Making Assistive Devices Essential: Prioritizing Products in Global Health

Until recently, the World Health Organization (WHO) specified just one resource as essential for the health of the population: prescription medications. Over time, it became clear that the essential medications list excluded other, arguably equally necessary, interventions from the domain of humanitarian aid, and the WHO developed a “priority assistive products” in 2016. I argue that the WHO created this list because disability rights activists worldwide are couching access to assistive devices in terms of human rights. In this paper, I use ethnographic analysis to follow the pathway of lower extremity prosthetic devices as they are distributed throughout Uganda. This study suggests that, by glossing over the details of who gets devices and how, the WHO may not be addressing real concerns surrounding the social factors that mediate access or be attending to the plurality of ways people in the developing world obtain access to assistive devices.Master of Art

Prosthetic Entanglements: Living with Transnational Prosthetic Limb Design in Uganda and the United States

This dissertation explores how engineers from the United States design assistive devices such as prosthetic legs for recipients living in differently resourced settings and social worlds. It then asks how people with limb loss in Uganda and the United States accept, reject, or modify assistive devices to better meet their needs for self-efficacy, improved economic prospects, and social relationships. This multi-sited research was conducted in the United States, Switzerland and Uganda with disability rights activists, engineers, prosthetists, policy makers, health care providers, and people with limb loss and their families. Starting in March 2020, much of this work moved to virtual spaces online due to the Covid-19 pandemic.Engineers working in industry and professional schools in high-resource settings like North America and Western Europe are increasingly designing assistive devices specifically for people living in low-resource settings. In designing for this new market, engineers and device makers follow a techno-optimistic path, as they modify standard prototypes by using cheaper materials and simplifying product design to make the final product easier to build, use, and repair. But people with limb loss and limb difference value more than simplicity and cost when it comes to assistive devices. Prosthetic Entanglements engages with the tension between how engineers design devices and the lived experiences of people who use devices. It examines the boundaries and limitations of biomedical technologies for reconstructing and enhancing human bodies and, presumptively, human lives. However, it is not only about boundaries and limitations. This dissertation is also about realities and possibilities of, and alternatives to, living with limb loss in different social worlds. I take up the questions of what kinds of devices are used and under what circumstances they are used, by considering how the permeable nature of bodies, the material possibilities for reconstruction, and the use of prosthetic devices as forms of assistive technologies influence how people reconfigure their embodied selves, identities, and social relationships after limb loss.Doctor of Philosoph

Biodegradable esophageal stents in benign and malignant strictures – a single center experience

Background and study aims: Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited. Patients and methods: This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included. Results: Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 – 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 – 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 – 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 – 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 – 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 – 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 – 263) following stent placement. Conclusions: BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome

A percepção de profissionais do segmento financeiro que atuam de forma autônoma frente ao open banking e o novo formato de atuação profissional

TCC (graduação) - Universidade Federal de Santa Catarina, Centro Socioeconômico, Administração.O mercado brasileiro encontra-se em crescente expansão e atualização, com a popularização do Open Banking, as fintechs que surgem como uma nova maneira de se negociar, a Lei Geral de Proteção de Dados – LGPD, que traz segurança jurídica e legal para os investidores e aquelas pessoas que fazem uso dessas instituições financeiras. Surge assim, uma nova maneira de se negociar, e, um novo profissional vislumbra um meio de fazer negócios, o empreendedor bancário autônomo, utiliza-se dessa tecnologia oferecida pelas fintechs e pelo Open Banking e pelas vantagens oferecidas por essas instituições para negociar, de maneira independente, através do home office, de acordo com a sua disponibilidade. Trata-se de um novo modelo de trabalho, que ganhou importância após a pandemia do Covid-19 e, que, está se popularizando e ganhando força. Para fundamentar esse estudo, foram entrevistados oito bancários autônomos, que depois de muitos anos de trabalho em agências, viram nessa plataforma financeira, uma oportunidade de continuar exercendo suas profissões.The Brazilian market is increasingly expanding and updating, with the popularization of Open Banking, fintechs that emerge as a new way of negotiating, the General Data Protection Law - LGPD, which brings legal and legal security to investors and those people who make use of these financial institutions. Thus, a new way of negotiating emerges, and a new professional envisions a way of doing business, the autonomous banking entrepreneur, uses this technology offered by fintechs and Open Banking and the advantages offered by these institutions to negotiate, independently, through the home office, according to your availability. This is a new work model, which gained importance after the Covid-19 pandemic and which is becoming popular and gaining strength. To support this study, eight self-employed bankers were interviewed, who after many years of working in agencies, saw in this financial platform an opportunity to continue exercising their professions

Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer

BACKGROUND: Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used. OBJECTIVE: The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy. METHODS: Single centre, retrospective analysis of all patients (n = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n = 160) or APC (n = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan–Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test. RESULTS: Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13–1.65 of SEMS over APC, p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p = 0.02 and 0.05 respectively). CONCLUSIONS: APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results

Prevalence and determinants of sex-specific dietary supplement use in a greek cohort

We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history and clinical measurements was assessed using logistic regression models, separately for women and men. The overall prevalence of dietary supplement use was 31.4%, and it was higher in women (37.3%) compared to men (22.4%; p-value = 4.2−08). Based on multivariable logistic regression models, dietary supplement use in women was associated with age (positively until middle-age and slightly negatively afterwards), the presence of a chronic health condition (OR = 1.71; 95% CI, 1.18–2.46), lost/removed teeth (OR = 0.52; 95% CI, 0.35–0.78) and diastolic blood pressure (OR per 5 mmHg increase =0.84; 95% CI, 0.73–0.96); body mass index and worse general health status were borderline inversely associated. In men, dietary supplement use was positively associated with being employed (OR = 2.53; 95% CI, 1.21–5.29). A considerable proportion of our sample used dietary supplements, and the associated factors differed between women and men

Genome-wide association study identifies common variants associated with circulating vitamin E levels

In genome-wide association studies (GWAS) of common genetic variants associated with circulating alpha- and gamma-tocopherol concentrations in two adult cohorts comprising 5006 men of European descent, we observed three loci associated with alpha-tocopherol levels, two novel single-nucleotide polymorphisms (SNPs), rs2108622 on 19pter-p13.11 (P= 1.7 × 10−8) and rs11057830 on 12q24.31 (P= 2.0 × 10−8) and confirmed a previously reported locus marked by rs964184 on 11q23.3 (P= 2.7 × 10−10). The three SNPs have been reported to be associated with lipid metabolism and/or regulation. We replicated these findings in a combined meta-analysis with two independent samples, P= 7.8 × 10−12 (rs964184 on 11q23.3 near BUD13, ZNF259 and APOA1/C3/A4/A5), P= 1.4 × 10−10 (rs2108622 on 19pter-p13.11 near CYP4F2) and P= 8.2 × 10−9 (rs11057830 on 12q24.31 near SCARB1). Combined, these SNPs explain 1.7% of the residual variance in log alpha-tocopherol levels. In one of the two male GWAS cohorts (n= 992), no SNPs were significantly associated with gamma-tocopherol concentrations after including data from the replication sample for 71 independent SNPs with P< 1 × 10−4 identified

STrengthening the Reporting of OBservational studies in Epidemiology – Molecular Epidemiology (STROBE-ME): An Extension of the STROBE Statement

Valentina Gallo and colleagues provide detailed guidance to authors to help more accurately report the findings of epidemiological studies involving biomarkers. Their guidance covers issues regarding collection, handling and storage of biological samples; laboratory methods, validity and reliability of biomarkers; specificities of study design; and ethical considerations

Antioxidants and breast cancer risk- a population-based case-control study in Canada

<p>Abstract</p> <p>Background</p> <p>The effect of antioxidants on breast cancer is still controversial. Our objective was to assess the association between antioxidants and breast cancer risk in a large population-based case-control study.</p> <p>Methods</p> <p>The study population included 2,362 cases with pathologically confirmed incident breast cancer (866 premenopausal and 1,496 postmenopausal) and 2,462 controls in Canada. Intakes of antioxidants from diet and from supplementation as well as other potential risk factors for breast cancer were collected by a self-reported questionnaire.</p> <p>Results</p> <p>Compared with subjects with no supplementation, 10 years or longer supplementation of zinc had multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) of 0.46 (0.25-0.85) for premenopausal women, while supplementation of 10 years or longer of multiple vitamin, beta-carotene, vitamin C, vitamin E and zinc had multivariable-adjusted ORs (95% CIs) of 0.74 (0.59, 0.92), 0.58 (0.36, 0.95), 0.79 (0.63-0.99), 0.75 (0.58, 0.97), and 0.47 (0.28-0.78), respectively, for postmenopausal women. No significant effect of antioxidants from dietary sources (including beta-carotene, alpha-carotene, lycopene, lutein and zeaxanthin, vitamin C, vitamin E, selenium and zinc) or from supplementation less than 10 years was observed.</p> <p>Conclusions</p> <p>This study suggests that supplementation of zinc in premenopausal women, and supplementation of multiple vitamin, beta-carotene, vitamin C, vitamin E and zinc in postmenopausal women for 10 or more years may protect women from developing breast cancer. However, we were unable to determine the overall effect of total dose or intake from both diet and supplement.</p