INTRODUÇÃO: A baixa visão na infância pode limitar as experiências de vida, a velocidade de realização de tarefas, o desenvolvimento motor, as habilidades, a educação e o desenvolvimento emocional e social, com comprometimento da qualidade de vida. O conhecimento de aspectos médico-sociais colaboram para a elaboração de ações efetivas para a reabilitação visual e a inclusão educacional. OBJETIVOS: 1)Identificar aspectos clínicos referentes a população com baixa visão em idade escolar atendida no Serviço de Visão Subnormal da Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e da Associação Brasileira de Assistência ao Deficiente Visual, com relação a causa da baixa visão, localização da anormalidade, classes de comprometimento visual, função visual atual, prescrição óptica para correção de ametropias e para auxílios para baixa visão; necessidades reabilitacionais; 2) Verificar percepção de mães ou responsáveis quanto a detecção da deficiência visual, encaminhamentos e condutas realizados por profissionais da área médica, acesso a serviços de atenção oftalmológica especializada à baixa visão, acesso a auxílios ópticos prescritos para baixa visão; 3) fornecer subsídios para desenvolvimento de ações para habilitação/reabilitação da baixa visão na infância. MÉTODOS: Realizou-se estudo transversal analítico, tendo sido estudadas a população de 115 escolares com baixa visão, sem outras deficiências associadas e a população de mães ou responsáveis pelos escolares, detectados no período de fevereiro a novembro de 2005. Realizou-se a avaliação oftalmológica dos escolares e aplicou-se questionário semi-estruturado às mães ou responsáveis. RESULTADOS: As principais causas da deficiência visual foram a retinocoroidite macular bilateral por toxoplasmose congênita (27,8%), a catarata congênita (11,3%), o albinismo oculocutâneo (7,8%) e o glaucoma congênito (6,1%); a retina foi a principal localização da afecção ocular causadora da deficiência visual (54,8%); as principais etiologias foram hereditárias (36,5%) e pré-natais infecciosas (32,1%); as classes de deficiência visual moderada(67,8%) e grave (27,0%) foram mais freqüentes;a correção óptica da ametropia foi prescrita para todos os casos de retinocoroidite macular bilateral, de amaurose congênita de Leber e de albinismo oculocutâneo; os auxílios ópticos para longe (87,8%) foram mais prescritos que os auxílios ópticos para perto (34,7%); a mãe foi a pessoa que percebeu primeiro a dificuldade visual em 53,0%; a escola foi importante na detecção de problemas visuais nos escolares com baixa visão (6,1%); o pediatra mostrou-se despreparado para a detecção de problemas visuais, tratamentos, orientação à família e encaminhamentos; diagnosticou-se a baixa visão no primeiro ano de vida em 83,0% dos casos; o encaminhamento a serviços de reabilitação visual foi realizado tardiamente ao diagnóstico e ocorreu principalmente na idade escolar (53,9%); o principal responsável pelo encaminhamento a serviços de reabilitação foi o oftalmologista(60%); a menor parte dos escolares havia sido atendida por outro serviço de reabilitação (23,0%); apesar da existência de outros serviços terciários de reabilitação visual na cidade de São Paulo, 67,0% dos responsáveis não tinha conhecimento dos mesmos. CONCLUSÕES: Verifica-se necessidade de: programas de detecção precoce de problemas visuais na infância, por meio de capacitação de pediatras em saúde ocular; programas de detecção de problemas oculares na idade escolar, em parceria com serviços de saúde e educação, como a Campanha Olho no Olho; capacitação de professores do sistema regular de ensino, quanto à saúde ocular e aspectos da baixa visão; maior acesso a auxílios ópticos prescritos à pessoa com baixa visão;educação continuada de oftalmologistas para atuação na área da baixa visão e maior divulgação das implicações da baixa visão na infância e na vida adulta e dos serviços disponíveis na comunidade. / INTRODUCTION: Low vision in childhood can limit experiences, speed in performing daily activities, sensory and motor development, educational, social and emotional improvement and compromise quality of life. Knowledge of medical and social features can cooperate to the development of effective actions to educational inclusion and visual rehabilitation. OBJECTIVES: 1. to identify clinical features of a population of school age children with low vision evaluated at the low vision service of the University of São Paulo Ophthalmology Department and the Brazilian Association for the Visually Impaired. (Laramara) concerning causes of low vision, anatomical site of the abnormality, classes of visual impairment, visual functions, use of optical correction, low vision devices and rehabiliattion needs. 