Delayed diagnosis of coeliac disease increases cancer risk

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial

Background Results from small randomised trials on tamoxifen in the treatment of hepatocellular carcinoma (HCC) are conflicting, We studied whether the addition of tamoxifen to best supportive care prolongs survival of patients with HCC. Methods Patients with any stage of HCC were eligible, irrespective of locoregional treatment. Randomisation was centralised, with a minimisation procedure accounting for centre, evidence of disease, and time from diagnosis. Patients were randomly allocated best supportive care alone or in addition to tamoxifen, Tamoxifen was given orally, 40 mg per day, from randomisation until death. Results 496 patients from 30 institutions were randomly allocated treatment from January, 1995, to January, 1997. Information was available for 477 patients. By Sept 15, 1997, 119 (50%) of 240 and 130 (55%) of 237 patients had died in the control and tamoxifen arms, respectively. Median survival was 16 months and 15 months (p=0.54), respectively, No differences were found within subgroups defined by prognostic variables. Relative hazard of death for patients receiving tamoxifen was 1.07 (95% CI 0.83-1.39). Interpretation Our findings show that tamoxifen is not effective in prolonging survival of patients with HCC

Sleep Home Monitoring: A Technical Option! [monitorização Domiciliar Do Sono: Uma Criteriosa Opção!]

[No abstract available]793266Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., Badr, S., The occurrence of sleep-disordered breathing among middle-aged adults (1993) N Engl J Med, 328 (17), pp. 1230-1235. , http://dx.doi.org/10.1056/NEJM199304293281704Tufik, S., Santos-Silva, R., Taddei, J.A., Bittencourt, L.R., Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study (2010) Sleep Med, 11 (5), pp. 441-446. , http://dx.doi.org/10.1016/j.sleep.2009.10.005Ferber, R., Millman, R., Coppola, M., Fleetham, J., Murray, C.F., Iber, C., Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice (1994) Sleep, 17 (4), pp. 378-39

Three Ebook Outlooks: What Humanists, Social Scientists and Scientists Want and Predict (A LibValue Study)

An e-book survey focused on user attitudes and valuation was conducted at the University of Illinois at Urbana-Champaign between 2013 and 2014 to determine how humanities, social science, and science scholars viewed the current and future use of e-books in their field. Participants were also asked to follow a link to use an e-book in their discipline on the e-brary platform and to report their experiences. Survey questions included an evaluation of present experiences and level of use, the value associated with e-books, and predictions of what their discipline’s e-book future will look like in the next five years. This study, supported by a grant from the Institute of Museum and Library Services (via “LibValue,” http://libvalue.cci.utk.edu/) grew over time to encompass the three disciplines as questions arose concerning how a spectrum of scholars adopted e-books or planned to migrate to the e-book format. The data from this study were used to inform library subject selectors concerning collection trends observed and predicted by their clientele. One result is the patron-driven acquisition of highuse e-books, which demonstrates the use and value scholars find in this book format

Quality of sleep, health and well-being in a population-based study

Estimar a prevalência de sono autoavaliado como ruim e identificar os subgrupos da população mais susceptíveis ao problema. Trata-se de estudo transversal, de base populacional, desenvolvido com dados de Inquérito de Saúde conduzido no município de Campinas (ISACamp 2014/2015). Foram analisados dados de amostra representativa de 1.998 indivíduos com 20 anos ou mais de idade. A qualidade autoavaliada do sono foi analisada segundo características sóciodemográficas, morbidades, comportamentos de saúde e sentimentos de bem-estar. Analisou-se também a associação da qualidade do sono com diferentes queixas e características do sono. Foram estimadas razões de prevalências e desenvolvido modelo de regressão múltipla de Poisson, considerando-se nas análises os pesos amostrais. A prevalência de sono autoavaliado como ruim foi 29,1% e mostrou-se significativamente mais elevada nas mulheres, em indivíduos de 40 a 50 anos de idade, migrantes, sem ocupação, fisicamente inativos em contexto de lazer, com transtorno mental comum (RP = 1,59), com maior número de problemas de saúde (RP = 2,33), com saúde autoavaliada como ruim (RP = 1,61) e que manifestavam insatisfação com a vida. Sono ruim esteve fortemente associado com relatos de dificuldade de iniciar o sono (RP = 4,17), de manter o sono (RP = 4,40) e com nunca ou quase nunca se sentir bem-disposto ao acordar (RP = 4,52). Os resultados identificam os segmentos da população com má qualidade do sono que merecem maior atenção e destacam a necessidade de avaliar, além da presença de comorbidades, a saúde mental e a presença de sentimentos de bem-estar no processo de cuidado dos pacientes com problemas de sono e no planejamento de intervenções voltadas à promoção de sono saudável5382FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2012/23324-3To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem. This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights. Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52). The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy slee

Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study

Abstract Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OAm) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OAm is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OAm use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OAm, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance. Results Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. Conclusion In this pilot study, DIORS OAm as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.</jats:p