Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).

The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data.

Immunologic work up of subjects who didn't respond appropriately to a rabies post exposure prophylaxis

Background New recommendations for rabies postexposure prophylaxis (rPEP) were published by the Centers for Disease Control and Prevention and the World Health Organization in 2010. In view of these new recommendations, the adequacy of rPEP among patients consulting the travel clinic of the University Hospital of Lausanne has been investigated and 6,8% of patients have been identified as non-responders with the new rPEP regimen. In this study we have selected the non-responders for a complete immunologic work up. Method Clinical and paraclinical immunologic investigations have been done to the non- responders patients. Those investigations have been conducted to look for an increased susceptibility to infections and an immunodeficiency. The investigations included a clinical evaluation, a full blood count, measurement of the immunoglobulin levels, a numeration of the subpopulations of the lymphocytes, a HIV test and an evaluation of the humoral response to tetanus, pneumococcal, and hepatitis B vaccinations. A lymphocyte proliferation assay with rabies antigen was performed to assess the cellular immune response. Results 9 subjects with rabies antibody titers ≤0,5 IU/ml after an rPEP with 4 doses were included in this study (=non-responders). 8/9 of these non-responders had an unremarkable medical history. 9/9 of them had normal paraclinical tests that did not suggest an immunodeficiency. The results of the lymphocyte proliferation assay with rabies antigen showed a significant correlation between the level of the humoral and cellular response. Conclusion These results suggest that a 4 dose intramuscular rPEP elicits in some patients a relatively poor humoral and cellular response, even in the absence of any immunosuppression. A serology on day 21 of the rPEP seems therefore useful to identify the patients who don't respond appropriately. Those non-responders should receive additional doses until they reach an antibody titer above 0.5 IU/ml.

Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain

Myeloid malignancies (MMs) are a heterogeneous group of hematologic malignancies presenting different incidence, prognosis and survival.1–3 Changing classifications (FAB 1994, WHO 2001 and WHO 2008) and few available epidemiological data complicate incidence comparisons.4,5 Taking this into account, the aims of the present study were: a) to calculate the incidence rates and trends of MMs in the Province of Girona, northeastern Spain, between 1994 and 2008 according to the WHO 2001 classification; and b) to predict the number of MMs cases in Spain during 2013. Data were extracted from the population-based Girona Cancer Registry (GCR) located in the north-east of Catalonia, Spain, and covering a population of 731,864 inhabitants (2008 census). Cases were registered according to the rules of the European Network for Cancer Registries and the Manual for Coding and Reporting Haematological Malignancies (HAEMACARE project). To ensure the complete coverage of MMs in the GCR, and especially myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS), a retrospective search was performed. The ICD-O-2 (1990) codes were converted into their corresponding ICD-O-3 (2000) codes, including MDS, polycythemia vera (PV) and essential thrombocythemia (ET) as malignant diseases. Results of crude rate (CR) and European standardized incidence rate (ASRE) were expressed per 100,000 inhabitants/year

"Me gustaría ser militar". Reproducción de la masculinidad hegemónica en la patologización de la transexualidad

La Organización Mundial de la Salud y la Asociación de Psiquiatría Americana catalogan la transexualidad como una patología bajo el nombre de ‘trastorno de identidad de género’ y ‘disforia de género’, respectivamente. En el contexto español, la Ley 3/2007 establece que para poder modificarse la mención de sexo hace falta presentar, entre otros, un certificado de dicho diagnóstico. Las Unidades de Trastornos de Identidad de Género, ubicadas en las unidades de psiquiatría de diferentes hospitales públicos, son las encargadas de expedir este tipo de certificados una vez pasado un proceso que puede durar dos años. En este artículo, tras analizar la construcción del género que subyace en el discurso médico oficial sobre la transexualidad se concluye que se establece una visión patologizadora, binarista, biologista y que fomenta, en el caso de los trans masculinos, los estereotipos de la masculinidad hegemónica.

Danza movimiento terapia y abuso sexual

L'organització mundial de la salut, assenyala que la major part de les agressions sexuals tenen com a víctimes a dones i nenes, i són perpetrades per homes i nens. En alguns països, gairebé una de cada quatre dones ha estat víctima de violència sexual per part de la seva parella i fins a una tercera part de les adolescents han sofert una iniciació sexual forçada. Estudis especialitzats fan referència al percentatge de dones que han sofert alguna forma d'abús sexual abans dels 18 anys. En el mateix sentit, enquestes mundials assenyalen que entre el 10% i el 69% de les dones diuen haver estat agredides físicament per una parella masculina en algun moment de la seva vida. La violència sexual infantil provoca a les seves víctimes una sèrie de repercussions i seqüeles, psicològiques, emocionals, socials; compromet el desenvolupament integral de l'individu, i provoca l'aparició d'una sèrie de patologies a l'edat adulta. La present investigació fa una revisió teòrica de la violència sexual, de la violència de gènere, i de les aportacions del procés de recuperació a través de la dansa moviment teràpia d'aquesta població. També es mostra el recorregut del marc d'actuació dels organismes d'ordre públic de la ciutat de Barcelona per a l'atenció i detecció en casos d'abús sexual

