Lipid profile in adult patients with idiopathic juvenile arthritis

AbstractThe inflammatory processes in the joints of a child with juvenile idiopathic arthritis (JIA) can persist into adulthood. Inflammation has been linked to distortions of the lipid profile and accelerated atherogenesis. In the present study, we examined the lipid profiles of adults with JIA compared with those of healthy people. A lipid profile of a sample of 54 adults with JIA (57.3% with polyarticular JIA, 37.0% with oligoarticular JIA, 1.9% with enthesitis-related JIA and 3.7% with systemic onset JIA) and 54 healthy subjects were compared. In the adults with JIA, data on gender, age, age at disease onset, the presence of rheumatoid factor (RF) and antinuclear antibodies (ANA), a Health Assessment Questionnaire (HAQ) and the disease duration were collected. We found that hypercholesterolaemia, increased low-density lipoprotein (LDL) and decreased high-density lipoprotein (HDL) were more common in patients with JIA than the controls (P=0.016, P<0.0001 and P=0.0008, respectively). Changes in the levels of total cholesterol (TC) and LDL were more common in the individuals who had a later onset of disease (P=0.0017 for TC and P=0.023 for LDL). In the entire JIA group, no other variable, such as RF, ANA, disease duration or responses to the HAQ, could be linked to dyslipidaemia (P = non-significant). We concluded that the adult patients with JIA have a lipid profile with increased TC and LDL levels and decreased levels of HDL compared to the controls. No clinical feature could be correlated with this change except for the age at disease onset

The chronic care model use in the emirate of Abu Dhabi helth system: is it enough to address the growing problem of chronic diseases?

Abu Dhabi é a capital dos Emirados Árabes Unidos e o maior emirado em termos de área e população. Os emirados árabes unidos tem um elevado índice de morbilidade e mortalidade relacionados com as doenças crónicas. Para abordar o crescente problema das doenças não comunicáveis, o Modelo de Doença Crónica (CCM) tem a intenção de ter cuidados diários baseados na população, com intervenções de equipa estruturadas e planeadas; com o objectivo de converter a vida dos doentes crónicos de reactiva a proactiva. O modelo integra seis elementos para facilitar uma qualidade elevada dos cuidados. Objectivos Esta tese tem como objectivo explorar o sistema de saúde de Abu Dhabi usando a abordagem do CCM para melhorar e desenvolver a prestação de cuidados a pessoas com doenças crónicas. Foram desenhados quatro objectivos específicos: Caracterizar os serviços de saúde do emirado de Abu Dhabi; Analisar o alinhamento dos serviços de saúde com o CCM, identificando as principais lacunas; Explorer a percepcão dos profissionais de saúde sobre o nível de integração do CCM nos cuidados diários a doentes com diabetes, doenças cardiovasculares e cancro; Priorizar os subcomponentes e as barreiras para o desenvolvimento do CCM no sistema de saúde do emirado de Abu Dhabi. Métodos Para operacionalizar os objectivos foi desenhado um estudo com três componentes distintas: Revisão sistemática da literatura usando o CCM como uma framework para explorar a sua implementação e desenvolvimento nos cuidados de saúde primários; Estudo transversal misto para recolher informações sobre a percepção dos profissionais de saúde sobre os cuidados diários a doentes crónicos; Painel Delphi utilizado para ordenar as prioridades e barreiras da implementação e desenvolvimento do CCM. Resultados As clinicas que prestam cuidados de saúde primários adotaram os princípios do modelo Patient-centered medical home, que está alinhado com o CCM. Parece que existe um esforço em seguir as últimas evidências científicas com a intenção de atingir ganhos em saúde. A implementação dos elementos do CCM está alinhada com os standards e é positivamente associada com o uso de intervenções dirigidas a comportamentos de alto risco. Os profissionais de saúde têm a percepção de que cinco elementos (sistemas de informação clínica, decisão suportada, comunidade, autogestão e sistema de saúde) foram considerados razoavelmente bons. Os participantes deram pontuações elevadas a alguns componentes, no entanto, os resultados qualitativos nem sempre suportaram os resultados quantitativos, indicando ainda a transição do modelo centrado no médico para o modelo centrado no doente. A ‘liderança organizacional para os cuidados da doença crónica’ foi considerada como a primeira prioridade (26.3%) e ‘participação do doente’ foi considerada como a primeira barreira (36.8%). Conclusão O sistema de saúde do emirado de Abu Dhabi está internacionalmente bem posicionado e competitivo face a outros países desenvolvidos, mesmo enfrentando o desafio da sua população única. Tem um razoavelmente bom suporte aos cuidados de doença crónica e o top cinco das prioridades e barreiras estão delineados. Este estudo representa um importante passo para compreender onde e mais relevante intervir de forma a maximizar o desenvolvimento do CCM no Sistema de saúde de Abu Dhabi.Abu Dhabi is the capital of the United Arab Emirates (UAE) and the largest emirate in terms of land mass and population. The UAE has a high population-burden of morbidity and mortality related to chronic diseases. To address the growing burden of non-communicable diseases, the Chronic Care Model (CCM) has the purpose of having population-based daily care for all with structured and planned team care interventions; aiming to convert the life of patients with chronic disease from reactive to proactive. The model integrates six elements to facilitate high-quality care. Aim and Objectives This thesis aims to explore the health system of the Abu Dhabi emirate, using the CCM approach to improve and develop the healthcare delivery to people with chronic diseases. Four specific objectives were outlined: Characterize the healthcare services in the emirate of Abu Dhabi; Analyze the alignment of the healthcare services with the CCM, identifying main gaps; Explore the perception of the healthcare workers about the level of integration of the CCM in the daily care of patients with chronic diseases: diabetes, cardiovascular diseases, and cancer; Prioritize the subcomponents and the barriers for the development of the CCM in the health system of the emirate of Abu Dhabi. Methods To operationalize the objectives, a study with three different components was designed: Systematic review used the CCM as a framework to further explore its implementation or development in primary health care; The cross-sectional mixed-methods study collected information about the perception of the healthcare workers about the stage of implementation and development of the CCM in the daily care of patients; Modified Delphi technique was used to rank the priorities and barriers of the implementation and development of the CCM. Results The primary health care clinics adopted the principles of the patient-centred medical home model, a model aligned with the CCM. It seems there is an effort in following the latest scientific evidence with the intention to achieve health gains. The implementation of the CCM elements aligns with those standards and is positively associated with the use of interventions targeting high-risk behaviours. The healthcare workers have the perception that five elements (i.e. clinical information system, decision support, community, self-management, health system) were rated as reasonably good. Participants awarded high scores for some components; however, the qualitative findings did not always support the quantitative data indicating that the transition from doctor-centred to patient-centred is still in process. The ‘overall organizational leadership in chronic illness care’ was considered as the priority to address (26.3%) and ‘patient compliance’ the top barrier (36.8%). Conclusion The Abu Dhabi emirate health system is internationally well positioned and competing with others from the high-income developed countries, even facing the challenge of the unique population. It has reasonably good support for chronic illnesses care and the top five priorities and barriers to further improve it was outlined. This study represents an important step to understanding where it is more relevant to intervene in order to maximize the development of the CCM in the Abu Dhabi health system