2. to evaluate perceptions of mothers or the persons responsible concerning detection of the visual impairment, procedures of the professionals involved, access to low vision services and to the prescribed low vision aids. 3. to contribute to improve actions of habilitation or rehabilitation of visually impaired school children. METHODS: a population of 115 school children with visual impairment was submitted to ophthalmologic low vision evaluation and a semistructured questionnaire was applied to the mother or person responsible. RESULTS: main causes of visual impairment were presumed toxoplasmic retinochoroiditis(27,8%), congenital cataracts (11,3%), albinism (7,8%) and congenital glaucoma (6,1%). Retina (54,8%) was the main affected area and the main causes involved heredity (36,5%) or pre-natal infections (32,1%). Moderated (67,8%) and Severe (27,0%) low vision were more frequent. Glasses for refractive errors were prescribed to all with bilateral macular retinochoroiditis, Leber congenital amaurosis and albinism. Mothers were the first to notice visual impairment in the majority of cases (53,0%) and the school was also important (6,1%). Pediatricians were not very efficient in the detection of visual impaiment in these children. Low vision was detected in the first year of life in 83% and referral to visual rehabilitation unit ocurred chiefly at school age (53,9%), being the ophthalmologist the professional responsible for the majority of referrals(60%). These children, in general, never had a prior low vision examination (73%) and the mothers or responsibles had little knowledge of other available rehabilitation units in the area (67,0%). CONCLUSIONS: early detection programs for visual impairment in children and capacitation of pediatricians is important as well as the screening for refractive errors of children at school age. Regular school teachers should receive information on basic eye health and low vision. Improved access to low vision aids and increased awareness on the subject among ophthalmologists is a necessity as well as more information on community services and visual impairment should be available to the population.

Os antimicrobianos são amplamente utilizados no tratamento e prevenção de doenças do gado leiteiro. A ocorrência de resíduos de gentamicina, resultante principalmente do tratamento da mastite bovina é uma das principais causas o aparecimento de resíduos no leite. Neste estudo utilizando como técnica LC/MS-MS, foram analisadas 48 amostras de leite adquiridas em estabelecimentos comerciais, apenas uma apresentou resíduos de gentamicina no valor de 0, 112 ug/mL, superior ao LMR de 100 µg/ml estabelecido pela União Européia (UE), já para o leite in natura, das 55 amostras analisadas, quatro amostras foram positivas apresentando os valores 0,155 ug/mL, 0,192 ug/mL, 0,130 ug/ml e 0,167 ug/mL, todos acima do LMR estabelecido pela União Européia (UE). O método apresentou limite de quantificação de e 0,1 ng/mL, linearidade de 0,1-1500 ng/mL e coeficientes de determinação de 0,992557, recuperação de 91,5 % e com precisão e exatidão adequadas. Conhecer a dimensão da exposição da população a esses compostos é de fundamental importância para promover as ações de controle visando à proteção do consumidor. Desta forma as políticas de inspeção e qualidade do leite criadas pelo governo devem ser aplicadas e servir de garantia para o consumo seguro deste alimento pela população. / The antibiotics are widely used to treat and preventions diseases for dairy cattle. The occurrence of residues of gentamicin, resulting mainly from treatment of bovine mastitis are a major cause the appearance of residues in milk. In this study using the technique LC/MS-MS, were analyzed 48 samples of milk purchased in shops, only one sample present residues of gentamicin showing the value 0,112 ug/ml, exceeding the MRLs of µg/ml established by the European Union (EU) already for milk in nature, from 55 samples, four samples were positive showing the values 0,155 ug/mL, 0,192 ug/mL, 0,130 ug/ml and 0,167 ug/mL, All above the MRLs set by the European Union (EU). The method presented limit of quantification, and 0.1 ng/mL, linearity of 0,1-1500 ng/mL and coefficients of determination of 0.992557, recovery of 91.5% and with precision and accuracy appropriate. know the size of population\'s exposure to these compounds is of fundamental importance to promote measures to control aimed at protecting the consumer. Thus the politics of inspection and quality of milk created by the government should be implemented and serve as a guarantee for the safe consumption of food by the population.

