new economic paradigma based on kowledge. In order to maintain their competitive position there are many challenges to overcome. Surely and steadily, they will have to reorganize and redefine their business processes and strategies in a coherent way. The IS/IT (information systems / information technologies) constitute the potential factor of reorganization and modernization, the boost-lever that will produce competitive diferentiation and concretization of businesses and additional results. The main goal of this work is development and validation of a methology of insertion, analysis and evaluation of investments in the IS/IT. The proposed procedure is fundamented by the literature and practice of the Capeverdian companies, and aims at supporting these companies so that they can reach high stages of performance and productivity due to the correct use of the resources offered by the IS/IT. As high amounts of financial resources are invested in Information Systems and Tehnologies, and because of the fact that not all associated benefits may be quantified, and since the associated risks are high, with this work we propose a methodological procedure to support these companies. This simplified analysis methodology in Information and Technologies Systems proposes a sound and objective scientific approach to evaluate investments in IS/IT aiming at providing an increase of the added value of the products and/or services supplied by these companies. The incoming results from the quantitative and qualitative analyses made will allow portraying the practice of the capeverdean companies in the domain of analysis and evaluation of investments in IS/IT and generating important inferences on the behaviour of the executives and IS/IT.

Annual Report 2006 Neglected Tropical Diseases

World health organization

Oportunidades para os Recém-nascidos em Africa

Africana possui agora três estratégias regionais em várias fases de desenvolvimento: • Roteiro para a diminuição da mortalidade materno-infantil e dos recém-nascidos (2004) • Quadro da Sobrevivência Infantil (2005) • Plano de Acção de Maputo para a Saúde e Direitos Sexuais e Reprodutivos (2006) Cada uma destas políticas-quadro permite que os governos nacionais as adaptem e as implementem de acordo com as necessidades e características do seu país, com o apoio de parceiros e ao abrigo dos princípios da Declaração de Paris sobre a eficácia das ajudas - “Um só plano, um só mecanismo de coordenação, um só mecanismo de monitorização e de avaliação”. 35 países já iniciaram o processo que os levará a um Roteiro nacional, processo que arrancou com a “MNCH Task Force” em 2004. Estas políticas-quadro representam um grande avanço, mas constituem apenas um primeiro passo na via que levará a salvar vidas pelo aumento das áreas de cobertura das intervenções essenciais. O tempo escasseia - só nos restam nove anos antes da meta de 2015 para se alcançarem os Objectivos de Desenvolvimento do Milénio (ODM). A África pode e deve acelerar a marcha dos acontecimentos. A publicação Oportunidades para os recém-nascidos em Africa ajuda a colmatar o fosso existente entre as políticas e as acções no que se refere à Saúde Materna, Neonatal e Infantil (SMNI). O recém-nascido está no âmago dos cuidados continuados de saúde. Uma atenção sistemática prestada à melhoria e ao alargamento dos cuidados de saúde que lhe devem ser prestados no âmbito dos planos e dos programas nacionais será recompensada pela prestação de melhores serviços de SMNI. Esta publicação inclui os seguintes temas: A Secção I põe em destaque as mortes de recém-nascidos em África, o que é complementado pelos perfis apresentados na Secção V, que mostram qual é a situação fundamental da Saúde Materna, Neonatal e Infantil em 46 países de África, incluindo os progressos já alcançados no sentido do 4º objectivo dos ODM, a cobertura dos cuidados continuados de saúde prestados, a avaliação da equidade e a análise do financiamento destinado à saúde, fornecendo dados para a tomada de decisões na área das políticas e dos programas de SMNI.

