Safety of low- to medium-dose glucocorticoid treatment in rheumatoid arthritis: myths and reality over the years

Low- to medium-dose glucocorticoids have been shown to have not only anti-inflammatory but also disease-modifying properties in rheumatoid arthritis. The evidence for the benefit of its early use in combination with disease-modifying antirheumatic drugs underlines the need for a close evaluation of their risk-benefit ratio. Over time, numerous myths and fears about glucocorticoid toxicity in rheumatoid arthritis have arisen from observational studies, and many concerns have been unduly extrapolated from observations with higher-dose treatment. Furthermore, we cannot exclude the possibility of a powerful effect of bias by indication in these studies. Low- to medium-dose glucocorticoid regimens continued to be evaluated in randomized clinical trials, particularly in early disease, but these studies also have relevant methodological limitations in assessing safety, particularly due to small size and/or short duration. At present, the evidence on which to support clear recommendations about glucocorticoid toxicity remains remarkably weak. A large prospective pragmatic trial dedicated to the toxicity of low-dose glucocorticoids is dearly needed. Meanwhile, adherence to recommendations on standardized methodologies for registration and report of glucocorticoid adverse events is essential for improving our knowledge and competence in the best management of these important medications

Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants

Introdução e Objetivos: Avaliar a taxa de prescrição de anticoagulantes orais na fibrilhação auricular, os fatores associados à não prescrição, os motivos referidos pelos clínicos para não prescrição de anticoagulantes incluindo os de nova geração e realizar estudo evolutivo a médio prazo. Material e Métodos: Estudo prospetivo sobre casos consecutivos de doentes com fibrilhação auricular com alta hospitalar. Registaram- se os scores CHA2DS2VASc e HASBLED, comorbilidades associadas e a medicação prévia e à data de alta. Na alta hospitalar, o médico assistente indicou em questionário o motivo de não prescrição de anticoagulantes orais e dos novos anticoagulantes orais. Exclusão: contra-indicação absoluta para anticoagulação, CHA2DS2VASc ≤ 1 e doença valvular. Os doentes foram reavaliados um ano após o recrutamento do primeiro doente. Resultados: Identificaram-se 103 candidatos a anticoagulação oral (79,6 ± 8,0 anos; CHA2DS2VASc 5,8 ± 1,4; HASBLED 2,6 ± 1,0; HASBLED ≥ 3 em 55,3%); os anticoagulantes foram prescritos em 34,0%. Fatores associados à não prescrição por ordem decrescente de relevância: uso prévio de antiagregantes, doente acamado e/ou demente, ausência de insuficiência cardíaca e número de fatores de risco hemorrágico. Razões invocadas para não prescrição por ordem decrescente de frequência: risco hemorrágico elevado, pequeno benefício, incapacidade de seguir o esquema terapêutico e dificuldade na monitorização da razão normalizada internacional(INR). Os novos anticoagulantes não foram prescritos e as razões invocadas foram, por ordem decrescente de frequência: informação insuficiente sobre estes fármacos, risco hemorrágico elevado, custo elevado e pequeno benefício. Aos 8,2 ± 2,5 meses de estudo evolutivo 33,3% dos doentes encontravam-se sob anticoagulação sem que os novos anticoagulantes tivessem sido prescritos. Conclusões: Nesta amostra, a taxa de prescrição de anticoagulação oral foi baixa e o fator mais associado à não prescrição foi o uso prévio de antiagregantes. O impedimento à prescrição mais referido foi o risco hemorrágico, seguido do pequeno benefício reconhecido. Os principais impedimentos referidos à prescrição dos novos anticoagulantes foram a informação insuficiente e o alto risco hemorrágico. A médio prazo, a proporção de doentes sob anticoagulação mantinha-se baixa e os novos anticoagulantes não tinham sido prescritos

Psychological factors associated with response to treatment in rheumatoid arthritis

This paper presents a comprehensive review of research relating psychological domains with response to therapy in patients with rheumatoid arthritis. A holistic approach to the disease was adopted by incorporating not only disease activity but also dimensions of the impact of disease on patients' lives. Psychological distress, including depression and anxiety, is common among patients with rheumatoid arthritis and has a significant negative impact on response to therapy and on patients' abilities to cope with chronic illness. Evidence regarding the influence of positive psychological dimensions such as acceptance, optimism, and adaptive coping strategies is scarce. The mechanisms involved in these interactions are incompletely understood, although changes in neuro-endocrine-immune pathways, which are common to depression and rheumatoid arthritis, seem to play a central role. Indirect psychological influences on therapeutic efficacy and long-term effectiveness include a myriad of factors such as adherence, placebo effects, cognition, coping strategies, and family and social support. Data suggest that recognition and appropriate management of psychological distress may improve response to treatment and significantly reduce disease burden

Wood Gasification in Uganda – Is this a solution for the Energy Crisis? Hard facts from installed units

