PReS-FINAL-2170: Work disability in adult patients with juvenile idiopathic arthritis (JIA)

Introduction Approximately 20% JIA patients enters adulthood with clinically active disease and disabled, therefore work condition may be affected. Objectives To assess the prevalence of work disability among adult patients with JIA regularly attending a tertiary heumatology center and to determine possible associated risk factors. Methods This was a cross-sectional study that enrolled 43 JIA patients according to 2004 revised ILAR criteria. A questionnaire was developed in order to evaluate working status and labor activity: occupation, current/previous work, employment status and withdrawal rate were actively searched. Demographic data, JIA characteristics, clinical activity (DAS28>2.6), therapeutic intervention, comorbidities, physical activity, sedentarism (WHO definitions), functional class (1991 ACR criteria), HAQ and SF-36 were recorded. The prevalence of work disability was calculated using 95% confidence interval, and compared to all parameters; qualitative variables were analyzed using tests of association (chi-square test) and quantitative variables by Mann-Whitney or student test. Results Patients' mean age was 29+7.4 yrs (range 19-41) with mean JIA duration = 17.2+12.3 yrs (range 3-33); 63% were males and 37% females. JIA subtypes were 64% polyarticular, 11% oligoarticular, 9% systemic, 9% ERA, 2% extended oligoarticular, 2% psoriatic arthritis; 7% had uveitis. Serum RF was positive in 21% and ANA in 21%. The majority (72%, n = 31) of JIA patients were employed, whereas 28% (n = 12) were currently not working. In the latter group, 83% (10/12) were retired due to JIA related disability. Further analysis comparing those currently working vs. Those not working revealed similar age (25,3 yrs vs.29,5 yrs, p = 0,09). Although not significantly, most patients currently working had Poly onset JIA (22 vs. 6 p = 0,37), higher frequencies of good education level >12 yrs of school (31 vs.9, p = 0,38), functional class I (p = 0,96), practiced regular physical activity (9 vs. 0, p = 0,89), were singles (26 vs. 8, p = 0,15). Both groups had comparable HAQ and DAS 28 scores (0,62 vs. 0.59, p = 0,47 and 2,51 vs.2,07, p = 0,64) and similar arthroplasty rate (8 vs. 4, p = 0,427). Frequencies of hypertension (3 vs.1, p = 0,999), dyslipidemia (1 vs. 1, p = 0,125), diabetes (1 vs. 0 p = 0,999), depression (1 vs. 0, p = 0,999) and smokers (3 vs. 1, p = 0,99) were alike in both groups. Remarkably, employed patients had higher SF 36 mental health component (84.0 vs. 70.42, P = 0.01). Conclusion High prevalence of almost 1/3 work disability and of retirement due to disease related incapacity remain major problems for adult JIA individuals. We also identified worse mental health in employed patients indicating that further research is needed, in addition to intense affirmative disability actions in order to remove possible disabling barriers and to adapt restrictive environments for these patients. Moreover, enhanced strategies and policy for inclusion of JIA patients in the job market is urged.

Immunogenicity and Reactogenicity of 2009 Influenza A (H1N1) Inactivated Monovalent Non-Adjuvanted Vaccine in Elderly and Immunocompromised Patients