Cenário para Reforçar os Sistemas na Procura de Melhores Produtos da Saúde

uma oportunidade para impulsionar o desenvolvimento e o crescimento económico, contribuir para salvar milhões de vidas e evitar incapacidades ao longo da vida, aproximando os países da consecução dos objectivos das estratégias nacionais de redução da pobreza e dos Objectivos de Desenvolvimento do Milénio (ODM). Para promover um maior e melhor investimento na saúde, a Harmonização da Saúde na África concebeu o Cenário de Investimento para a África com estas finalidades: 1) ajudar os dirigentes africanos e os seus parceiros regionais e globais a centrar as atenções e os recursos num investimento profícuo em saúde; 2) dar aos Ministérios da Saúde bases factuais para convencer os Ministérios das Finanças, os parlamentos nacionais e outros intervenientes chave de que investir na saúde faz sentido do ponto de vista económico e de que terá um retorno considerável; 3) obter mais valor pelo dinheiro investido, demonstrando como a eficácia com que os recursos novos ou já existentes são injectados no sistema de saúde pode ser potenciada graças a um processo de definição de prioridades, com base nas tendências demográficas e no fardo da doença; e 4) mobilizar as lideranças, a nível nacional, regional e global, para que apoiem os sistemas nacionais de saúde da África, nos seus esforços para aumentar o ritmo e a sustentabilidade na procura de melhor saúde e maior desenvolvimento económico para as populações africanas.

Women survivors of intimate partner violence: the difficult transition to independence

Objective To understand the trajectories that women go through from entering into to leaving relationships involving intimate partner violence (IPV), and identify the stages of the transition process. Method We utilized a constructivist paradigm based on grounded theory. We ensured that the ethical guidelines of the World Health Organization for research on domestic violence were followed. The analysis focused on narratives of 28 women survivors of IPV, obtained from in-depth interviews. Results The results showed that the trajectories experienced by women were marked by gender issues, (self) silencing, hope and suffering, which continued after the end of the IPV. Conclusion The transition process consists of four stages: entry - falls in love and becomes trapped; maintenance - silences own self, consents and remains in the relationship; decides to leave - faces the problems and struggles to be rescued; (re) balance - (re) finds herself with a new life. This (long) process was developed by wanting (and being able to have) self-determination.

Clinical activity of ipilimumab for metastatic uveal melanoma: a retrospective review of the Dana-Farber Cancer Institute, Massachusetts General Hospital, Memorial Sloan-Kettering Cancer Center, and University Hospital of Lausanne experience.

BACKGROUND: Uveal melanoma exhibits a high incidence of metastases; and, to date, there is no systemic therapy that clearly improves outcomes. The anticytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) antibody ipilimumab is a standard of care for metastatic melanoma; however, the clinical activity of CTLA-4 inhibition in patients with metastatic uveal melanoma is poorly defined. METHODS: To assess ipilimumab in this setting, the authors performed a multicenter, retrospective analysis of 4 hospitals in the United States and Europe. Clinical characteristics, toxicities, and radiographic disease burden, as determined by central, blinded radiology review, were evaluated. RESULTS: Thirty-nine patients with uveal melanoma were identified, including 34 patients who received 3 mg/kg ipilimumab and 5 who received 10 mg/kg ipilimumab. Immune-related response criteria and modified World Health Organization criteria were used to assess the response rate (RR) and the combined response plus stable disease (SD) rate after 12 weeks, after 23 weeks, and overall (median follow-up, 50.4 weeks [12.6 months]). At week 12, the RR was 2.6%, and the response plus SD rate was 46.%; at week 23, the RR was 2.6%, and the response plus SD rate was 28.2%. There was 1 complete response and 1 late partial response (at 100 weeks after initial SD) for an immune-related RR of 5.1%. Immune-related adverse events were observed in 28 patients (71.8%) and included 7 (17.9%) grade 3 and 4 events. Immune-related adverse events were more frequent in patients who received 10 mg/kg ipilimumab than in those who received 3 mg/kg ipilimumab. The median overall survival from the first dose of ipilimumab was 9.6 months (95% confidence interval, 6.3-13.4 months; range, 1.6-41.6 months). Performance status, lactate dehydrogenase level, and an absolute lymphocyte count ≥ 1000 cells/μL at week 7 were associated significantly with survival. CONCLUSIONS: In this multicenter, retrospective analysis of 4 hospitals in the United States and Europe of patients with uveal melanoma, durable responses to ipilimumab and manageable toxicity were observed.

