Asociación entre psoriasis y el control de diabetes mellitus tipo 2

La psoriasis es una enfermedad que se caracteriza por un proceso inflamatorio crónico y exagerado local y sistémico. Se ha encontrado en la literatura una relación entre la psoriasis y el desarrollo de patologías como diabetes mellitus tipo 2 y el mal control de estas patologías, lo cual aumenta la morbimortalidad de estos pacientes. El presente estudio mostró que no se encontró asociación entre psoriasis y el control de la DM2 , y que la variable mas significativa sobre el control es la adherencia al tratamiento hipoglicemiante.

La experiencia de los receptores en el trasplante de órganos y tejidos

El trasplante de órganos y/o tejidos es considerado como una opción terapéutica viable para el tratamiento tanto de enfermedades crónicas o en estadios terminales, como de afectaciones no vitales, pero que generen una disminución en la calidad de vida percibida por el paciente. Este procedimiento, de carácter multidimensional, está compuesto por 3 actores principales: el donante, el órgano/tejido, y el receptor. Si bien un porcentaje significativo de investigaciones y planes de intervención han girado en torno a la dimensión biológica del trasplante, y a la promoción de la donación; el interés por la experiencia psicosocial y la calidad de vida de los receptores en este proceso ha aumentado durante la última década. En relación con esto, la presente monografía se plantea como objetivo general la exploración de la experiencia y los significados construidos por los pacientes trasplantados, a través de una revisión sistemática de la literatura sobre esta temática. Para ello, se plantearon unos objetivos específicos derivados del general, se seleccionaron términos o palabras claves por cada uno de estos, y se realizó una búsqueda en 5 bases de datos para revistas indexadas: Ebsco Host (Academic Search; y Psychology and Behavioral Sciences Collection); Proquest; Pubmed; y Science Direct. A partir de los resultados, se establece que si bien la vivencia de los receptores ha comenzado a ser investigada, aún es necesaria una mayor exploración sobre la experiencia de estos pacientes; exploración que carecería de objetivo si no se hiciera a través de las narrativas o testimonios de los mismos receptores

Actitudes hacia el VIH/SIDA, el cáncer y la enfermedad de Alzheimer

Esta revisión de la literatura tuvo como objetivo describir las actitudes hacia el VIH/SIDA, el cáncer y la Enfermedad de Alzheimer desde el modelo tripartito. Se revisaron 109 artículos publicados entre 2005 y 2015 en algunas bases de datos especializadas y herramientas de análisis de impacto. También se incluyeron fuentes secundarias ampliándose la búsqueda a los últimos 20 años (1995-2015). Los resultados mostraron que la mayoría de los estudios realizados sobre las actitudes hacia estas tres enfermedades son de tipo cuantitativo y la información se analizó con base en los componentes del modelo tripartito. Algunos aspectos sociodemográficos como el sexo y la edad están asociados con las actitudes hacia las tres enfermedades y predominan las creencias erróneas sobre ellas respecto a sus causas, curso y tratamiento. También predominan actitudes negativas hacia las tres enfermedades y las conductas e intenciones conductuales son diversas hacia cada una de ellas. No se hallaron antecedentes empíricos del estudio de la estructura de las actitudes propuesta por el modelo tripartito hacia las tres enfermedades. La Salud Pública ha liderado la investigación con base en el modelo de conocimientos, actitudes y prácticas propuesto por la OMS.

Representaciones sociales de la medicina complementaria y alternativa (MCA) para el cáncer en estudiantes universitarios de carreras de ciencias de la salud

Se realizó un estudio cualitativo exploratorio con estudiantes de carreras de Ciencias de la Salud con el objetivo de comprender las representaciones sociales que tienen acerca de la Medicina Complementaria y Alternativa (MCA) para el cáncer. Se desarrollaron grupos focales y la información obtenida fue analizada a través del Análisis Temático e interpretada con base en la Teoría de las Representaciones Sociales. Se encontraron diversas representaciones sociales asociadas con la definición, los objetivos, los tratamientos, la eficacia, las fuentes de información y el origen de la MCA. En conclusión se evidenció una alta tendencia a la aceptación y a la manifestación de una actitud positiva, aunque ambivalente frente a la MCA, además de un desconocimiento por la diferenciación conceptual entre este tipo de Medicina y la Medicina Popular. La cultura y las creencias sociales predominan en las representaciones sociales que tienen los estudiantes de la MCA para el cáncer, pese a su formación académica.

