Reported adverse drug reactions during the use of inhaled steroids in children with asthma in the Netherlands

Objective: Inhaled corticosteroids (ICS) are widely used in the treatment of asthma. We studied the suspected adverse drug reactions (sADRs) reported during the use of ICS in the Netherlands. Methods: In the Netherlands, health professionals and patients can report suspected ADRs to the Pharmacovigilance Centre Lareb. All reported sADRs on ICS were categorised and assessed as to whether these were likely to be associated with use of the steroid. Age and gender adjusted Reported Odds Ratios (RORs) and Naranjo Scores (NS) were computed for sADRs reported more than 3 times. Results: Since 1984, sADRs of ICS were reported in 89 children (mean age 6 years), 48 (54%) were boys. Suspected drugs were fluticasone in 46 children (52%), budesonide in 21 (24%), and beclomethasone in 22 cases (24%). Psychiatric symptoms were reported in 19 children (21%; ROR 3.8, NS 3.6), growth retardation in 6 children (7%; ROR 47.8, NS 3.0) and rashes in 6 cases (7%; ROR 0.7, NS 2.4). There were 7 reports (8%; ROR 2.1, NS 3.4) concerning abnormalities of the teeth, 4 reports of alopecia (4%; ROR 3.3, NS 3.5), and 3 reports of hirsutism and hypertrichosis (NS 4.0). Non-fatal adrenal insufficiency was reported once. Conclusion: Alteration of behaviour was the most frequently reported sADR. There are more indications that alterations of behaviour could be a real sADR of ICS. Non-fatal adrenal insufficiency was the only reported possible life threatening sADR. The association of hypertrichosis and teeth abnormalities after ICS in children has not been reported in the literature before

Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder:An implementation study

Introduction: Web-based guided self-help cognitive behavioral therapy-enhanced (CBT-E) is a 12-weeks, 12-sessions, digitalized version of part II of the self-help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized-controlled-trial. It is unknown how patients with binge-eating disorder (BED) respond to this intervention when offered in real-world clinical-settings. The aim of this study is to examine post-intervention effectiveness of guided self-help CBT-E for BED in real-world settings.Method: The present study used a cohort-design examining the effectiveness of web-based guided self-help CBT-E according to an intention-to-treat (ITT) analysis. BED patients (n = 278) were assessed pre- and post-intervention. The primary outcome was reduction in binge-eating episodes. Other outcomes were full-recovery (EDE-Q score <2.77 and abstinence from binge-eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post-intervention.Results: The number of binge-eating episodes reduced by an average of 16 binge-eating episodes per 4 weeks pre-intervention to five binge-eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d >= 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample.Discussion: Guided self-help CBT-E is associated with significant improvements. The effects of guided self-help CBT-E offered in a real-world-setting are comparable to self-help CBT-E offered in a randomized-controlled-trial. However, it should be noted that comparisons with randomized-controlled-trials requires caution. Longer-term follow-up data are necessary to measure persistence of treatment benefits.Public Significance: Offering CBT-E as a web-based guided self-help intervention has several benefits for patients with BED. Guided self-help CBT-E is associated with significant improvements on the short term when offered in real-world clinical settings

В. Б. Антонович у листах, спогадах та працях Д. І. Багалія

The previous interglacial (Eemian, 130–114 kyr BP) had a mean sea level highstand 4 to 7 m above the current level, and, according to climate proxies, a 2 to 6 K warmer Arctic summer climate. Greenland ice cores extending back into the Eemian show a reduced depletion in δ18O of about 3‰ for this period, which suggests a significant warming of several degrees over the Greenland ice sheet. Since the depletion in δ18O depends, among other factors, on the condensation temperature of the precipitation, we analyze climatological processes other than mean temperature changes that influence condensation temperature, using output of the regional climate model RACMO2. This model is driven by ERA-40 reanalysis and ECHO-G GCM boundaries for present-day, preindustrial and Eemian climate. The processes that affect the condensation temperature of the precipitation are analyzed using 6-hourly model output. Our results show that changes in precipitation seasonality can cause significant changes of up to 2 K in the condensation temperature that are unrelated to changes in mean temperature

Ten years after the Dutch public health campaign on folic acid: the continuing challenge

