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First-generation somatostatin analogues (SSA) are indicated as a first-line medical treatment for acromegaly in patients with persistent disease after surgery or who are not eligible for surgery. These drugs are the largest contributor to the direct medical cost of acromegaly management worldwide. We analyze the patterns of prescription and costs of SSA for the treatment of acromegaly in Brazil.
Methods
The first-generation SSA, octreotide LAR (OCT-LAR) and lanreotide autogel (LAN-ATG), are available in Brazil to treat acromegaly through the Specialized Component of Pharmaceutical Assistance policy. The public records of the nationwide database (DATASUS) were accessed to identify the drug use patterns during the year 2022. The current values of the drug acquisition costs of each medication in 2022 were consulted at the national prices database (BPS). Results were converted in purchase power parity (PPP) dollars according to the World Bank rates.
Results
The acquisition cost of each octreotide (OCT-LAR) ampoule was USD492.33 (10 mg), USD537.04 (20 mg), and USD703.79 (30 mg); for lanreotide (LAN-ATG), each ampoule was USD394.74 for the 60 mg dosage, and USD418.48 for the 90 mg and 120 mg dosages. The average annual cost of a monthly 30 mg dosage of OCT-LAR would be estimated as USD8,445,48 against an average annual cost of USD5,021.76 for a monthly 120 mg dosage of LAN-ATG. Thus, we estimate that USD15,520,747.59 was spent on first-generation SSA to treat acromegaly in Brazil’s Unified Health System (SUS) in the year 2022; of this, 79 percent was attributed to OCT-LAR.
Conclusions
Life-long treatment with SSA is related with a high economic burden in Brazil. There is a predominance of OCT-LAR prescription, where expanding the use of LAN-ATG may help reduce costs to the SUS. Nevertheless, studies and investments in other treatments, such as pituitary surgery and radiotherapy access, at a national level are also essential to improve acromegaly treatment costs.
The work in this paper introduces finite mixture models that can be used to simultaneously cluster the rows and columns of two-mode ordinal categorical response data, such as those resulting from Likert scale responses. We use the popular proportional odds parameterisation and propose models which provide insights into major patterns in the data. Model-fitting is performed using the EM algorithm, and a fuzzy allocation of rows and columns to corresponding clusters is obtained. The clustering ability of the models is evaluated in a simulation study and demonstrated using two real data sets.
This study aimed to identify meal and snack patterns and assess their association with sleep timing in schoolchildren. This is a cross-sectional study carried out in 2018/2019 with 1333 schoolchildren aged 7–14 years from public and private schools in Florianópolis, Brazil. Previous-day dietary intake data for breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack were collected using a validated online questionnaire. Sleep timing was measured by the midpoint of sleep and classified as quartiles (very early, early, late and very late). Latent class analysis was performed to identify meal and snack patterns, and multinomial logistic regression was used to assess associations. Students with very late sleep timing were less likely to consume the ‘coffee with milk, bread and cheese’ breakfast pattern compared with very early group. Also, the former were more likely to consume the ‘mixed’ breakfast pattern (healthy and unhealthy foods) compared with very early students. The latter were more likely to eat the ‘Brazilian traditional, processed meat, egg and fish’ lunch pattern to the late students and less likely to consume the ‘pasta and cheese’ lunch pattern compared with the students with later sleep timing. Students with later sleep timing were more likely to eat ultra-processed food at mid-afternoon snacks compared with early group. The study findings suggest that morning preference appears to promote healthier breakfast, lunch and afternoon snack patterns, whereas later sleep timing may pose challenges in maintaining healthy patterns at these meals/snacks.
Clay minerals are suitable matrices to anchor organic molecules such as antimicrobial peptides (AMPs) so that their bioactivity is maintained, enabling the formation of new materials with potential for new applications in biotechnology. The objective of the present study was to develop a nanostructured film where the properties of palygorskite (Plg) were combined at the molecular level with Dermaseptin 01 (DRS 01), in which the clay mineral also served as a substrate for the immobilization of this peptide. The films were prepared using the Layer-by-Layer (LbL) self-assembly technique. Crude palygorskite without purification (Plg IN) was subjected to physical and chemical procedures to increase its adsorptive properties. The structure, chemical composition, and morphology of Plg were investigated by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), X-ray fluorescence spectrometry (XRF), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). LbL films were adsorbed onto ITO (Indium Tin Oxide) and characterized electrochemically by cyclic voltammetry (CV), UV-Visible spectroscopy, and atomic force microscopy (AFM). For the ITO/DRS 01 and ITO/Plg/DRS 01 films, an oxidation process at +0.77 V was observed, confirming that the DRS 01 maintained its electroactive behavior and intrinsic properties. The results also showed that Plg served as excellent support for the immobilization of DRS 01, increasing its concentration and availability in the film form. This work reported immobilizing the DRS 01 peptide with Plg for the first time in an ultrathin film with bioactive properties. Thus, the film developed can be explored for applications such as biosensor devices and antimicrobial coating materials as well as other biotechnological applications.