Occupational Exposure to Solar Radiation and the Eye: A Call to Implement Health Surveillance of Outdoor Workers

Globally, hundreds of millions of outdoor workers are exposed to solar radiation (SR) for most of their work. Such occupational exposure is known to induce various adverse health effects on the eyes, mainly related to its ultraviolet (UV) component. The present work is a call to action to raise awareness of the need for health surveillance to prevent chronic ocular diseases in outdoor workers. Photo-chemical chronic damage can induce pterygium at the eye's outer layer and cataracts in the lens. Considering carcinogenic effects, rare squamous-cell tumors of the cornea and/or the conjunctiva and ocular melanomas are associated with UV radiation exposure. Solar UV-related eye diseases should be considered "occupational diseases" when workers have sufficient exposure. Still, they are often not recognized and/ or frequently not reported to the national compensation authorities. Therefore, to prevent the burden of these work -related eye pathologies, an adequate risk assessment with identification of appropriate preventive measures and a provision of periodic health surveillance to the exposed workers, particularly those at higher risk of exposure or with individual susceptibility, should be urgently implemented

Diabetes-related symptoms, acute complications and management of diabetes mellitus of patients who are receiving palliative care: A protocol for a systematic review

Introduction: Worldwide, an estimated 40 million people are in need of palliative care each year, but only 14% receive it. The incidence of diabetes mellitus (DM) in patients receiving palliative care is higher than in the general population. This association is intended to grow as a result of the rising burden of DM worldwide, ageing populations and the improved overall survival time of several diseases over the last few decades. Recommendations for DM management in the context of palliative care are mainly based on expert opinion as there is a lack of suitable evidence base and randomised clinical trials in palliative care are scarce. The aim of our systematic review is to identify the best DM management practices in order to reduce important DM-related symptoms and acute complications in patients receiving palliative care. Methods and analysis: The authors will study the DM treatment and management literature, surveying the different approaches employed to treat adult palliative patients. Core health bibliographic databases will be searched from January 1990 to May 2019. Data sources will include Ovid MEDLINE, Embase, PubMed, Web of Sciences, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature and grey literature. Details regarding diet, oral and injectable glucose-lowering medicines, insulin regimens and blood glucose monitoring strategies will be evaluated. We defined the primary outcomes to compare between DM management approaches as the presence of symptoms (polyuria, polydipsia and polyphagia) and acute complications of DM (hypoglycaemia, hyperglycaemic hyperosmolar state and diabetic ketoacidosis), and secondary outcomes as hospital admissions and deaths due to DM-related complications, health-related quality of life and glycaemic control. Ethics and dissemination: The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available

Diversidade de Aves, Mamíferos e Répteis Atropelados em Região de Floresta Subtropical no Sul do Brasil