Caracterización epidemiológica de la artritis idiopática juvenil y refractariedad a dmard en una institución en Bogotá

La artritis idiopática juvenil (AIJ) es la enfermedad reumatológica crónica más común de la infancia con repercusiones importantes en la calidad de vida del paciente y su familia; las alteraciones físicas presentadas pueden ocasionar ausentismo escolar. Los tratamientos de uso crónico utilizados hacen que la adherencia al mismo en la población infantil y adolescente sea todo un reto. A esto se adiciona la refractariedad a DMARDs (Disease – Modifying – Antirheumatic – Drugs) que conlleva al inicio de terapia biológica y a cambios en el pronóstico de la enfermedad. Materiales y métodos: Estudio observacional retrospectivo mediante la revisión de las historias clínicas de pacientes con diagnóstico de artritis idiopática juvenil que consultaron a la Fundación Cardioinfantil desde enero del 2008 a septiembre de 2015. Se obtuvieron datos como edad, sexo, edad de diagnóstico, manejo actual, remisión, seguimiento, tratamiento, cambios realizados en el mismo y refractariedad a DMARD. Resultados: De 108 registros clínicos evaluados, 90 cumplieron los criterios de elegibilidad. Se diagnosticó con mayor frecuencia en el sexo femenino con un 57.8%, media de edad de 7.88 años. El subtipo poliarticular con Factor Reumatoideo negativo se presentó con una frecuencia con 31,1 %. El tiempo transcurrido entre el inicio de la sintomatología en meses, previo a realizar el diagnóstico, osciló entre 1 y 60 meses con una media de 10,6 meses. Se usaron con mayor frecuencia: AINES (61,1%), metotrexate (47,8%) y corticoides (42,2%). De los 90 pacientes, solo un 11.1% de la población presentó complicaciones, siendo la más frecuente la obesidad en un 3,3 % y la menos frecuente la uveítis con un 1,1%. Discusión: Es importante el entendimiento de la Artritis idiopática juvenil como una entidad de carácter sistémica, lo cual hace necesario el conocimiento de la epidemiología para establecer estrategias de manejo y seguimiento adecuadas. El género femenino continúa siendo afectado en mayor porcentaje. Se observaron leves cambios respecto al subtipo de mayor frecuencia comparado con estudios previos. Se necesitan más estudios de caracterización epidemiológica en la población Colombiana para realización de políticas de salud pública

Development, implementation and evaluation of an activated sludge supervisory system for the Granollers WWTP

La present tesi pretén recollir l'experiència viscuda en desenvolupar un sistema supervisor intel·ligent per a la millora de la gestió de plantes depuradores d'aigües residuals., implementar-lo en planta real (EDAR Granollers) i avaluar-ne el funcionament dia a dia amb situacions típiques de la planta. Aquest sistema supervisor combina i integra eines de control clàssic de les plantes depuradores (controlador automàtic del nivell d'oxigen dissolt al reactor biològic, ús de models descriptius del procés...) amb l'aplicació d'eines del camp de la intel·ligència artificial (sistemes basats en el coneixement, concretament sistemes experts i sistemes basats en casos, i xarxes neuronals). Aquest document s'estructura en 9 capítols diferents. Hi ha una primera part introductòria on es fa una revisió de l'estat actual del control de les EDARs i s'explica el perquè de la complexitat de la gestió d'aquests processos (capítol 1). Aquest capítol introductori juntament amb el capítol 2, on es pretén explicar els antecedents d'aquesta tesi, serveixen per establir els objectius d'aquest treball (capítol 3). A continuació, el capítol 4 descriu les peculiaritats i especificitats de la planta que s'ha escollit per implementar el sistema supervisor. Els capítols 5 i 6 del present document exposen el treball fet per a desenvolupar el sistema basat en regles o sistema expert (capítol 6) i el sistema basat en casos (capítol 7). El capítol 8 descriu la integració d'aquestes dues eines de raonament en una arquitectura multi nivell distribuïda. Finalment, hi ha una darrer capítol que correspon a la avaluació (verificació i validació), en primer lloc, de cadascuna de les eines per separat i, posteriorment, del sistema global en front de situacions reals que es donin a la depuradora