Monte Perdido Glacier, located in the central Pyrenees, is one of the southernmost glaciers in Europe. Due to climate change, this glacier is suffering an accelerated mass loss, especially in the last decades. If the current trends persist, this glacier is expected to disappear in the next 50 years. As part of the efforts of the scientific community to increase the knowledge about this glacier, this research presents the first microstructural characterization of the Monte Perdido Glacier, focused on a high-impurity concentration segment that belongs to an ice core drilled in 2017. The results reveal the ice has a layering defined by air bubbles and non-soluble impurities. The bubble-defined layering exhibits features of both a primary (sedimentary) and a secondary (strain-induced) origin. We found a clear inverse correspondence between the particle concentration and the grains' size and roundness index. A preliminary micro-Raman characterization of the particles shows the occurrence of atacamite, anatase (likely related to ancient mining activities in the vicinity of the glacier) and quartz. The latter could be an indicator of mineral dust, probably suggesting the arrival of dust-laden air masses from the north of the African continent.
The aim of the current study was to identify and describe the meal and snack patterns (breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack) of public schoolchildren.
Design:
Cross-sectional study. Information on the previous day’s food intake was obtained through the Web-CAAFE (Food Intake and Physical Activity of Schoolchildren), an interactive questionnaire, which divides daily food consumption into three meals (breakfast, lunch and dinner) and three snacks (mid-morning, mid-afternoon and evening). Each meal contains thirty-one food items and the schoolchildren clicked on the food items consumed in each meal. Factor analysis was used to identify meal and snack patterns. The descriptions of the dietary patterns (DP) were based on food items with factor loads ≥ 0·30 that were considered representative of each DP.
Setting:
Schoolchildren, Florianopolis, Brazil.
Participants:
Children (n 1074) aged 7–13 years.
Results:
Lunch was the most consumed meal (96·0 %), followed by dinner (86·4 %), breakfast (85·3 %) and mid-afternoon snack (81·7 %). Four DP were identified for breakfast, mid-morning snack, lunch, dinner and evening snack, and three for mid-afternoon snack. Breakfast, lunch and dinner patterns included traditional Brazilian foods. DP consisting of fast foods and sugary beverages were also observed, mainly for the evening snack.
Conclusions:
The results of the current study provide important information regarding the meal and snack patterns of schoolchildren to guide the development of nutrition interventions in public health.
Palliative care (PC) aims to improve patients' and families' quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a PC team in the first PC consultation.
Method
The retrospective descriptive analysis of all first PC consultations registered in our anonymized database (December 2018–January 2020), searching for written documentation regarding (1) Edmonton Symptom Assessment Scale (ESAS) physical subscale (pain, tiredness, nausea, drowsiness, appetite, shortness of breath, constipation, insomnia, and well-being), (2) the single question “Are you depressed?” (SQD), (3) the question “Do you feel anxious?” (SQA), (4) feeling a burden, (5) hope-related concerns, (6) the dignity question (DQ), and (7) will to live (WtL).
Results
Of the 174 total of patients anonymously registered in our database, 141 PC home patients were considered for analysis; 63% were male, average age was 70 years, the majority had malignancies (82%), with a mean performance status of 52%. Evidence of written documentation was (1) ESAS pain (96%), tiredness (89%), nausea (89%), drowsiness (79%), appetite (89%), shortness of breath (82%), constipation (74%), insomnia (72%), and well-being (52%); (2) the SQD (39%); (3) the SQA (11%); (4) burden (26%); (5) hope (11%); (6) the DQ (33%); and (7) WtL (33%).
Significant differences were found between the frequencies of all documented items of the ESAS physical subscale (29%), and all documented psychosocial items (SQD + SQA + burden + DQ) (1%), hope (11%), and WtL (33%) (p = 0.0000; p = 0.0005; p = 0.0181, respectively).
Significance of results
There were differences between documentation of psychosocial, hope, and physical assessments after the first PC consultation, with the latter being much more frequent. Further research using multicenter data is now required to help identify barriers in assessing and documenting non-physical domains of end-of-life experience.
Dignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10–18).
Method
Five stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the original author's collaboration, (2) an expert committee provided feedback on the adapted version, (3) an initial consensus version of the DT-QF-Adol was created, (4) expert committee consult affirmed final consensus, and (5) validation stage with a sample of 17 adolescents followed in ambulatory psychology clinic.
Results
DT's original author endorsed the final Portuguese DT-QF-Adol, reinforcing that it captures the fundamental dimensions of DT. There was 100% agreement on the final consensus version and defined age group (10–18 years old). Twenty adolescents were invited to participate, and 17 were included after informed consent was obtained; 53% were female. The average age was 12.7 years. The interviewed adolescents reported that the DT-QF-Adol was clear, and they did not identify any ambiguity or difficulty in answering any of the questions. They assumed that this information could positively affect the way parents and friends see and cared for them, permitting others to understand their concerns and preferences. Participants felt that the DT-QF-Adol could be a good starting point for a conversation with their loved ones. Although they did not consider vital for health professionals to access their answers, they strongly felt that the DT-QF-Adol might be essential to sick adolescents and they would recommend it to others.
