Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Creation of the WATCH Forcing Data and Its Use to Assess Global and Regional Reference Crop Evaporation over Land during the Twentieth Century

The Water and Global Change (WATCH) project evaluation of the terrestrial water cycle involves using land surface models and general hydrological models to assess hydrologically important variables including evaporation, soil moisture, and runoff. Such models require meteorological forcing data, and this paper describes the creation of the WATCH Forcing Data for 1958–2001 based on the 40-yr ECMWF Re-Analysis (ERA-40) and for 1901–57 based on reordered reanalysis data. It also discusses and analyses modelindependent estimates of reference crop evaporation. Global average annual cumulative reference crop evaporation was selected as a widely adopted measure of potential evapotranspiration. It exhibits no significant trend from 1979 to 2001 although there are significant long-term increases in global average vapor pressure deficit and concurrent significant decreases in global average net radiation and wind speed. The near-constant global average of annual reference crop evaporation in the late twentieth century masks significant decreases in some regions (e.g., the Murray–Darling basin) with significant increases in others.

The Prospective and Retrospective Memory Questionnaire: A population-based random sampling study

The Prospective and Retrospective Memory Questionnaire (PRMQ) has been shown to have acceptable reliability and factorial, predictive, and concurrent validity. However, the PRMQ has never been administered to a probability sample survey representative of all ages in adulthood, nor have previous studies controlled for factors that are known to influence metamemory, such as affective status. Here, the PRMQ was applied in a survey adopting a probabilistic three-stage cluster sample representative of the population of Sao Paulo, Brazil, according to gender, age (20-80 years), and economic status (n=1042). After excluding participants who had conditions that impair memory (depression, anxiety, used psychotropics, and/or had neurological/psychiatric disorders), in the remaining 664 individuals we (a) used confirmatory factor analyses to test competing models of the latent structure of the PRMQ, and (b) studied effects of gender, age, schooling, and economic status on prospective and retrospective memory complaints. The model with the best fit confirmed the same tripartite structure (general memory factor and two orthogonal prospective and retrospective memory factors) previously reported. Women complained more of general memory slips, especially those in the first 5 years after menopause, and there were more complaints of prospective than retrospective memory, except in participants with lower family income.

Demonstration of Solar Heating and Cooling System using Sorption Integrated Solar Thermal Collectors

Producing cost-competitive small and medium-sized solar cooling systems is currently a significant challenge. Due to system complexity, extensive engineering, design and equipment costs; the installation costs of solar thermal cooling systems are prohibitively high. In efforts to overcome these limitations, a novel sorption heat pump module has been developed and directly integrated into a solar thermal collector. The module comprises a fully encapsulated sorption tube containing hygroscopic salt sorbent and water as a refrigerant, sealed under vacuum with no moving parts. A 5.6m2 aperture area outdoor laboratory-scale system of sorption module integrated solar collectors was installed in Stockholm, Sweden and evaluated under constant re-cooling and chilled fluid return temperatures in order to assess collector performance. Measured average solar cooling COP was 0.19 with average cooling powers between 120 and 200 Wm-2 collector aperture area. It was observed that average collector cooling power is constant at daily insolation levels above 3.6 kWhm-2 with the cooling energy produced being proportional to solar insolation. For full evaluation of an integrated sorption collector solar heating and cooling system, under the umbrella of a European Union project for technological innovation, a 180 m2 large-scale demonstration system has been installed in Karlstad, Sweden. Results from the installation commissioned in summer 2014 with non-optimised control strategies showed average electrical COP of 10.6 and average cooling powers between 140 and 250 Wm-2 collector aperture area. Optimisation of control strategies, heat transfer fluid flows through the collectors and electrical COP will be carried out in autumn 2014.

Coordenação governamental no presidencialismo de coalizão: o Programa de Aceleração do Crescimento e o seu impacto no Ministério dos Transportes

As interpretações a respeito do funcionamento do presidencialismo de coalizão buscam compreender como o Presidente é capaz de implementar sua agenda política, utilizando, para isso, as suas prerrogativas constitucionais. Sejam eles os poderes legislativos, sejam os de nomeação e de organização das estruturas administrativas. Apesar da existência de uma vasta literatura a respeito do processo legislativo e das relações entre o Legislativo e o Executivo, ainda são poucos os estudos sobre a dinâmica interna de funcionamento do Executivo e do impacto da dinâmica política – a formação do gabinete – sobre as políticas públicas. O presente trabalho analisa a constituição do Programa de Aceleração do Crescimento (PAC), enquanto mecanismo de coordenação criado pelo Presidente, analisando o contexto político, o papel da Casa Civil e as experiências anteriores de coordenação de investimentos prioritários. Do mesmo modo, investiga os possíveis impactos do PAC no Ministério dos Transportes.