SBR technology for wastewater treatment: suitable operational conditions for a nutrient removal

Actualment, la legislació ambiental ha esdevingut més restrictiva pel que fa a la descàrrega d'aigües residuals amb nutrients, especialment en les anomenades àrees sensibles o zones vulnerables. Arran d'aquest fet, s'ha estimulat el coneixement, desenvolupament i millora dels processos d'eliminació de nutrients. El Reactor Discontinu Seqüencial (RDS) o Sequencing Batch Reactor (SBR) en anglès, és un sistema de tractament de fangs actius que opera mitjançant un procediment d'omplerta-buidat. En aquest tipus de reactors, l'aigua residual és addicionada en un sol reactor que treballa per càrregues repetint un cicle (seqüència) al llarg del temps. Una de les característiques dels SBR és que totes les diferents operacions (omplerta, reacció, sedimentació i buidat) es donen en un mateix reactor. La tecnologia SBR no és nova d'ara. El fet, és que va aparèixer abans que els sistema de tractament continu de fangs actius. El precursor dels SBR va ser un sistema d'omplerta-buidat que operava en discontinu. Entre els anys 1914 i 1920, varen sorgir certes dificultats moltes d'elles a nivell d'operació (vàlvules, canvis el cabal d'un reactor a un altre, elevat temps d'atenció per l'operari...) per aquests reactors. Però no va ser fins a finals de la dècada dels '50 principis del '60, amb el desenvolupament de nous equipaments i noves tecnologies, quan va tornar a ressorgir l'interès pels SBRs. Importants millores en el camp del subministrament d'aire (vàlvules motoritzades o d'acció pneumàtica) i en el de control (sondes de nivell, mesuradors de cabal, temporitzadors automàtics, microprocessadors) han permès que avui en dia els SBRs competeixin amb els sistemes convencional de fangs actius. L'objectiu de la present tesi és la identificació de les condicions d'operació adequades per un cicle segons el tipus d'aigua residual a l'entrada, les necessitats del tractament i la qualitat desitjada de la sortida utilitzant la tecnologia SBR. Aquestes tres característiques, l'aigua a tractar, les necessitats del tractament i la qualitat final desitjada determinen en gran mesura el tractament a realitzar. Així doncs, per tal d'adequar el tractament a cada tipus d'aigua residual i les seves necessitats, han estat estudiats diferents estratègies d'alimentació. El seguiment del procés es realitza mitjançant mesures on-line de pH, OD i RedOx, els canvis de les quals donen informació sobre l'estat del procés. Alhora un altre paràmetre que es pot calcular a partir de l'oxigen dissolt és la OUR que és una dada complementària als paràmetres esmentats. S'han avaluat les condicions d'operació per eliminar nitrogen d'una aigua residual sintètica utilitzant una estratègia d'alimentació esglaonada, a través de l'estudi de l'efecte del nombre d'alimentacions, la definició de la llargada i el número de fases per cicle, i la identificació dels punts crítics seguint les sondes de pH, OD i RedOx. S'ha aplicat l'estratègia d'alimentació esglaonada a dues aigües residuals diferents: una procedent d'una indústria tèxtil i l'altra, dels lixiviats d'un abocador. En ambdues aigües residuals es va estudiar l'eficiència del procés a partir de les condicions d'operació i de la velocitat del consum d'oxigen. Mentre que en l'aigua residual tèxtil el principal objectiu era eliminar matèria orgànica, en l'aigua procedent dels lixiviats d'abocador era eliminar matèria orgànica i nitrogen. S'han avaluat les condicions d'operació per eliminar nitrogen i fòsfor d'una aigua residual urbana utilitzant una estratègia d'alimentació esglaonada, a través de la definició del número i la llargada de les fases per cicle, i la identificació dels punts crítics seguint les sondes de pH, OD i RedOx. S'ha analitzat la influència del pH i la font de carboni per tal d'eliminar fòsfor d'una aigua sintètica a partir de l'estudi de l'increment de pH a dos reactors amb diferents fonts de carboni i l'estudi de l'efecte de canviar la font de carboni. Tal i com es pot veure al llarg de la tesi, on s'han tractat diferents aigües residuals per a diferents necessitats, un dels avantatges més importants d'un SBR és la seva flexibilitat.