INTRODUÇÃO: A violência sexual é um importante problema de saúde pública. Em São Paulo, cerca de 5% dos apenados estão cumprindo pena por crimes sexuais violentos. No Brasil e em outros países, muitos agressores sexuais retornarão à sociedade sem quaisquer intervenções psicossociais para prevenir a reincidência criminal. O objetivo deste estudo foi avaliar o consumo de álcool e de outras drogas e a impulsividade sexual entre agressores sexuais. MÉTODOS: Trata-se de estudo observacional, retrospectivo e seccional realizado na Penitenciária de Sorocaba – São Paulo. Entre julho de 2004 e setembro de 2005, todos os 218 sentenciados apenas por crimes sexuais violentos foram entrevistados, avaliando o consumo de álcool e de outras drogas, impulsividade, dependência de sexo e risco de reincidência criminal, além dos seus prontuários jurídicos revisados. 20 (9,17%) sentenciados foram excluídos da amostra. Os agressores sexuais foram divididos em três grupos: molestadores de crianças (n = 101), agressores sexuais de adolescentes (n = 56) e agressores sexuais de adultos (n = 41). Além disso, os apenados foram também divididos em outros três grupos, de acordo com o número de vítimas envolvidas: agressores sexuais de uma vítima (n = 149), agressores sexuais de duas vítimas (n = 25) e agressores sexuais de três ou mais vítimas (n = 24). RESULTADOS: 1) Agressores sexuais de adultos foram mais jovens do que os outros dois grupos de agressores sexuais (p < 0,01); 2) Agressores sexuais de adultos mostraram mais problemas com o uso de drogas do que os outros dois grupos comparados (p < 0,01); 3) Molestadores de crianças mostraram significativamente maior gravidade de dependência de álcool do que os outros dois grupos (p < 0,01); 4) Molestadores de crianças do sexo masculino mostraram maior gravidade de dependência de álcool do que os molestadores de crianças do sexo feminino (p < 0,01); 5) Agressores sexuais seriais apresentaram significativamente maior nível de impulsividade do que os agressores não seriais (p < 0,01); 6) Agressores sexuais seriais registraram mais freqüentemente história de abuso sexual na infância do que os agressores sexuais de uma vítima (p < 0,01). CONCLUSÕES: O consumo de substâncias psicoativas pode ser um dos fatores de distinção entre molestadores de crianças e agressores sexuais de adultos. História de abuso sexual e altos níveis de impulsividade podem estar associados com a repetição do comportamento sexualmente agressivo. / INTRODUCTION: Sexual violence is an important public health problem. In São Paulo, about 5% of male prison inmates are serving a sentence for a serious sexual offense. In Brazil and other countries, many sexual offenders will return home without any psychosocial interventions to prevent recidivism. The aim of this study was to evaluate the role of alcohol and drug consumption and the sexual impulsivity level among sexual offenders. METHODS: It was an observational, retrospective and cross-sectional study carried out inside the Penitentiary of Sorocaba – São Paulo. From July 2004 to September 2005, all 218 convicts sentenced only for sexual crimes were evaluated with reference to alcohol and drug use, impulsivity, sexual addiction, recidivism risk and their juridical reports were reviewed. 20 (9.17%) recruited convicts were excluded from the sample. The sexual offenders were divided in three groups, such as children molesters (n= 101), sexual aggressors against adolescents (n = 56) and sexual offenders against adults (n = 41). Moreover, the sexual offenders were also divided in three groups with reference to the number of involved victims, such as sexual aggressors against one victim (n = 149), sexual offenders against two victims (n = 25) and sexual offenders against three or more victims (n = 24). RESULTS: 1) Sexual offenders against adults were found to be significantly younger than children molesters and sexual offenders against adolescents (p < 0.01); 2) Sexual offenders against adults had more difficulties with drug use than the comparison groups (p < 0.01); 3) Children molesters showed significantly higher severity of alcohol dependence than the comparison groups (p < 0.01); 4) Children molesters against boys showed significantly higher severity of alcohol dependence than children molesters against girls (p < 0.01); 5) Serial sexual offenders had significantly higher impulsivity level than nonserial sexual offenders (p < 0.01); 6) Serial sexual offenders reported significantly more personal history of being sexually abused than nonserial sexual offenders (p < 0.01). CONCLUSIONS: Substance use may be one of the distinguishing factors between offenders who target children and those who target adults. History of sexual abuse and high impulsivity levels may be associated with the repetition of sexual aggression.

