The case for and against the regulation of food marketing directed towards children

Trabalho final de mestrado integrado em Medicina (Hematologia), apresentado á Faculdade de Medicina da Universidade de CoimbraAs Hemofilias A e B são as deficiências de fatores da coagulação mais comuns e definem-se pela ausência ou diminuição dos níveis de FVIII e FIX, respetivamente. Resultam de mutações nos genes que codificam os referidos fatores e caracterizam-se pela sua hereditariedade ligada ao sexo. A sua apresentação clínica nas formas graves (a maioria) é muito típica, sendo a hemartrose o seu sinal clássico. Nesta situação, mesmo que não exista história familiar, o diagnóstico não apresenta dificuldades significativas. Contudo, no que diz respeito a uma deficiência de FVIII, terá sempre que se descartar a hipótese se estar perante uma DvW e não uma Hemofilia A, devido à semelhança clínica e laboratorial. Nas formas leves, a sua apresentação mais tardia, implica não só excluir a DvW, como a HAA, pelos mesmos motivos. Assim sendo, estes são distúrbios abordados ao longo desta revisão. A terapêutica da hemofilia sofreu uma tremenda evolução nas últimas três décadas. Atualmente, dispõe-se de concentrados de fator derivados de plasma e recombinantes que, especialmente em países desenvolvidos, permitem a sua administração pelo doente ou família, na sua própria casa. Este progresso permitiu um considerável aumento na sobrevivência e uma marcada redução da incapacidade devidas aos danos articulares característicos da hemofilia. As recomendações terapêuticas assentam numa abordagem profilática contínua iniciada precocemente e mantida pelo menos até ao início da vida adulta. No entanto, poucas certezas existem ainda sobre as doses ótimas a serem administradas, a frequência da sua administração e o momento ótimo em que o doente deve abandonar a terapêutica profilática e iniciar tratamento apenas on demand. Já quase ultrapassado o flagelo das infeções pelo HIV, HBV e HCV, a principal e mais grave complicação do tratamento da hemofilia é, nos dias de hoje, o desenvolvimento 5 de inibidores. Também nesta área é necessário mais estudos que determinem as doses ótimas da ITI e as possíveis vantagens do uso de fármacos adjuvantes. Prevê-se que num futuro próximo sejam desenvolvidos e aprovados concentrados de fator com semi-vidas mais longas e metodologias de terapia génica. Assim sendo, esta revisão tem como objetivo apresentar os conceitos propostos atualmente pela comunidade científica no que concerne à abordagem da Hemofilia, desde o seu diagnóstico até às complicações do seu tratamento e perspetivas futuras. Com este intuito, foi realizada a pesquisa da literatura científica publicada até 2014 na base de dados PubMed, com recurso aos meios disponibilizados pela Biblioteca do Centro Hospitalar e Universitário de Coimbra. Após o levantamento dos artigos publicados na área, procedeu-se à seleção dos artigos, inicialmente com base no título e, posteriormente, pela leitura dos resumos daqueles que mostraram ser relevantes. Por último, sempre que possível, obteve-se a versão completa dos artigos cujo resumo demonstrou conter informação pertinente no âmbito da abordagem clínica das HemofiliasHemophilia A and B are the most common deficiencies of coagulation factors and are defined by the absence or decreased levels of FVIII and FIX, respectively. They are a result of the gene mutations of FVIII and FIX and are characterized by their sex-linked inheritance. In severe forms, which are the majority, the clinical presentation is typical, with hemarthrosis being the classical sign. Therefore, in the presence of a hemarthrosis, even if there is no family history, the diagnosis does not present significant difficulties. However, if FVIII deficiency is suspected, it’s important to discard the hypothesis of a vWD, due to the similar clinical and laboratory features. In mild forms, their later presentation implies not only discard vWD, but also AHA, for the same reason. Consequently, these are two disorders discussed throughout this review. The treatment of hemophilia has undergone tremendous development in the last three decades. Currently, plasma-derived and recombinant factor concentrates are available, especially in developed countries, enabling home infusion therapy by either the patient or his family. This progress has led to a significant increase in survival and a marked reduction of joint damage and consequent disability. Nowadays, prophylactic factor replacement is considered the standard care of hemophilia, starting in early childhood and continuing at least until early adulthood. However, there are few certainties about the optimal doses, its administration frequency and when prophylactic therapy should be stopped. Since the HIV, HBV and HCV infection issue is almost overcome, the main and most serious complication of hemophilia is, these days, the inhibitors development. Also in this field, further studies are needed to determine optimal doses of ITI and the possible advantages of adjuvant drugs. We hope that, in the near future, longer half-life coagulation products and emerging methodology based on gene transfer are developed and approved to hemophilia treatment. 7 Therefore, this review aims to present the currently proposed concepts by the scientific community regarding the approach of Hemophilia, from diagnosis to treatment complications and future prospects. For this purpose, a search of the scientific literature published until 2014 in the PubMed database was performed, using the resources made available by the Library of Coimbra’s University Hospital. After the assessment of articles published in the area, it was performed the article selection, initially based on the title and then by reading the abstracts of those who proved to be relevant. Finally, wherever possible, we obtained a full version of the articles shown to contain in their abstract relevant information within the clinical approach of hemophili

The Impact of the Kalamazoo Promise on College Choice: An Analysis of Kalamazoo Area Math and Science Center Graduates