Lessons learned from developing a national NCD programme in low- and middle-income countries (Seychelles)

This paper identifies selected issues and lessons learned from the implementation of a national program of prevention and control of non-communicable diseases (NCD) during the past 20 years in the Seychelles, a small island state in the African region. As early as in 1989, population-based surveys demonstrated high levels of several cardiovascular risk factors, which prompted an organized response by the government. The early creation of a NCD unit within the Ministry of Health, coupled with cooperation with international partners, enabled incremental capacity building and coherent development of NCD programs and policy. Information campaigns and screening for hypertension and diabetes in work/public places raised awareness and rallied increasingly broad awareness and support to NCD prevention and control. A variety of interventions were organized for tobacco control and comprehensive tobacco control legislation was enacted in 2009 (including total bans on tobacco advertising and on smoking in all enclosed public and work places). A recent School Nutrition Policy prohibits the sale of soft drinks in schools. At primary health care level, guidelines were developed for the management of hypertension and diabetes (these conditions are managed in all health centers within a national health system); regular interactive education sessions were organized for groups of high risk patients ("heart health club"); and specialized "NCD nurses" were trained. Decreasing prevalence of smoking is evidence of success, but the raising "diabesity epidemic" calls for strengthened health care to high-risk patients and broader multisectoral policy to mould an environment conducive to healthy behaviors. Key components of NCD prevention and control in Seychelles include effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus on the need for prevention and control of NCD; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multisectoral approaches.

APPROACH AND TREATMENT OF SUICIDAL BEHAVIOR IN THE CLINICAL PRACTICE OF DIFFERENT GROUPS OF HEALTH PROFESSIONALS IN SPAIN: RESULTS OF THE PROJECT EUREGENA.

According to the WHO (World Health Organization) and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project “European Regions Enforcing Actions against Suicide (EUREGENAS), funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health.

Analysis of the physical aspects of quality of life of kidney recipients

OBJECTIVE To identify the main factors of the physical domain modified after kidney transplantation and analyze the influence of those aspects in the perception of Overall quality of life (QOL). METHOD Longitudinal study, conducted with 63 chronic kidney patients, evaluated before and after kidney transplant, using the quality of life scale proposed by the World Health Organization. RESULTS We observed significant improvement in the physical aspects of QOL after kidney transplantation. Significant correlations were observed between physical aspects and the Overall QOL. CONCLUSION The kidney transplant generated improvement in all physical aspects of QOL. The factors that showed stronger correlation with the Overall QOL before the transplant were the capacity to work and pain. After the transplant, the perception of need for treatment was the factor that showed stronger correlation with the Overall QOL.

Analysis of malaria associated genetic traits in Cabo Verde, a melting pot of European and sub Saharan settlers

Malaria has occurred in the Cabo Verde archipelago with epidemic characteristics since its colonization. Nowadays, it occurs in Santiago Island alone and though prophylaxis is not recommended by the World Health Organization, studies have highlight the prospect of malaria becoming a serious public health problem as a result of the presence of antimalarial drug resistance associated with mutations in the parasite populations and underscore the need for tighter surveillance. Despite the presumptive weak immune status of the population, severe symptoms of malaria are not observed and many people present a subclinical course of the disease. No data on the prevalence of sicklecell trait and red cell glucose-6-phosphate dehydrogenase deficiency (two classical genetic factors associated with resistance to severe malaria) were available for the Cabo Verde archipelago and, therefore, we studied the low morbidity from malaria in relation to the particular genetic characteristics of the human host population. We also included the analysis of the pyruvate kinase deficiency associated gene, reported as putatively associated with resistance to the disease. Allelic frequencies of the polymorphisms examined are closer to European than to African populations and no malaria selection signatures were found. No association was found between the analyzed human factors and infection but one result is of high interest: a linkage disequilibrium test revealed an association of distant loci in the PKLR gene and adjacent regions, only in non-infected individuals. This could mean a more conserved gene region selected in association to protection against the infection and/or the disease.