Cooking and Active Leisure TAS Program, Spain: A Program Impact Pathways (PIP) analysis

Background. The “Cooking and Active Leisure” Tu y Alícia por la Salud (CAL-TAS) Program is a schoolbased pilot that addresses healthy lifestyle needs of Spanish secondary school students with initiatives that research has proven to improve dietary and physical activity behaviors. Objective. The objectives were to perform a Program Impact Pathways (PIP) analysis to describe key activities and processes of the CAL-TAS Program, identify Critical Quality Control Points (CCPs), and identify a suite of common indicators of healthy lifestyles to be applied across participant schools. Methods. The CAL-TAS Program designers and implementation team developed this PIP analysis through an iterative process and presented the results for feedback at the seven-country Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13–14 September 2013, under the auspices of the Mondelēz International Foundation. Results. The team identified three PIP CCPs: teachers’ motivation and training, changes in students’ knowledge of healthy lifestyles, and changes in students’ healthy lifestyle behavior. The selected indicators of the program’s impact on healthy lifestyles are adequacy of food intake, level of knowledge of healthy lifestyles gained, and adequacy of physical activity level according to World Health Organization recommendations. A clear definition of impact indicators, as well as collection of accurate data on healthy lifestyle behaviors and knowledge, is essential to understanding the effectiveness of this program before it can be scaled up. Conclusions. CAL-TAS is an effective secondary school-based program encouraging healthy lifestyles. The PIP analysis was instrumental in identifying CCPs to sustain and improve the quality of the program. The team hopes to sustain and improve the program through these program evaluation recommendations.

Survival of European patients diagnosed with lymphoid neoplasms in 2000-2002: results of the HAEMACARE project

The European Cancer Registry-based project on hematologic malignancies (HAEMACARE), setup to improve the availability and standardization of data on hematologic malignancies in Europe, used the European Cancer Registry-based project on survival and care of cancer patients (EUROCARE-4) database to produce a new grouping of hematologic neoplasma(defined by the International Classification of Diseases for Oncology, Third Edition and the 2001/2008 World Health Organization classifications) for epidemiological and public healthpurposes. We analyzed survival for lymphoid neoplasms in Europe by disease group, comparing survival between different European regions by age and sex. Design and Methods Incident neoplasms recorded between 1995 to 2002 in 48 population-based cancer registries in 20 countries participating in EUROCARE-4 were analyzed. The period approach was used to estimate 5-year relative survival rates for patients diagnosed in 2000-2002, who did not have 5years of follow up. Results: The 5-year relative survival rate was 57% overall but varied markedly between the definedgroups. Variation in survival within the groups was relatively limited across European regions and less than in previous years. Survival differences between men and women were small. The relative survival for patients with all lymphoid neoplasms decreased substantially after the age of 50. The proportion of ‘not otherwise specified’ diagnoses increased with advancing age.Conclusions: This is the first study to analyze survival of patients with lymphoid neoplasms, divided into groups characterized by similar epidemiological and clinical characteristics, providing a benchmarkfor more detailed analyses. This Europe-wide study suggests that previously noted differences in survival between regions have tended to decrease. The survival of patients with all neoplasms decreased markedly with age, while the proportion of ‘not otherwise specified’ diagnoses increased with advancing age. Thus the quality of diagnostic work-up and care decreased with age, suggesting that older patients may not be receiving optimal treatment

The association between obesity and back pain in nine countries: a cross-sectional study