Statistical inference of OH concentrations and air mass dilution rates from successive observations of non-methane hydrocarbons in single air masses

Bayesian inference has been used to determine rigorous estimates of hydroxyl radical concentrations () and air mass dilution rates (K) averaged following air masses between linked observations of nonmethane hydrocarbons (NMHCs) spanning the North Atlantic during the Intercontinental Transport and Chemical Transformation (ITCT)-Lagrangian-2K4 experiment. The Bayesian technique obtains a refined (posterior) distribution of a parameter given data related to the parameter through a model and prior beliefs about the parameter distribution. Here, the model describes hydrocarbon loss through OH reaction and mixing with a background concentration at rate K. The Lagrangian experiment provides direct observations of hydrocarbons at two time points, removing assumptions regarding composition or sources upstream of a single observation. The estimates are sharpened by using many hydrocarbons with different reactivities and accounting for their variability and measurement uncertainty. A novel technique is used to construct prior background distributions of many species, described by variation of a single parameter . This exploits the high correlation of species, related by the first principal component of many NMHC samples. The Bayesian method obtains posterior estimates of , K and following each air mass. Median values are typically between 0.5 and 2.0 × 106 molecules cm−3, but are elevated to between 2.5 and 3.5 × 106 molecules cm−3, in low-level pollution. A comparison of estimates from absolute NMHC concentrations and NMHC ratios assuming zero background (the “photochemical clock” method) shows similar distributions but reveals systematic high bias in the estimates from ratios. Estimates of K are ∼0.1 day−1 but show more sensitivity to the prior distribution assumed.

Effect of high dose selenium enriched yeast diets on the distribution of total selenium and selenium species within lamb tissues

The objective of this study was to determine the distribution of total selenium (Se) and of the proportion of total Se comprised as the selenized amino acids selenomethionine (SeMet) and selenocysteine (SeCys) within the post mortem tissues of lambs that were fed high dose selenized enriched yeast (SY), derived from a specific strain of Saccharomyces cerevisae CNCM (Collection Nationale de Culture de Micro-organism) I-3060. Thirty two Texel X Suffolk lambs (6.87 ± 0.23 kg BW) were offered both reconstituted milk replacer and a pelleted diet, both of which had been either supplemented with high SY (6.30 ± 0.18 mg Se/kg DM) or unsupplemented (0.13 ± 0.01 mg Se/kg of DM), depending on treatment designation, for a continuous period of 91 d. At enrollment and 28, 56 and 91 d following enrollment lambs were blood sampled. At the completion of the treatment period, five lambs from each treatment group were euthanased and samples of heart, liver, kidney and skeletal muscle (Longissimus Dorsi and Psoas Major) were retained for Se analysis. The inclusion of high SY increased (P < 0.001) whole blood Se concentration, reaching a maximum mean value of 815.2 ± 19.1 ng Se/mL compared with 217.8 ± 9.1 ng Se/mL in control animals. Tissue total Se concentrations were significantly (P < 0.001) higher in SY supplemented animals than in controls irrespective of tissue type; values were 26, 16, 8 and 3 times higher in skeletal muscle, liver, heart and kidney tissue of HSY lambs when compared to controls. however, the distribution of total Se and the proportions of total Se comprised as either SeMet or SeCys differed between tissue types. Selenocysteine was the predominant selenized amino acid in glandular tissues, such the liver and kidney. irrespective of treatment, although absolute values were markedly higher in HSY lambs. Conversely selenomethionine was the predominat selenized amino acid in cardiac and skeletal muscle (Longissimus Dorsi, and Psoas Major) tissues in HSY animals, although the same trend was not apparent for control lambs in which SeCys was the predominant selenized amino acid. It was concluded that there were increases in both whole blood and tissue total Se concentrations as a result of dietary supplementation with high dose of SY. Furthermore, distribution of total Se and Se species differed between both treatment designation and tissue type.