O lítio é freqüentemente utilizado no tratamento do Transtorno Bipolar, doença associada a um risco aumentado para demência. Evidências experimentais sugerem efeitos neuroproterores do lítio. O lítio inibe a amiloidogênese e a fosforilação da proteína tau tanto in vitro como in vivo. Estes são processos importantes na patogênese da doença de Alzheimer. O objetivo este estudo foi a investigação do efeito do lítio na prevalência de Transtorno Cognitivo Leve e doença de Alzheimer em 114 bipolares idosos eutímicos. Todos os sujeitos completaram uma avaliação catamnéstica, psicopatológica e cognitiva que incluía o mini-exame do estado mental (Mini-mental), o teste cognitivo de Cambridge (CAMCOG) e o questionário do informante sobre o declínio cognitivo do idoso (IQCODE). Foi feita uma comparação da prevalência de Transtorno Cognitivo Leve e doença de Alzheimer entre pacientes em uso de lítio e pacientes em uso de outros estabilizadores de humor. Os sujeitos que entraram na pesquisa tinham em média 68,2 ± 5,0 anos e preenchiam os critérios da Décima Revisão da Classificação Internacional de Doenças e Problemas de Saúde Relacionados (CID-10) para o transtorno bipolar. Durante a avaliação os bipolares estavam eutímicos. Eutimia foi definida como uma pontuação máxima de 7 pontos na escala de Hamilton de 21 pontos para Depressão e 4 na escala de Young para mania. 66 pacientes em uso contínuo do lítio por 6 anos em média foram comparados com 48 pacientes em tratamento com outros estabilizadores de humor. O diagnóstico de Transtorno Cognitivo Leve foi feito de acordo com os critérios de Petersen(1999) e de doença de Alzheimer de acordo com o critério do “National Institute for Communicative Disorders and Stroke - Alzheimer’s Disease and Related Disorders Association” (NINCDS/ADRDA). A prevalência de demência nesta amostra (19,4%) foi mais elevada do que o esperado para uma população comparável (7,1%). A prevalência de doença de Alzheimer entre aqueles com lítio foi 4,5% quando comparada com 33,3% entre aqueles sem lítio. Controlando idade e outras variáveis relacionadas ao curso da doença, o efeito do lítio na prevalência de doença de Alzheimer permaneceu significativo (OR = 0,079; p < 0,001). Nenhuma associação foi encontrada com Transtorno Cognitivo Leve. A alta da prevalência de doença de Alzheimer neste estudo está de acordo com as evidências de risco aumentado para demência em pacientes bipolares. Nesta amostra o tratamento com lítio reduziu a prevalência de Alzheimer aos níveis da população idosa em geral. Estes achados estão de acordo com os efeitos neuroprotetores do lítio em eventos cruciais para a patologia da doença de Alzheimer. Estudos prospectivos são necessários para avaliar se o lítio também pode ser efetivo na prevenção de doença de Alzheimer em outras populações. / Lithium is widely used in the treatment of bipolar disorder, a condition associated with an increased risk for dementia. Experimental evidence suggests that lithium has a neuroprotective effect. Both in vitro and in vivo, lithium inhibits amyloidogenesis and phosphorilation of tau protein, which are two crucial processes in the pathogenesis of Alzheimer’s disease. The objective of this study was to investigate the effect of lithium on the prevalence of Mild Cognitive Impairment and