Changes in Body Weight and Psychotropic Drugs: A Systematic Synthesis of the Literature

<div><h3>Introduction</h3><p>Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders.</p> <h3>Objective</h3><p>To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics.</p> <h3>Methodology and Results</h3><p>We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs.</p> <h3>Conclusion</h3><p>Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices.</p> </div

Termination of the leprosy isolation policy in the US and Japan : Science, policy changes, and the garbage can model

BACKGROUND: In both the US and Japan, the patient isolation policy for leprosy /Hansen's disease (HD) was preserved along with the isolation facilities, long after it had been proven to be scientifically unnecessary. This delayed policy termination caused a deprivation of civil liberties of the involuntarily confined patients, the fostering of social stigmas attached to the disease, and an inefficient use of health resources. This article seeks to elucidate the political process which hindered timely policy changes congruent with scientific advances. METHODS: Examination of historical materials, supplemented by personal interviews. The role that science played in the process of policy making was scrutinized with particular reference to the Garbage Can model. RESULTS: From the vantage of history, science remained instrumental in all period in the sense that it was not the primary objective for which policy change was discussed or intended, nor was it the principal driving force for policy change. When the argument arose, scientific arguments were employed to justify the patient isolation policy. However, in the early post-WWII period, issues were foregrounded and agendas were set as the inadvertent result of administrative reforms. Subsequently, scientific developments were more or less ignored due to concern about adverse policy outcomes. Finally, in the 1980s and 1990s, scientific arguments were used instrumentally to argue against isolation and for the termination of residential care. CONCLUSION: Contrary to public expectations, health policy is not always rational and scientifically justified. In the process of policy making, the role of science can be limited and instrumental. Policy change may require the opening of policy windows, as a result of convergence of the problem, policy, and political streams, by effective exercise of leadership. Scientists and policymakers should be attentive enough to the political context of policies

Morphometrical analysis of cleaning capacity using nickel-titanium rotary instrumentation associated with irrigating solutions in mesio-distal flattened root canals Análise morfológica da capacidade de limpeza promovida pela instrumentação rotatória, associada à soluções irrigantes, com limas de níquel-titânio em canais radiculares com achatamento mesio-distal

Variations in the internal anatomy of root canals may interfere with the success of root canal because tissue remnants may remain in the isthmus, re-entrances and ramifications of flattened root canals making instrumentation more difficult. Successful root canal treatment depends fundamentally on shaping, cleaning, disinfection and obturation. This study verified the quality of cleaning of ProFile .04 rotary technique associated with different irrigating solutions: 0.5% sodium hypochlorite, calcium hydroxide + Tergentol and 2% chlorhexidine in canals with mesio-distal flattening. Twelve human mandibular central incisors were randomly divided into 3 groups and instrumented up to ProFile 0.4 #35 file after cervical preparation, and processed histologically. After optical microscopic evaluation, statistical analysis showed that the percentage of cleaning of the three irrigating solutions was statistically different. Two-by-two comparisons classified the irrigating solutions in increasing order of cleaning: calcium hydroxide + Tergentol < chlorhexidine < 0.5% sodium hypochlorite.<br>As variações da anatomia interna de cada canal radicular podem interferir no sucesso da terapêutica endodôntica devido ao fato de que em canais radiculares achatados, pode persistir remanescentes teciduais em istmos, reentrâncias e ramificações dificultando a execução das técnicas de instrumentação. O sucesso do tratamento dos canais radiculares depende fundamentalmente do preparo da forma, limpeza, desinfecção e obturação. Poucos trabalhos avaliaram a limpeza dos canais radiculares após a instrumentação rotatória. O presente trabalho verificou a qualidade de limpeza dos canais radiculares, por meio da microscopia óptica, promovida pela técnica de instrumentação rotatória associada ao hipoclorito de sódio 0,5%, HCT20 e clorexidina, em canais achatados no sentido mésio-distal. Doze incisivos centrais inferiores humanos foram divididos aleatoriamente em três grupos para que fossem instrumentados com instrumetação rotatória (ProFile .04). A análise estatística evidenciou que os valores da porcentagem de limpeza para as diferentes soluções irrigantes foram estatisticamente diferentes entre si. Comparações duas a duas permitiram dispor as soluções irrigantes em ordem crescente de efetividade na limpeza, sendo: hipoclorito de sódio a 0,5% > clorexidina > HCT20