Point estimates and confidence regions for sequential trials involving selection

A number of authors have proposed clinical trial designs involving the comparison of several experimental treatments with a control treatment in two or more stages. At the end of the first stage, the most promising experimental treatment is selected, and all other experimental treatments are dropped from the trial. Provided it is good enough, the selected experimental treatment is then compared with the control treatment in one or more subsequent stages. The analysis of data from such a trial is problematic because of the treatment selection and the possibility of stopping at interim analyses. These aspects lead to bias in the maximum-likelihood estimate of the advantage of the selected experimental treatment over the control and to inaccurate coverage for the associated confidence interval. In this paper, we evaluate the bias of the maximum-likelihood estimate and propose a bias-adjusted estimate. We also propose an approach to the construction of a confidence region for the vector of advantages of the experimental treatments over the control based on an ordering of the sample space. These regions are shown to have accurate coverage, although they are also shown to be necessarily unbounded. Confidence intervals for the advantage of the selected treatment are obtained from the confidence regions and are shown to have more accurate coverage than the standard confidence interval based upon the maximum-likelihood estimate and its asymptotic standard error.

Statistical design and analysis of pharmacogenetic trials

Pharmacogenetic trials investigate the effect of genotype on treatment response. When there are two or more treatment groups and two or more genetic groups, investigation of gene-treatment interactions is of key interest. However, calculation of the power to detect such interactions is complicated because this depends not only on the treatment effect size within each genetic group, but also on the number of genetic groups, the size of each genetic group, and the type of genetic effect that is both present and tested for. The scale chosen to measure the magnitude of an interaction can also be problematic, especially for the binary case. Elston et al. proposed a test for detecting the presence of gene-treatment interactions for binary responses, and gave appropriate power calculations. This paper shows how the same approach can also be used for normally distributed responses. We also propose a method for analysing and performing sample size calculations based on a generalized linear model (GLM) approach. The power of the Elston et al. and GLM approaches are compared for the binary and normal case using several illustrative examples. While more sensitive to errors in model specification than the Elston et al. approach, the GLM approach is much more flexible and in many cases more powerful. Copyright © 2005 John Wiley & Sons, Ltd.

Antioxidant properties of kilned and roasted malts

Compounds possessing antioxidant activity play a crucial role in delaying or preventing lipid oxidation in foods and beverages during processing and storage. Such reactions lead to loss of product quality, especially as a consequence of off-flavor formation. The aim of this study was to determine the antioxidant activity of kilned (standard) and roasted (speciality) malts in relation to phenolic compounds, sugars, amino acids, and color [assessed as European Brewing Convention units (degrees EBC) and absorbance at 420 nm]. The concentrations of sugars and amino acids decreased with the intensity of the applied heat treatment, and this was attributed to the extent of the Maillard reaction, as well as sugar caramelization, in the highly roasted malts. Proline, followed by glutamine, was the most abundant free amino/imino acid in the malt samples, except those that were highly roasted, and maltose was the most abundant sugar in all malts. Levels of total phenolic compounds decreased with heat treatment. Catechin and ferulic acid were the most abundant phenolic compounds in the majority of the malts, and amounts were highest in the kilned samples. In highly roasted malts, degradation products of ferulic acid were identified. Antioxidant activity increased with the intensity of heating, in parallel with color formation, and was significantly higher for roasted malts compared to kilned malts. In kilned malts, phenolic compounds were the main identified contributors to antioxidant activity, with Maillard reaction products also playing a role. In roasted malts, Maillard reaction products were responsible for the majority of the antioxidant activity.