Alzheimer’s disease in 114 elderly euthymic bipolar patients. Subjects completed a thorough catamnestic, psychopathological and cognitive tests evaluation including the Mini-mental state evaluation, Cambridge cognitive test (CAMCOG) and the informant questionnaire on cognitive decline in the elderly (IQCODE). The prevalence of Mild Cognitive Impairment and Alzheimer’s disease between patients on lithium therapy and patients on treatment with other mood-stabilizing drugs was compared. Patients were 68.2 ± 5.0 years old and fulfilled of the International Classification of Diseases - 10th Revision (ICD-10) diagnosis for bipolar disorder. At the time of the evaluation patients were euthymic, as defined by a maximum score of 7 in the 21-item Hamilton Rating Scale for Depression, and 4 in the Young Mania Rating Scale. Sixty-six patients were continuously being treated with lithium for six years, on average, and 48 patients were receiving other mood-stabilizing drugs. Diagnosis of Mild Cognitive Impairment was made according to Petersen (1999) and of Alzheimer’s disease was made according to the National Institute for Communicative Disorders and Stroke - Alzheimer’s Disease and Related Disorders Association (NINCDS/ADRDA) criteria. The overall prevalence of dementia in our sample (19.4%) was higher than the prevalence expected in the age-comparable general population (7.1%). The prevalence of Alzheimer’s disease among lithium users was 4.5% as compared to 33.3% among non-users. After controlling for age and other variables related to the clinical course of the bipolar disorder, the effect of lithium on Alzheimer’s disease prevalence remained significant (OR = 0.079; p < 0.001). No association was found with Mild Cognitive Impairment. The higher prevalence of Alzheimer’s disease in our study supports the reports of increased risk for dementia in bipolar patients. In our sample, lithium treatment reduced the prevalence of Alzheimer’s disease to the levels of the general elderly population. This finding is in line with the neuroprotective effects of lithium on crucial events for the pathology of Alzheimer’s disease. Further prospective studies are needed to clarify whether lithium may also be effective in the prevention of Alzheimer’s disease in the general population.

Chung, Jennifer Siu Toye. / "June 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 145-157). / Abstracts in English and Chinese, some text in appendix also in Chinese. / Abstract of Thesis in English --- p.i / Abstract of Thesis in Chinese --- p.iii / Acknowledgments --- p.v / List of Tables --- p.xi / List of Figures --- p.xiii / List of Abbreviations --- p.xiv / List of Publications and Presentations related to Thesis --- p.xvi / Contributions related to Thesis --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Introduction of the Thesis --- p.1 / Chapter 1.2 --- Review on Coronary Heart Disease --- p.3 / Chapter 1.2.1 --- Definition of Coronary Heart Disease --- p.3 / Chapter 1.2.2 --- Risk factors for the development of Coronary Heart Disease --- p.3 / Chapter 1.2.3 --- Worldwide Figures for Coronary Heart Disease --- p.9 / Chapter 1.2.4 --- Coronary Heart Disease in Asia Pacific --- p.10 / Chapter 1.2.5 --- Coronary Heart Disease in Hong Kong --- p.11 / Chapter 1.3 --- Dyslipidaemia --- p.14 / Chapter 1.3.1 --- Lipid Transport and Lipoprotein Metabolism --- p.14 / Chapter 1.3.2 --- Definition and Classification of Dyslipidaemia --- p.16 / Chapter 1.3.3 --- Coronary Heart Disease and Dyslipidaemia --- p.17 / Chapter 1.3.4 --- Lifestyle Modifications for the Management of Dyslipidaemia --- p.19 / Chapter 1.3.4.1 --- Dietary Measures --- p.20 / Chapter 1.3.4.2 --- Cigarette Smoking --- p.23 / Chapter 1.3.4.3 --- Physical Activity --- p.24 / Chapter 1.3.4.4 --- Weight Control --- p.25 / Chapter 1.3.5 --- Lipid-lowering Drug Therapy for Dyslipidaemia --- p.29 / Chapter 1.3.5.1 --- Statins --- p.31 / Chapter 1.3.5.2 --- Bile Acid Sequestrants --- p.35 / Chapter 1.3.5.3 --- Fibrates --- p.36 / Chapter 1.3.5.4 --- Ezetimibe --- p.37 / Chapter 1.3.5.5 --- Nicotinic Acid Group --- p.38 / Chapter 1.4 --- International Guidelines for Dyslipidaemic Management --- p.39 / Chapter 1.4.1 --- National Service Framework for Coronary Heart Disease (UK) --- p.39 / Chapter 1.4.1.1 --- National Service Framework Lipid-lowering Goals --- p.40 / Chapter 1.4.1.2 --- The Joint British Societies' Guidelines --- p.41 / Chapter 1.4.1.3 --- Achievement of the NSF Lipid Profile Targets --- p.42 / Chapter 1.4.2 --- National Cholesterol Education Program (United States) --- p.43 / Chapter 1.4.2.1 --- The Third Report of the National Cholesterol Education Program --- p.43 / Chapter 1.4.2.2 --- Review of Clinical Trials --- p.43 / Chapter 1.4.2.3 --- Low-Density Lipoprotein Cholesterol Goal Targets --- p.46 / Chapter 1.4.2.4 --- Compliance with the NCEP ATP III Guidelines --- p.48 / Chapter 1.4.3 --- Dyslipidaemic Guidelines for Study --- p.51 / Chapter 1.5 --- Clinical Pharmacy Services --- p.52 / Chapter 1.5.1 --- The Healthcare System in Hong Kong --- p.52 / Chapter 1.5.2 --- Clinical Pharmacy Services in Hong Kong --- p.54 / Chapter 1.5.3 --- Examples of successful Clinical Pharmacy Services --- p.55 / Chapter 1.5.3.1 --- Hypertension Clinic --- p.55 / Chapter 1.5.3.2 --- Diabetes Mellitus Clinic --- p.56 / Chapter 1.5.3.3 --- Smoking Cessation Clinic --- p.57 / Chapter 1.5.3.4 --- Anticoagulation Clinic --- p.57 / Chapter 1.5.3.5 --- Haematology-oncology Clinic --- p.57 / Chapter 1.5.4 --- Pharmacist-managed Lipid Clinics --- p.58 / Chapter 1.6 --- Objective & General Aims of the Study --- p.60 / Chapter 1.6.1 --- Objectives --- p.60 / Chapter 1.6.2 --- Study Hypothesis --- p.60 / Chapter 1.6.3 --- General Aims of the Study --- p.60 / Chapter Chapter 2 --- Methodology of Study --- p.62 / Chapter 2.1 --- Background Setting --- p.62 / Chapter 2.2 --- Subject Selection and Recruitment --- p.62 / Chapter 2.3 --- Intervention and Control Groups --- p.63 / Chapter 2.4 --- Validation of Survey --- p.67 / Chapter 2.5 --- Data Collection --- p.67 / Chapter 2.6 --- Outcome Measures --- p.68 / Chapter 2.6.1 --- Lipid value changes --- p.68 / Chapter 2.6.2 --- Compliance rate with medications --- p.68 / Chapter 2.6.3 --- Patient satisfaction survey assessment --- p.69 / Chapter 2.6.4 --- Time spent and Cost of clinical pharmacist --- p.69 / Chapter 2.7 --- Statistical Analysis --- p.70 / Chapter 2.7.1 --- Sample Size Calculation --- p.70 / Chapter 2.7.2 --- Methods of Statistical Analysis --- p.71 / Chapter Chapter 3 --- Results of Study --- p.72 / Chapter 3.1 --- Recruitment