The Kalamazoo Promise has led to a pronounced shift in the college-going patterns of Kalamazoo Public Schools (KPS) students who attend the Kalamazoo Area Math and Science Center (KAMSC). Following the introduction of the Kalamazoo Promise in 2005, the percentage of KPS KAMSC students attending public, in-state institutions of higher education has almost doubled—a shift that reflects the program rules of the Promise, which covers tuition and fees only at public postsecondary institutions in Michigan. The percentage of non-KPS KAMSC students attending an in-state, public institution also rose in the post-2006 period but only very slightly, suggesting that the Promise has shifted college choices among the eligible student population

The case for and against the regulation of food marketing directed towards children

Authoritative and comprehensive reviews of studies on the nature and extent of food marketing to children indicate that children are exposed to high levels of food marketing and that the \u27marketed diet\u27 typically comprises energy-dense, micronutirent-poor foods. However, the implication of causality between marketing, product exposures and childhood obesity is not universally accepted. A vigorous discussion rages about appropriate policy responses to children\u27s exposure to food marketing. The advocacy by many health and consumer groups for tighter government restrictions on food marketing is juxtaposed to the views held by many in the food and advertising industries. Pivotal in this debate is the role of evidence in policy decisions and the appropriateness of industry self-regulation versus government intervention in food marketing. This chapter will explore the dietary and health implications of children\u27s exposure to unhealthy food marketing and present arguments for and against regulations to restrict this marketing

Estimated Cost of Tuition-Free College in Illinois

This memo estimates the cost of two possible program designs for a statewide college scholarship program for the State of Illinois. These assumptions and associated cost estimates, once approved or revised, will form the basis for the next stage of this project, which is assessing the economic impact of tuition-free college in Illinois

Biostratigraphic utility of coiling direction in Miocene planktonic foraminiferal genus Paragloborotalia

Trochospiral planktonic foraminifera will coil either sinistral (left) or dextral (right). The prevalence of sinistral or dextral coiling can change through the stratigraphic range of morphospecies with a preference in coiling direction. A number of coiling shifts have been applied as secondary marker events through the Recent to late Miocene (~0–7 Ma) biochronology. However, no such events have been applied beyond this age despite a number of species being known to adopt preferential coiling directions. Here we investigate selected Miocene species within the genus Paragloborotalia. Previous work in the tropical to subtropical realm has shown that the mayeri–siakensis group undergoes a shift from random to sinistrally dominated coiling in the mid Miocene (~15 Ma). We extend the investigation to other Miocene paragloborotaliids in the low (IODP Sites U1337, U1338, ODP Sites 871 and 925), mid (JOIDES-3 hole) and high latitudes (ODP Site 747) in order to assess whether there is global synchronicity and if the change is unique to the mayeri-siakensis group. In addition, a number of outcrop samples from the Cipero and Lengua formations in southern Trinidad are quantitatively compared to previously published trends. Our results show that in the low-mid latitudes the coiling shift is at ~15.37 Ma within planktonic foraminiferal Zone M5 within both Paragloborotalia siakensis and Paragloborotalia continuosa. In the high latitudes the absence of paragloborotaliids through a portion of the mid Miocene interval prevents accurate dating of a shift from early forms showing random coiling to later paragloborotaliids adopting a sinistral preference. We also find two coiling changes in the genus Globorotalia at high latitude Site 747, from random to sinistral in the mid Miocene (15.14 Ma) and sinistral to dextral (10.02 Ma) in the late Miocene. We propose the recognition of a coiling change in Paragloborotalia as a secondary bioevent in the mid Miocene at 15.37 Ma, and a useful means for the recognition of the base of the Langhian. The coiling shift as a biostratigraphic marker is likely to be particularly useful in regions where the currently applied bioevents, namely the Praeorbulina–Orbulina lineage, is rare or poorly represented

Compliance with Intensity-Focused Prescription of Physical Activity Using Real-Time Cadence

The utility of wearable activity monitors can provide a better guide to increase adherence to the recommended physical activity levels for health improvement. However, the extent of participants’ ability to comply with the physical activity prescription using a newly developed, intensity-focused value, real-time cadence, remains unclear. PURPOSE: To examine the participants’ ability to comply with a given physical activity prescription focusing on intensity (i.e., real-time cadence). METHODS: Thirty-six healthy adult individuals (age 18-65 yrs; 18 female) participated in the study. During a 2-min over-ground walking trial, participants were prescribed to walk at any cadences (steps/min; an indicative of intensity of ambulatory activities) faster than 120 (i.e., equivalent to a brisk walking) using either one of the following devices in a counter-balanced order: (1) Garmin Forerunner 235 (GM) and (2) Polar M430 (PL), (3) Garmin Foot Pot (FP) and (4) Polar Stride Sensor (SS). Descriptive statistics were used to calculate the % of participants who complied accordingly with the given physical activity prescription as well as the means of cadence performed in each trial. Pearson correlation was conducted to determine the relationship between a criterion (i.e., hand count) and the measures from each device. RESULTS: In general, greater than 90% of the participants (91.7%, 97.2%, 100%, and 97.2% for the device (1) through (4), respectively) were able to maintain walking intensity at the prescribed level using real-time cadence. Mean cadences performed in the protocol were barely above the prescribed intensity, 120 steps/min (i.e., approximately 123 steps/min). The correlations showed strong relationships between the criterion and the measures of the monitors (p \u3c.001). GM and PL sometimes showed a value of zero (0), indicating no detection of steps, during the protocol (from 4 and 11 participants, respectively). CONCLUSION: The results suggest the potential to use the activity monitors providing real-time cadence for physical activity prescription and clarify the participants’ capability to manipulate the values of real-time cadence to maintain the targeted intensity of physical activity. A highly aimed intensity prescription rather than minimum requirement might help individuals ensure the compliance with targeted intensity