BACKGROUND: The association between obesity and back pain has mainly been studied in high-income settings with inconclusive results, and data from older populations and developing countries are scarce. The aim of this study was to assess this association in nine countries in Asia, Africa, Europe, and Latin America among older adults using nationally-representative data. METHODS: Data on 42116 individuals ≥50 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) study conducted in Finland, Poland, and Spain in 2011-2012, and the World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010 were analysed. Information on measured height and weight available in the two datasets was used to calculate Body Mass Index (BMI). Self-reported back pain occurring in the past 30 days was the outcome. Multivariable logistic regression analysis was used to assess the association between BMI and back pain. RESULTS: The prevalence of back pain ranged from 21.5% (China) to 57.5% (Poland). In the multivariable analysis, compared to BMI 18.5-24.9 kg/m(2), significantly higher odds for back pain were observed for BMI ≥35 kg/m(2) in Finland (OR 3.33), Russia (OR 2.20), Poland (OR 2.03), Spain (OR 1.56), and South Africa (OR 1.48); BMI 30.0-34.0 kg/m(2) in Russia (OR 2.76), South Africa (OR 1.51), and Poland (OR 1.47); and BMI 25.0-29.9 kg/m(2) in Russia (OR 1.51) and Poland (OR 1.40). No significant associations were found in the other countries. CONCLUSIONS: The strength of the association between obesity and back pain may vary by country. Future studies are needed to determine the factors contributing to differences in the associations observed.

Avaliação da labilidade de alumínio em infusões de erva-mate empregando voltametria adsortiva de redissolução catódica

Infusions of yerba mate obtained at different stages of industrialization were evaluated to determine the bioavailable fraction of Al. Adsorptive Cathodic Stripping Voltammetry using DASA (complexing agent) was applied to determine the labile fraction of Al at pH 5.0 and pH 8.0 for the total fraction of dissolved Al. The results indicate that on average 60% of Al is complexed with organic compounds, minimizing their bioavailability; however, the labile fraction exceeds by up to 4 times the maximum weekly intake recommended by the World Health Organization.

Determination of patulin in apple juice by HPLC using a simple and fast sample preparation method

The goal of this work was to develop a simple and rapid preparation method for patulin analysis in apple juice without previous clean-up. This method combined sonication and liquid extraction techniques and was used for determination of patulin in 37 commercial apple juices available on the market in the South of Brazil. The method performance characteristics were determined using a sample obtained in a local market fortified at five concentration levels of patulin and done in triplicates. The coefficient of variation for repeatability at the fortification level of 20.70µg.L-1 was 3.53 % and the recovery 94.63 %, respectively. The correlation coefficient was 0.9996 and agrees with the requirements for a linear analytical method value. The detection limit was 0.21µg.L-1 and the quantification limit 0.70 µg.L-1. Only three of the analyzed samples were upper the allowed level of 50.00 µg.L-1 recommended for the World Health Organization.

Natural history of celiac disease-associated antibodies and progression to overt disease in children at increased genetic risk

Background: Celiac disease is a lifelong, gluten-sensitive, autoimmune-mediated chronic enteropathy, tightly associated with risk alleles at the HLA class II genes. Aims: This study was carried out as a part of the population-based Type 1 Diabetes Prediction and Prevention (DIPP) Project. The first aim was to study the natural history of celiac disease-associated antibodies before the diagnosis of celiac disease was made. The second aim was to describe when and in which order celiac disease-associated and type 1 diabetes-associated antibodies appeared in children with genetic risk for both diseases. Subjects and Methods: Antibodies against tissue transglutaminase (TGA) and other celiac disease-associated antibodies were measured in serum samples collected at 3- to 12-month intervals of children at genetic risk for celiac disease who participated in the DIPP project. Celiac disease was confirmed by duodenal biopsy. Type 1 diabetes-associated antibodies were measured in all samples that had been collected. Overt disease was diagnosed according to World Health Organization criteria. Follow-up continued until a diagnosis of type 1 diabetes or until the end of a defined follow-up period. Results: TGA appeared in children at genetic risk for celiac disease only after the first year of life, but anti-gliadin antibodies often emerged significantly earlier, at age 6 months. The data show that spontaneous disappearance of celiac disease-associated antibodies, transient or persisting, is a common phenomenon, at least in prepubertal children. In children with genetic susceptibility to type 1 diabetes and celiac disease, celiac disease-associated antibodies usually develop earlier than the type 1 diabetes-associated antibodies. Conclusions: The transient nature of celiac disease-associated antibodies emphasizes the significance of establishing seropositivity repeatedly in screening detected celiac disease before gastroscopy and duodenal biopsy are considered and emphasized the importance of duodenal biopsy for diagnosing celiac disease.

Kansainliiton tilastojulkaisut

Kansainliiton tilastojulkaisujen kokoelmaan kuuluu Kansainliiton julkaisemia tilastosarjoja ja vähäisessä määrin muita julkaisuja vuosilta 1920-1946. Tilastojen aiheina ovat mm. maailmankauppa, maksutase ja valuuttakysymykset. Kokoelmaan kuuluvia sarjoja ovat esimerkiksi Statistical year-book of the League of Nations, Review of world trade ja Memorandum on balance of payments and foreign trade balances. Kokoelmaan kuuluvat sarjat eivät ole täydellisiä. Kansainliitto (engl. League of Nations, ransk. Société des Nations) perustettiin ensimmäisen maailmansodan jälkeen tehtävänään aseistariisunta ja valtioiden välisen yhteistyön edistäminen. Kansainliitto lopetti toimintansa 1946, jolloin sen tehtävät siirtyivät juuri perustetulle YK:lle.