Wood Gasification in Uganda – Is this a solution for the Energy Crisis? Hard facts from installed unitsThere is urgent need to increase Uganda’s electricity supply and more importantly reduce the country’s dependence on the presently meager hydro electric power generation. Uganda is a growing economy with an average GDP growth rate estimated at 6.4% per annum. Economic growth is matched by growth in energy demands; fortunately we have a number of options at our disposal. Of interest to the country is harnessing electricity from biomass. In small scale this can be done by gasification of the biomass. There are already some players in this sector of energy in Uganda. Musizi Tea Estate/James Finlay Uganda Limited has a 205 kW wood gasification unit. Yet another small unit belongs to Kasenge Electricity Power owned by a retired British civil engineer, Brian Frawley. A 10 kW unit generates electricity by wood gasification. Nonetheless gasification is a complex process when compared with diesel genset electricity generation, maintenance is rather intensive. High level engineering and technical skills are require on a full time basis. This is lacking at the moment. In addition, the fuel supply chain has to be sustainable and it may require some added costs and organization, etc. In an attempt to address these constraints CREEC, Centre for Research in Energy and Energy Conservation has developed a program to work with these pioneers to sustain the units and make viable the technology. It is also exploring alternative fuels such as agricultural residues. This paper presents experiences from the use of gasification to meet small scale electricity generation using this technology and proposes some strategies for small scale gasification systems implementation

Aplicação do algoritmo LEGAL/SPRING na cobertura florestal do município de Ivorá/RS nos anos de 2011 e 2012.

Neste trabalho, foram utilizadas técnicas de sensoriamento remoto a fim de analisar a distribuição dos recursos florestais do Município de Ivorá, RS, enfocando sua evolução, para, com isso, manejar a área do município visando a sustentabilidades de suas atividades. A área de estudo é caracterizada pelos biomas Mata Atlântica e Pampa, característicos do Estado do Rio Grande do Sul, e tem sua economia fortemente baseada na pecuária e agricultura. Para a realização do trabalho, foram utilizados dados temporais do satélite RapidEye, sensor Reis, datados de 2011 e 2012. Foi criado um banco de dados, que foi usado para: testar variadas composições e contrastes; definir as legendas das categorias de uso e cobertura da terra; realizar testes de segmentação, classificação das imagens e elaborar uma programação em Linguagem Espacial para Geoprocessamento Algébrico (LEGAL) (CÂMARA, 1995); e elaborar os mapas temáticos. A classificação supervisionada das imagens revelou que a classe de uso do solo ?Floresta? foi predominante no município em 2011 e 2012, quando representou um quarto da sua área total. Conclui-se que, por meio da análise LEGAL, houve aumento da expansão florestal em detrimento do desmatamento, o que evidencia a importância da análise de uso do solo para a adequação e o planejamento ambiental do município

Key sources of strength and resilience for persons receiving services for Hansen's disease (leprosy) in Porto Velho, Brazil:What can we learn for service development?

Background: Individuals affected by Hansen's disease (leprosy) often experience stigma and discrimination. Greater psychosocial resilience may enable people to deal with such discrimination. This study aimed to explore sources of strength and resilience for individuals affected by Hansen's disease in Brazil. Methods: We used a cross-sectional study design with a qualitative approach. Semistructured focus groups were conducted. Analysis comprised thematic categorisation of transcripts. Results: Thirty-one participants were included: 23 individuals affected by Hansen's disease and 8 healthcare providers. We found that while a few individuals affected were provided with formal psychological support in the early phases of their treatment, many noted the importance of providing such support at this time. Most participants described relationships with and social support from family members, friends and with others affected by Hansen's disease as their primary source of resilience. A key context for building resilience was through the peer-level sharing and engagement experienced in self-care and support groups. Participants also emphasised the importance of providing appropriate information about Hansen's disease and the importance of beliefs and spirituality. Conclusions: Hansen's disease services should seek to build resilience in early treatment through counselling and during treatment and beyond by having people affected getting together. Across both settings supporting family and social relationships, providing accurate information and acknowledging spiritual beliefs are important.</p

A maturity model for DevOps

Nowadays, businesses aim to respond to customer needs at unprecedented speed. Thus, many companies are rushing to the DevOps movement. DevOps is the combination of Development and Operations and a new way of thinking in the software engineering domain. However, no common understanding of what it means has yet been achieved. Also, no adoption models or fine-grained maturity models to assist DevOps maturation and implementation were identified. Therefore, this research attempt to fill these gaps. A systematic literature review is performed to identify the determining factors contributing to the implementation of DevOps, including the main capabilities and areas with which it evolves. Then, two sets of interviews with DevOps experts were performed and their experience used to build the DevOps Maturity Model. The DevOps maturity model was then developed grounded on scientific and professional viewpoints. Once developed the Maturity Model was demonstrated in a real organisation.info:eu-repo/semantics/acceptedVersio

Determinants of the intention to consume edible insects in Brazil

Entomophagy has grown in interest as an alternative source of protein that could complement future demand for meat products. As a novel food, there are still many barriers to the adoption in western countries. Based on three models, the Theory of Planned Behavior, Expectancy Value and SPARTA, a new model is proposed. It considers key factors that could most influence consumers about their intentions, rejection and determinant behaviors regarding the extent insects such as crickets and cricket protein could replace animal protein in Brazil. Data from a sample of 404 respondents was analyzed using Structural Equation Modeling. The results reveal the positive influence of the perceived Behavioral Control and the negative influence of Subjective Norm as the main determinants of the intention to consume insects. The theoretical contribution of the research was the construction of a comprehensive and replicable converged behavioral model for application in the food innovation sector