Significance of results
We developed a DT-QF of nine questions for Portuguese adolescents (DT-QF-Adol), coined Protocolo de Perguntas da Terapia da Dignidade para Adolescentes — 10–18 anos. This tool can potentially be considered a good addition for pediatric palliative care.
The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of a literature pervaded by a lack of conceptual and methodological self-criticism. In this article we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and a number of individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions.
We suggest an alternative explanation for the emergence of Big Gods that places less emphasis on the role of cognitive tendencies and selection of prosocial cultural variants. Instead, we argue that the fundamental motivation to reduce uncertainty and increase long-term predictability provides a better account for the rise of Big moralizing Gods in a complex and heavily regulated social environment.
In this study we examined the epibiont assemblage on shells of the living limpet Patella aspera. Limpets were collected at two sites at each of the nine islands of the Azores, totalling 707 individuals examined. Shells were measured and all the epibiota identified to the lowest taxonomic resolution possible. 190 taxa were recorded, of which 97% were algae, including 17 new records for the Azores. Only five shells were devoid of fouling organisms. The assemblage was dominated by a few algal taxa, whereas the majority of species occurred on less than 10% of the shells. A significant and positive relationship was generally found between basibiont size (shell length) and epibiota richness. The strength (slope) of the relationship, however, varied between islands and sites. These results suggest that a range of processes operating at multiple spatial scales influenced epibiont assemblages. Many features identified in these assemblages resemble, in many ways, those examined in island biogeography, suggesting that basibionts may be considered as ‘islands’ and may provide a suitable model system to test ecological hypotheses about ecosystems that are not so amenable to experimentation.
Seroprevalence of Toxocara and Taenia solium and risk factors for infection with these parasites were explored in a long-term rural settlement in São Paulo state, Brazil. An ELISA for the detection of anti-Toxocara IgG and IgE and anti-T. solium cysticerci was standardized using Toxocara excretory-secretory antigens (TES) obtained from the cultured second-stage larvae of T. canis and by vesicular fluid antigen from Taenia crassiceps cysticerci (VF). For cysticercosis, the reactive ELISA samples were assayed by Western blot using 18 kDa and 14 kDa proteins purified from VF. Out of 182 subjects, 25 (13·7%) presented anti-Toxocara IgG and a positive correlation between total IgE and the reactive index of specific anti-TES IgE (P=0·0265) was found amongst the subjects found seropositive for anti-Toxocara IgG. In these individuals 38·0% showed ocular manifestations. The frequency of anti-T. solium cysticerci confirmed by Western blot was 0·6%. Seropositivity for Toxocara was correlated with low educational levels and the owning of dogs. Embryonated eggs of Toxocara spp. were found in 43·3% of the analysed areas.
We all seem to be in favour of spirituality these days. But what are we in favour of? (Chatterjee, 1989, p xvii)
Introduction
In one of her last public interventions at a British Academy symposium on neo-evolutionary views of religion, anthropologist Mary Douglas argued that modern Man was not mentally more complex than 2,000 years ago; he was simply more confused. This thought is well illustrated by the recent history of the term ‘spirituality’, which is now widely used in an astonishing variety of ways and almost invariably with a positive connotation, although very few people seem to know what they are referring to. Central to the matter is a construction of spirituality as a universal feature of human experience addressing a feeling of a transcendent force or presence, which need not be framed within any particular theological or belief system but can instead rely solely on the individual's experience.
Many academics have embraced the popular understanding of spirituality as distinct from the religious, notwithstanding the very flaky historical grounds on which to base this differentiation. We can think of several reasons why the idea of spirituality has become socially agreeable and detached from that of religion. These include a sense of distrust and disenchantment with institutions, a search for meaning that appeals to our modern ‘homeless’ minds and sensitivities (Berger et al, 1974), and an awareness of commonalities in the different human cultures, expressed in terms like ‘global consciousness’ (Chatterjee, 1989). Spirituality is seen as addressing something deep and private within each one of us but which is also envisioned to be potentially shared by the whole humankind beyond racial, national and cultural distinctions.
However, the term elicits ambiguity, subjectivity and is read in a variety of ways within academia. The first part of the chapter discusses the major ways in which spirituality is constructed by academics. After this we move on to discuss the empirical attempts to assess spirituality as a universal experience. Our analysis of the literature, with a special focus on psychological studies, sheds a very different light on our understanding of spirituality. We suggest that the most statistically reliable measures of spirituality to date are simply assessing a human capacity to experience non-ordinary states of consciousness, a capacity which largely overlaps with partly inheritable personality traits of schizotypy or psychoticism.
The BFS method for alloys is applied to the study of Co growth on Cu(111). The parameterization of the Co-Cu system is obtained from first-principles calculations, and tested against known experimental features for low coverage Co deposition on Cu(100) and Cu(111). Atomistic simulations are performed to investigate the behavior of Co on Cu(111) as a function of coverage.
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