Organizational learning from customer interaction

In the fierce competition of today‟s business world an organization‟s capacity to learn maybe its only competitive advantage. This research aims at increasing the understanding on how organizational learning from the customer happens in technology companies. In doing so it provides a synthesized definition of organizational learning and investigates processes of organizational learning within technology companies. A qualitative research method and in-depth interviews with different sized high technology companies, as applied here, enables in-depth study of the learning processes. Research contributes to the understanding of what type of knowledge firms acquire, how new knowledge is transferred and used in a learning firm‟s routines and processes. Research findings show that SMEs and large size companies also, depending on their position in the software value chain, consider different knowledge types as most important and that they use different learning methods to acquire knowledge from their customers.

Carcinoma renal dos ductos de Bellini

Two types primary epithelial tumours of the kidney have been distinguished, such as renal cell carcinoma (hypernephroma or Grawitz) deriving from proximal tubules and carcinoma arising in the urothelium of the kidney's collecting system. Mancilla-Jimenez e cols were the first to describe in 1976 an atypical papillary carcinoma of the kidney deriving from collecting duct system-Bellini duct carcinoma (BDC). In the World Healthy Organization classification it is listed as a rare carcinoma ( 1 % of the renal malignancies) originating in the renal medulla. Histologic examination shows both tubular and papillary architeture, which can lead to misinterpretation as renal cell or transitional cell carcinoma. Renal cell carcinoma originates from the metanephrogenic blastema and collecting duct carcinoma derived embryologicaly from the mesonephron Wolff duct. Renal cell carcinoma has been shown to express both cytokeratins and vimetin, whereas the distal convoluted tubule expresses only cytokeratins. BDC can be considered as a renal malignancy with a very bad prognosis compared to the other renal cell carcinoma. The best treatment is radical nephrectomy. A case of BDC is reported in a young black man, 27 year old with only history of light left back pain. Ultrasound and other image examinations showed a tumour about 6 cm in the middle and low left kidney. Patient was submitted to extraperitoneal radical nephectomy. Microscopic evaluation revealed kidney's collecting duct carcinoma with metastasis on two retroperitoneal lymphy nodes.

Associação entre o estado nutricional pré-gestacional e a predição do risco de intercorrências gestacionais

OBJETIVO: analisar a associação entre o estado nutricional pré-gestacional materno e os desfechos maternos - síndromes hipertensivas da gravidez, diabetes gestacional, deficiência de vitamina A e anemia - e do concepto - baixo peso ao nascer. MÉTODOS: estudo transversal, com 433 puérperas adultas (>20 anos), atendidas na Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ) e seus respectivos recém-nascidos. As informações foram coletadas em consulta a prontuários e entrevistas. O estado nutricional pré-gestacional materno foi definido por meio do índice de massa corporal pré-gestacional, segundo os pontos de corte para mulheres adultas da World Health Organization (WHO), em 1995. Estimou-se a associação entre os desfechos gestacionais e o estado nutricional pré-gestacional, por meio da odds ratio (OR) e intervalo de confiança (IC) de 95%. RESULTADOS: a freqüência de desvio ponderal pré-gestacional (baixo peso, sobrepeso e obesidade) foi de 31,6%. Considerando-se o estado nutricional pré-gestacional, aquelas com sobrepeso e obesidade apresentaram menor ganho ponderal do que as eutróficas e as com baixo peso (p<0,05). As mulheres com obesidade pré-gestacional apresentaram risco aumentado de desenvolver síndromes hipertensivas da gravidez (OR=6,3; IC95%=1,90-20,5) e aquelas com baixo peso pré-gestacional, maior chance de ter recém-nascidos com baixo peso ao nascer (OR=7,1; IC95%=1,9-27,5). Não foi evidenciada a associação entre estado nutricional pré-gestacional e o desenvolvimento de anemia, deficiência de vitamina A e diabetes gestacional. A média de ganho de peso entre as gestantes com sobrepeso e obesas foi significativamente menor, quando comparadas às eutróficas e às com baixo peso (p=0,002, p=0,049, p=0,002, p=0,009). CONCLUSÕES: a expressiva quantidade de mulheres com desvio ponderal pré-gestacional reforça a importância da orientação nutricional que favoreça o estado nutricional adequado e minimize os riscos de intercorrências maternas e do recém-nascido.