BACKGROUND: Folic acid use in the periconceptional period reduces the risk of neural tube defects (NTDs). However, applying this knowledge in daily practice is not an easy task. We report here the current level of folic acid use in the Netherlands and discuss the figures within the framework of a national governmental campaign held in 1995 promoting the use of folic acid and the professional interventions undertaken since then. METHODS: We carried out six studies in the northern Netherlands during 1995, 1996, 1998, 2000, 2003 and 2005, respectively. The same methodology in the same health professionals' practices was followed in all studies. Pregnant women attending their first or second antenatal visit were asked to fill in a questionnaire aimed at assessing their awareness and use of folic acid. RESULTS: In 2005, most of the pregnant women used folic acid "at some time in their pregnancy", and 51% used it for the entire advised period. Prior knowledge on the protective affect of folic acid and on the period of use was strongly related to the level of education. The use of folic acid in a previous pregnancy [odds ratio (OR) 3.9, 95% confidence interval (95% CI) 1.6-9.9], the use of an oral contraceptive (OR 2.1, 95% CI 1.1-4.1) and parity (OR 0.08, 95% CI 0.01-0.5) significantly predicted the current correct use. The most recent figures revealed that there is still a large gap between more highly and less educated women in terms of taking folic acid in the advised period: 63 versus 31%, respectively. DISCUSSION: The aim of the Dutch Ministry of Health is to have 70% of Dutch women wanting to become pregnant use folic acid supplements in the advised period by 2010. While this level has almost been reached among more highly educated women (63%), it will take a great deal more effort, money and creativity to achieve the necessary increase from the current level of 31% among women with a lower educational background

Parental perspectives on green schoolyards:advantages outweigh disadvantages, but willingness to help is limited

Parental involvement is critical to the successful implementation of green schoolyards. This paper reports results from two surveys that asked a total of 402 parents of children in schools with green and paved schoolyards about their appreciation of the schoolyard, children’s behavior in the schoolyard, (dis)advantages of a green schoolyard, and willingness to become involved. Parents from schools with a green, compared to a paved, schoolyard showed higher appreciation of the schoolyard and more often reported that the schoolyard supports varied play and other behaviors. Parents generally saw more advantages than disadvantages of a green schoolyard, and many parents indicated that disadvantages, such as children coming home dirty, are not very important to them. Parents wanted to be involved in designing a green schoolyard and with schoolyard activities. However, they were less willing to help with maintenance, and their time to help is limited

Environmental psychology:History, scope and methods

This book aims to give an introduction in environmental psychology. We defi ne environmental psychology as the discipline that studies the interplay between individuals and their built and natural environment. This means that environmental psychology examines the infl uence of the environment on human experiences, behaviour and well - being, as well as the infl uence of individuals on the environment, that is, factors infl uencing environmental behaviour, and ways to encourage pro - environmental behaviour. This book will give an overview of theories and research on each of these topics. In this introductory chapter we fi rst give a brief overview of the history of the fi eld of environmental psychology, followed by a discussion of characteristics of the fi eld and a description of the main methods used in research. The chapter ends with an outline and rationale of the book

Environmental psychology:History, scope and methods

This book aims to give an introduction in environmental psychology. We defi ne environmental psychology as the discipline that studies the interplay between individuals and their built and natural environment. This means that environmental psychology examines the infl uence of the environment on human experiences, behaviour and well - being, as well as the infl uence of individuals on the environment, that is, factors infl uencing environmental behaviour, and ways to encourage pro - environmental behaviour. This book will give an overview of theories and research on each of these topics. In this introductory chapter we fi rst give a brief overview of the history of the fi eld of environmental psychology, followed by a discussion of characteristics of the fi eld and a description of the main methods used in research. The chapter ends with an outline and rationale of the book

Crescimento diamétrico de maçaranduba (Manilkara Huberi Chevalier) após a colheita da madeira.

Conhecer o crescimento das espécies de um povoamento florestal, principalmente daquelas de interesse econômico, é de fundamental importância para o manejo florestal. Nesse sentido, avaliou-se o processo dinâmico do crescimento diamétrico da população de maçaranduba (Manilkara huberi Chevalier), no período de 1981-1997, em uma área de 64 hectares localizada na Floresta Nacional do Tapajós, área experimental sob responsabilidade da Embrapa Amazônia Oriental. Os dados foram coletados em 36 parcelas permanentes de 0,25ha (50mx50m), divididas em 25 subparcelas de 10mx10m, onde foram medidas e identificadas todas as árvores com DAP (diâmetro a 1,30 do solo) e 5cm. A espécie teve, no período de 1981-1997, crescimento médio em diâmetro de 0,39cm/ano. As árvores cujas copas receberam iluminação total cresceram 0,67cm/ano, superior àquelas que receberam iluminação parcial (0,58cm/ano) e às que estavam totalmente sombreadas (0,26cm/ano). Portanto, as árvores necessitam de iluminação para acelerar seu crescimento. As árvores sem cipós na copa cresceram em média 0,60cm/ano, enquanto que aquelas com cipós cresceram 0,45cm/ano, indicando que a infestação de cipós nas árvores afeta o seu crescimento.Disponível também on-line