O objetivo deste estudo foi estimar a diversidade de espécies de aves, mamíferos e répteis atropelados em região de floresta subtropical e discutir quais fatores podem estar influenciando nos atropelamentos. Dados sobres os atropelamentos foram obtidos em dois trechos de 12 km, percorridos de carro em velocidade de 50 km/h. Foram realizados 10 dias de amostragens por mês, de setembro de 2014 a fevereiro de 2015. Foi calculada a taxa de atropelamentos e a curva de acumulação de espécies. Estimou-se a riqueza de espécies e determinou-se as espécies mais atropeladas. Foram encontrados 209 indivíduos atropelados de 45 espécies. A taxa de atropelamento foi de 0,14 ind./km/dia. Cinco espécies constam entre as mais atropeladas. As espécies com maior número de atropelamentos coincidem em grande parte com as espécies classificadas como Constantes ou Acessórias. A taxa de atropelamento indica que ao longo do período de um ano podem ser encontrados ao menos 50 animais atropelados por quilômetro nas rodovias avaliadas. A similaridade baixa e as diferenças na diversidade entre os dois trechos indicam a forte influência da paisagem do entorno da rodovia. Rodovias que cortam áreas preservadas tendem a gerar impactos sobre espécies mais exigentes em relação ao uso de habitat.

Acute strength exercise and the involvement of small or large muscle mass on plasma brain‐derived neurotrophic factor levels

OBJECTIVE: Blood neurotrophins, such as the brain-derived neurotrophic factor, are considered to be of great importance in mediating the benefits of physical exercise. In this study, the effect of acute strength exercise and the involvement of small versus large muscle mass on the levels of plasma brain-derived neurotrophic factor were evaluated in healthy individuals. METHODS: The concentric strengths of knee (large) and elbow (small) flexor and extensor muscles were measured on two separate days. Venous blood samples were obtained from 16 healthy subjects before and after exercise. RESULTS: The levels of brain-derived neurotrophic factor in the plasma did not significantly increase after both arm and leg exercise. There was no significant difference in the plasma levels of the brain-derived neurotrophic factor in the arms and legs. CONCLUSION: The present results demonstrate that acute strength exercise does not induce significant alterations in the levels of brain-derived neurotrophic factor plasma concentrations in healthy individuals. Considering that its levels may be affected by various factors, such as exercise, these findings suggest that the type of exercise program may be a decisive factor in altering peripheral brain-derived neurotrophic factor

DEP–DM: Uma Abordagem baseada em Ensemble Regression para o Diagnóstico de Problemas Educacionais

Este artigo apresenta a abordagem DEP-DM, baseada em modelos Ensemble Regression para o diagnóstico do problema do desempenho escolar dos estudantes das escolas públicas de Pernambuco. O estudo baseou-se em informações do SAEB do ano de 2013. O conhecimento foi extraído por meio da abordagem proposta, sendo possível identificar os fatores associados e estabelecer as relações de causa e efeito com o problema do desempenho escolar. Por fim, foram aplicados modelos de regressão paramétricos e não paramétricos para a previsão desse desempenho. Os resultados e diagnóstico apresentam que os fatores relacionados a infraestrutura da escola, ensino e familiares, exercem forte influência sobre o desempenho escolar

The protective effect of Canova homeopathic medicine in cyclophosphamide-treated non-human primates

Background: Canova activates macrophages and indirectly induces lymphocyte proliferation. Here we evaluated the effects of Canova in cyclophosphamide-treated non-human primates.Methods: Twelve Cebus apella were evaluated. Four animals were treated with Canova only. Eight animals were treated with two doses of cyclophosphamide (50 mg/kg) and four of these animals received Canova. Body weight, biochemistry and hematologic analyses were performed for 40 days. Micronucleus and comet assays were performed for the evaluation of DNA damage.Results: We observed that cyclophosphamide induced abnormal WBC count in all animals. However, the group treated with cyclophosphamide plus Canova presented a higher leukocyte count than that which received only cyclophosphamide. Cyclophosphamide induced micronucleus and DNA damage in all animals. the frequency of these alterations was significantly lower in the Canova group than in the group without this medicine.Conclusions: Our results demonstrated that Canova treatment minimizes cyclophosphamide myelotoxicity in C. apella. (C) 2012 Elsevier B.V. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Disciplina Genet, Dept Morfol & Genet, BR-04023900 São Paulo, BrazilUniv São Paulo, Dept Anal Clin Toxicol & Bromatol, Fac Ciencias Farmaceut Ribeirao Preto, BR-14040903 Ribeirao Preto, SP, BrazilFed Univ Para, Lab Citogenet Humana, Inst Ciencias Biol, BR-66059 Belem, Para, BrazilUniversidade Federal de São Paulo, Disciplina Ginecol, Dept Tocoginecol, BR-04039032 São Paulo, BrazilFed Univ Para, Serv Cirurgia, Hosp Univ Joao de Barros Barreto, BR-66073000 Belem, Para, BrazilMinist Saude, Ctr Nacl Primatas, BR-77030000 Ananindeua, PA, BrazilUniv Fed Piaui, Lab Genet & Biol Mol, BR-64202020 Parnaiba, PI, BrazilUniversidade Federal de São Paulo, Disciplina Genet, Dept Morfol & Genet, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Ginecol, Dept Tocoginecol, BR-04039032 São Paulo, BrazilCNPq: 550885/2007-2Web of Scienc