New scientific paradigms for probiotics and prebiotics

The inaugural meeting of the International Scientific Association for Probiotics and Prebiotics (ISAPP) was held May 3 to May 5 2002 in London, Ontario, Canada. A group of 63 academic and industrial scientists from around the world convened to discuss current issues in the science of probiotics and prebiotics. ISAPP is a non-profit organization comprised of international scientists whose intent is to strongly support and improve the levels of scientific integrity and due diligence associated with the study, use, and application of probiotics and prebiotics. In addition, ISAPP values its role in facilitating communication with the public and healthcare providers and among scientists in related fields on all topics pertinent to probiotics and prebiotics. It is anticipated that such efforts will lead to development of approaches and products that are optimally designed for the improvement of human and animal health and well being. This article is a summary of the discussions, conclusions, and recommendations made by 8 working groups convened during the first ISAPP workshop focusing on the topics of: definitions, intestinal flora, extra-intestinal sites, immune function, intestinal disease, cancer, genetics and genomics, and second generation prebiotics. Humans have evolved in symbiosis with an estimated 1014 resident microorganisms. However, as medicine has widely defined and explored the perpetrators of disease, including those of microbial origin, it has paid relatively little attention to the microbial cells that constitute the most abundant life forms associated with our body. Microbial metabolism in humans and animals constitutes an intense biochemical activity in the body, with profound repercussions for health and disease. As understanding of the human genome constantly expands, an important opportunity will arise to better determine the relationship between microbial populations within the body and host factors (including gender, genetic background, and nutrition) and the concomitant implications for health and improved quality of life. Combined human and microbial genetic studies will determine how such interactions can affect human health and longevity, which communication systems are used, and how they can be influenced to benefit the host. Probiotics are defined as live microorganisms which, when administered in adequate amounts confer a health benefit on the host.1 The probiotic concept dates back over 100 years, but only in recent times have the scientific knowledge and tools become available to properly evaluate their effects on normal health and well being, and their potential in preventing and treating disease. A similar situation exists for prebiotics, defined by this group as non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria. Prebiotics function complementary to, and possibly synergistically with, probiotics. Numerous studies are providing insights into the growth and metabolic influence of these microbial nutrients on health. Today, the science behind the function of probiotics and prebiotics still requires more stringent deciphering both scientifically and mechanistically. The explosion of publications and interest in probiotics and prebiotics has resulted in a body of collective research that points toward great promise. However, this research is spread among such a diversity of organisms, delivery vehicles (foods, pills, and supplements), and potential health targets such that general conclusions cannot easily be made. Nevertheless, this situation is rapidly changing on a number of important fronts. With progress over the past decade on the genetics of lactic acid bacteria and the recent, 2,3 and pending, 4 release of complete genome sequences for major probiotic species, the field is now armed with detailed information and sophisticated microbiological and bioinformatic tools. Similarly, advances in biotechnology could yield new probiotics and prebiotics designed for enhanced or expanded functionality. The incorporation of genetic tools within a multidisciplinary scientific platform is expected to reveal the contributions of commensals, probiotics, and prebiotics to general health and well being and explicitly identify the mechanisms and corresponding host responses that provide the basis for their positive roles and associated claims. In terms of human suffering, the need for effective new approaches to prevent and treat disease is paramount. The need exists not only to alleviate the significant mortality and morbidity caused by intestinal diseases worldwide (especially diarrheal diseases in children), but also for infections at non-intestinal sites. This is especially worthy of pursuit in developing nations where mortality is too often the outcome of food and water borne infection. Inasmuch as probiotics and prebiotics are able to influence the populations or activities of commensal microflora, there is evidence that they can also play a role in mitigating some diseases. 5,6 Preliminary support that probiotics and prebiotics may be useful as intervention in conditions including inflammatory bowel disease, irritable bowel syndrome, allergy, cancer (especially colorectal cancer of which 75% are associated with diet), vaginal and urinary tract infections in women, kidney stone disease, mineral absorption, and infections caused by Helicobacter pylori is emerging. Some metabolites of microbes in the gut may also impact systemic conditions ranging from coronary heart disease to cognitive function, suggesting the possibility that exogenously applied microbes in the form of probiotics, or alteration of gut microecology with prebiotics, may be useful interventions even in these apparently disparate conditions. Beyond these direct intervention targets, probiotic cultures can also serve in expanded roles as live vehicles to deliver biologic agents (vaccines, enzymes, and proteins) to targeted locations within the body. The economic impact of these disease conditions in terms of diagnosis, treatment, doctor and hospital visits, and time off work exceeds several hundred billion dollars. The quality of life impact is also of major concern. Probiotics and prebiotics offer plausible opportunities to reduce the morbidity associated with these conditions. The following addresses issues that emerged from 8 workshops (Definitions, Intestinal Flora, Extra-Intestinal Sites, Immune Function, Intestinal Disease, Cancer, Genomics, and Second Generation Prebiotics), reflecting the current scientific state of probiotics and prebiotics. This is not a comprehensive review, however the study emphasizes pivotal knowledge gaps, and recommendations are made as to the underlying scientific and multidisciplinary studies that will be required to advance our understanding of the roles and impact of prebiotics, probiotics, and the commensal microflora upon health and disease management.