Background Immunosuppressed individuals present serious morbidity and mortality from influenza, therefore it is important to understand the safety and immunogenicity of influenza vaccination among them. Methods This multicenter cohort study evaluated the immunogenicity and reactogenicity of an inactivated, monovalent, non-adjuvanted pandemic (H1N1) 2009 vaccine among the elderly, HIV-infected, rheumatoid arthritis (RA), cancer, kidney transplant, and juvenile idiopathic arthritis (JIA) patients. Participants were included during routine clinical visits, and vaccinated according to conventional influenza vaccination schedules. Antibody response was measured by the hemagglutination-inhibition assay, before and 21 days after vaccination. Results 319 patients with cancer, 260 with RA, 256 HIV-infected, 149 elderly individuals, 85 kidney transplant recipients, and 83 with JIA were included. The proportions of seroprotection, seroconversion, and the geometric mean titer ratios postvaccination were, respectively: 37.6%, 31.8%, and 3.2 among kidney transplant recipients, 61.5%, 53.1%, and 7.5 among RA patients, 63.1%, 55.7%, and 5.7 among the elderly, 59.0%, 54.7%, and 5.9 among HIV-infected patients, 52.4%, 49.2%, and 5.3 among cancer patients, 85.5%, 78.3%, and 16.5 among JIA patients. The vaccine was well tolerated, with no reported severe adverse events. Conclusions The vaccine was safe among all groups, with an acceptable immunogenicity among the elderly and JIA patients, however new vaccination strategies should be explored to improve the immune response of immunocompromised adult patients. (ClinicalTrials.gov, NCT01218685)

La caficultura en Brasil : Evolución, situación actual y nuevos retos cara al futuro

El café ha dominado totalmente la escena social, económica, política y cultural de Brasil desde la primera mitad del siglo XIX hasta comienzos del siglo XX. En efecto, los avatares que acompañan dicho cultivo se confunden con los hitos de la historia de este país latinoamericano. En este trabajo se analiza la caficultura en Brasil y su evolución a lo largo de las dos últimas décadas, período que coincide con unos cambios profundos tanto en la economía mundial como en la forma con que se estructura la producción cafetalera de Brasil, con la emergencia de nuevas dinámicas y procesos que se presentan como retos importantes para este importante sector de la economía de dicho país en el futuro inmediato.

La caficultura en Brasil : Evolución, situación actual y nuevos retos cara al futuro

El café ha dominado totalmente la escena social, económica, política y cultural de Brasil desde la primera mitad del siglo XIX hasta comienzos del siglo XX. En efecto, los avatares que acompañan dicho cultivo se confunden con los hitos de la historia de este país latinoamericano. En este trabajo se analiza la caficultura en Brasil y su evolución a lo largo de las dos últimas décadas, período que coincide con unos cambios profundos tanto en la economía mundial como en la forma con que se estructura la producción cafetalera de Brasil, con la emergencia de nuevas dinámicas y procesos que se presentan como retos importantes para este importante sector de la economía de dicho país en el futuro inmediato.

La caficultura en Brasil : Evolución, situación actual y nuevos retos cara al futuro

El café ha dominado totalmente la escena social, económica, política y cultural de Brasil desde la primera mitad del siglo XIX hasta comienzos del siglo XX. En efecto, los avatares que acompañan dicho cultivo se confunden con los hitos de la historia de este país latinoamericano. En este trabajo se analiza la caficultura en Brasil y su evolución a lo largo de las dos últimas décadas, período que coincide con unos cambios profundos tanto en la economía mundial como en la forma con que se estructura la producción cafetalera de Brasil, con la emergencia de nuevas dinámicas y procesos que se presentan como retos importantes para este importante sector de la economía de dicho país en el futuro inmediato.

A DOCÊNCIA EM ADMINISTRAÇÃO E ALGUMAS CONTRIBUIÇÕES DE PROJETOS EDUCATIVOS

Esta dissertação apresenta dois projetos que apontam possibilidades de se construir novos conhecimentos com práticas viáveis e significativas para os alunos de Administração de Empresas do ensino superior. O objetivo é fomentar a discussão sobre o papel do docente e a formação dos professores no ensino superior com qualidade, através dos estudos em uma Faculdade da Zona Leste da cidade de São Paulo. Este trabalho aponta que o bacharelado em Administração pode ir para além de meros conteúdos técnicos a serem humanizados a partir da utilização de recursos didáticos inovadores. A análise dos projetos permite concluir que ações educativas diferenciadas, inspiradas na teoria freiriana, apresentaram-se como forma de enfrentamento às dificuldades nas relações entre ensino e aprendizagem. Com a aplicação dos referidos projetos, as possíveis dificuldades de aprendizagem foram transformadas em oportunidades, e hoje são contribuições à qualidade educativa.