Details --- p.72 / Chapter 3.2 --- Demographic Characteristics of Patients --- p.73 / Chapter 3.3 --- Drug Therapy of Patients during Study Period --- p.75 / Chapter 3.4 --- LDL-C Lowering Potency of Statin Doses Prescribed --- p.80 / Chapter 3.5 --- Coronary Heart Disease Risk Category of Patients --- p.84 / Chapter 3.6 --- Lipid Profile Changes --- p.85 / Chapter 3.7 --- NCEP ATP III LDL-C Goal Attainment --- p.87 / Chapter 3.8 --- Relationship between Patient Characteristics and LDL-C Goal Attainment --- p.91 / Chapter 3.9 --- Compliance with Medications --- p.94 / Chapter 3.10 --- Pharmacist Intervention --- p.98 / Chapter 3.10.1 --- Range of Pharmacist Intervention --- p.98 / Chapter 3.10.2 --- Time spent by Pharmacist --- p.100 / Chapter 3.10.2.1 --- Time spent on Documentation --- p.100 / Chapter 3.10.2.2 --- Time spent on Direct Communication with Patients --- p.101 / Chapter 3.10.3 --- Cost of Clinical Pharmacy Service at the Lipid Clinic --- p.102 / Chapter 3.10.3.1 --- Cost of Pharmacist Involvement --- p.102 / Chapter 3.10.3.2 --- Potential Healthcare Cost Saving --- p.103 / Chapter 3.11 --- Clinical Pharmacy Service Satisfaction Survey --- p.105 / Chapter 3.11.1 --- Validation of Survey --- p.105 / Chapter 3.11.2 --- Questionnaire Survey for Intervention and Control Groups --- p.107 / Chapter 3.11.3 --- Physician Questionnaire Survey on Clinical Pharmacy Service --- p.110 / Chapter Chapter 4 --- Discussion --- p.111 / Chapter 4.1 --- Clinical Outcomes of Study --- p.111 / Chapter 4.1.1 --- Changes in Lipid Parameters --- p.111 / Chapter 4.1.2 --- Reduction in CHD risk --- p.113 / Chapter 4.1.3 --- Attainment in NCEP ATP III LDL-C goals --- p.114 / Chapter 4.1.4 --- Predictors for LDL-C Goal Attainment --- p.117 / Chapter 4.2 --- Drug-related Problems --- p.119 / Chapter 4.2.1 --- Statin Dosing and LDL-C Lowering Potency --- p.119 / Chapter 4.2.2 --- Adherence to Drug Therapy --- p.121 / Chapter 4.2.3 --- Polypharmacy --- p.126 / Chapter 4.2.4 --- Adverse Drug Events and Drug Interactions --- p.129 / Chapter 4.2.5 --- Patient Busy Lifestyle --- p.131 / Chapter 4.3 --- Role of Clinical Pharmacist --- p.133 / Chapter 4.3.1 --- Role of Pharmacist --- p.133 / Chapter 4.3.2 --- Multidisciplinary Team --- p.135 / Chapter 4.3.3 --- Healthcare Cost Saving --- p.137 / Chapter 4.4 --- Limitations of Study --- p.139 / Chapter 4.5 --- Further Study --- p.142 / Chapter Chapter 5 --- Conclusion --- p.144 / Chapter 5.1 --- Conclusion of Study --- p.144 / Bibliography --- p.145 / Appendices --- p.158 / Appendix I Data collection form --- p.158 / Appendix II Information sheet on study protocol to patient --- p.160 / Appendix III Patient consent form for study --- p.164 / Appendix IV Framingham risk scoring system for male --- p.165 / Appendix V Framingham risk scoring system for female --- p.166 / Appendix VI Patient educational leaflet --- p.167 / Appendix VII Physician-pharmacist communication sheet --- p.169 / Appendix VIII Telephone checklist --- p.170 / Appendix IX Questionnaire survey provided to Intervention Group --- p.172 / Appendix X Questionnaire survey provided to Control Group --- p.174 / Appendix XI Questionnaire survey provided to Physicians --- p.176