Patients' attitudes towards, and information needs in relation to, nurse prescribing in rheumatology

Aims and objectives: To assess the level of confidence that rheumatology patients would have in nurse prescribing, the effects on likely adherence and particular concerns that these patients have. In addition, given that information provision has been cited as a potential benefit of nurse prescribing, the present study assessed the extent to which these patients would want an explanation for the selected medicine, as well as which types of information should be included in such an explanation. Background: Nurse prescribing has been successfully implemented in the UK in several healthcare settings. Existing research has not addressed the effects on patients' confidence and likely adherence, nor have patients' information needs been established. However, we know that inadequate medicines information provision by health professionals is one of the largest causes of patient dissatisfaction. Methods: Fifty-four patients taking disease-modifying drugs for inflammatory joint disease attending a specialist rheumatology clinic self-completed a written questionnaire. Results: Patients indicated a relatively high level of confidence in nurse prescribing and stated that they would be very likely to take the selected medication. The level of concern was relatively low and the majority of concerns raised did not relate to the nurse's status. Strong support was expressed for the nurse providing an explanation for medicine choice. Conclusion: This research provides support for the prescription of medicines by nurses working in the area of rheumatology, the importance of nurses providing a full explanation about the selected medicines they prescribe for these patients and some indication as to which categories of information should be included. Relevance to clinical practice: Rheumatology patients who have not yet experienced nurse prescribing are, in general, positive about nurses adopting this role. It is important that nurses provide appropriate information about the prescribed medicines, in a form that can be understood.

Speciation and variation in the occurrence of haloacetic acids in three water supply systems in England

An investigation into the speciation and occurrence of nine haloacetic acids (HAAs) was conducted during the period of April 2007 to March 2008 and involved three drinking water supply systems in England, which were chosen to represent a range of source water conditions; these were an upland surface water, a lowland surface water and a groundwater. Samples were collected seasonally from the water treatment plants and at different locations in the distribution systems. The highest HAA concentrations occurred in the upland surface water system, with an average total HAA concentration of 21.3 μg/L. The lowest HAA levels were observed in the groundwater source, with a mean concentration of 0.6 μg/L. Seasonal variations were significant in the HAA concentrations; the highest total HAA concentrations were found during the autumn, when the concentrations were approximately two times higher than in winter and spring. HAA speciation varied among the water sources, with dichloroacetic acid and trichloroacetic acid dominant in the lowland surface water system and brominated species dominant in the upland surface water system. There was a strong correlation between trihalomethanes and HAAs when considering all samples from the three systems in the same data set (r2=0.88); however, the correlation was poor/moderate when considering each system independently.