A Formação de gabinetes no governo do Estado do Espírito Santo (1995-2014)

Este trabalho analisa a formação de gabinetes no Governo do Estado do Espírito Santo no período 1995-2014. Para isso, parte-se do debate em torno do presidencialismo de coalizão brasileiro e suas aplicações ao nível subnacional, reforçando a importância de estudos de caso e estudos comparativos. Um resgaste da trajetória política do Espírito Santo é feita, ressaltando o período de crise na década de 1990 e a virada institucional que se deu no começo dos anos 2000. A composição da Assembleia Legislativa no período também é destacada, dada a sua importância para o entendimento das relações entre o Executivo e o Legislativo. Foi construída uma base de dados com todos os Secretários de Estado do período, além de suas respectivas filiações partidárias, de acordo com dados do Tribunal Superior Eleitoral (TSE). Assim, pode-se comparar a composição partidária do gabinete e o tamanho das bancadas partidárias no Legislativo. Para análise da proporcionalidade dos gabinetes este estudo utiliza a Taxa de Coalescência de Amorim Neto (2000) e a aplicação do Índice G sugerido por Avelino, Biderman e Silva (2011). Além da tradicional utilização da filiação partidária dos secretários como proxy para a determinação de um elemento político no gabinete, há ainda a proposição e aplicação paralela de um novo critério que considera a filiação partidária e a ocorrência de candidatura prévia como indicativo de um secretário político. Os dois critérios utilizados mostram resultados diferenciados, e o fato de a maioria dos gabinetes formados não terem sido majoritários sugere que no Espírito Santo a distribuição de cargos no primeiro escalão de governo não seja a principal moeda de troca nos acordos entre Executivo e Legislativo.

A Competência normativa das agências reguladoras e seus limites principiológicos no direito brasileiro

The transition of the liberal state to welfare state, globalization and the crisis of funding from the government spending on the multiple roles demanded an overhaul of the means of intervention in the economic domain and structure organizational of the Public Administration by enhancing the performance of regulatory functions. Therefore appear in Brazilian law independent regulatory agencies with legal administrative particular that gives autonomy increased, with fixed terms and stability of its leaders, police and competencies, normative and administrative judges. In this scenario, given the autonomy granted by the laws of the creation of regulatory agencies, the legislative competence becomes the most contentious issue, as not infrequently is innovation in the legal system. The main foundations of innovative extension producible by regulatory agencies, which diverges doctrine, are the constitutional attribution of own competence of the Public Administration and the discretionary power. Thus, it is necessary to delimit the constitutional and legal foundations of special legislative powers of these autarchies in our legal system, seeking ways to limit and control the production rules of those entities, for the purpose of position them before the powers constitutionally constituted. We note that with the constitutionalisation of administrative law regulatory agencies found limits to its performance in the normative constitutional principles, especially through the principles of efficiency, morality and proportionality, which has enabled a more effective control of their normative acts

Germination performance of congeneric Styrax species from the Cerrado sensu lato areas and their distribution pattern in different physiognomies

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Copenhagen Burnout Inventory - student version: adaptation and transcultural validation for Portugal and Brazil

Realizou-se adaptação cultural do Inventário de Burnout de Copenhagen para estudantes (CBI-S) em português e estimou-se sua confiabilidade e validade. O CBI-S foi preenchido por 958 estudantes universitários brasileiros e 556 portugueses. O modelo fatorial original apresentou bom ajustamento entretanto, foram removidos dois itens com confiabilidade individual baixa (λ<0,5). A nova estrutura apresentou bom ajustamento a 2/3 da amostra total sendo invariante no 1/3 restante da amostra original. Verficou-se adequada consistência interna e validade convergente, discriminante e concorrente. Os pesos fatoriais do CBI-S não foram invariantes nas amostras de Brasil e Portugal. O CBI-S apresentou adequada confiabilidade e validade entretanto, verificou-se ausência de estabilidade transcultural.

Morphological changes in the cephalic salivary glands of females and males of Apis mellifera and Scaptotrigona postica (Hymenoptera, Apidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Women's contribution to equality in Latin America and the Caribbean

Includes bibliography

The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity in dementia

ABSTRACT Background: Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort. Methods: Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI). Results: Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS. Conclusion: The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains. © International Psychogeriatric Association 2013.

Autoritarismo e democracia: construindo instituições no processo constituinte de 1946

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Ascensão e queda do gabinete de 20 de novembro de 1827 (1827-1829)

Pós-graduação em História - FCHS

Concurrent training effect on muscle fibers in Wistar rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)