Introduction. The HIV prevalence among men who have sex with men (MSM) in China keeps increasing sharply. A high proportion of the MSM in China have male regular sex partner (RP) and prevalence of unprotected anal intercourse (UAI) involving such RP is higher than when non-RP is involved. Trust, intimacy and cognitive factors are the factors associated with UAI with RP. Several cross-sectional studies have been demonstrated the important factors associated with UAI with RP among MSM in China. However, no study about intervention for MSM-RP is found to be conducted. To reduce UAI with RP, an intervention tailored to RP is urgently developed and identified its efficacy. / Objectives. The study aimed to describe the prevalence of UAI, as well as of which associated factors among MSM-RP in Beijing and Chengdu, China, and to evaluate the efficacy of an enhanced HIV voluntary counseling and testing (VCT) in increasing condom use with RP among MSMRP in China by a randomized controlled trial (RCT). / Subjects and Methods. A cross-sectional survey and a randomized controlled trial have been conducted. For the cross-sectional survey, total 307 HIV negative MSM who have RP have been recruited by three ways. Face to face interview has been conducted to participants. Based on the associated factors found in the cross-sectional survey, interventions including video, education leaflets and enhanced counseling contents have been tailored to RP among MSMRP. For the randomized controlled trial, total 336 MSMRP have been recruited and randomly assigned 169 subjects to the Intervention Group in which participants have been given enhanced VCT plus an audio-visual and four leaflets components and 167 subjects to the Control Group in which participants have been given only standard-of-care VCT at the baseline. Evaluation was conducted at Month 3 and 6. Statistical methods such as descriptive analyses, Chi-square test and logistic regression were used in this study. / Results. The results have been found were the prevalence of UAI with RP among MSMRP was 52.4%, and the Theory of Planned Behavior (TPB) related cognitions, trust, intimacy, depression and anxiety were associated with UAI with RP among MSMRP. In the RCT study, participants in the Intervention Group had less UAI (36.1% vs. 49.1%) than those of the Control Group at Month 3. / Conclusions. This study showed a high prevalence of UAI among MSMRP, whilst trust, intimacy and cognitive factors were associated with UAI with RP. The efficacy of Enhanced VCT tailored to RP has been identified. The acceptability and feasibility of the tailored intervention were demonstrated. In the future HIV prevention programs, the effective intervention should be considered to be incorporated into standard-of-care VCT procedures and be implemented in the specific population. / 介紹：中國男男性接觸者中的愛滋病發病率一直保持著上升的狀態。而在中國男男性接觸者中有很大比例存在著固定性伴侶。男男性接觸者同固定性伴發生無保護肛交行為的比例大於其同非固定性伴。信任，親密以及認知因素已經被證實是影響男男性接觸者同其固定性伴發生無保護肛交行為的因素。但是在中國還沒有發現專門針對有固定性伴的男男性接觸者的干預研究。為了降低男男性接觸者同其固定性伴的無保護肛交的發生率，針對有固定性伴的男男性接觸者的干預方法應該被發展同時證實其有效性。 / 目的：本研究目的在於調查北京及成都男男性接觸者的固定性伴的比例，及其影響因素，包括健康行為理論的影響因素以及人際關係因素。同時，本研究也驗證了以隨機對照實驗來評估針對有固定性伴男男性接觸者的提高型愛滋病自願檢測諮詢對減少其高危性行為的效果。 / 對象與方法：本研究由橫斷面研究以及隨機對照試驗組成。在橫斷面調查中，307名愛滋病陰性的有固定性伴的男男性接觸者被招募。基於在橫斷面調查中發現的對男男性接觸者與固定性伴間發生無保護性行為的影響因素，一項專門針對有固定性伴的男男性接觸者的提高型愛滋病自願檢測諮詢干預方法被發展應用了隨機對照試驗中已驗證其有效性。在隨機對照試驗中，169名和167名研究對象被招募並分別被隨機分配到干預組（接受提高型愛滋病自願檢測諮詢）和對照組（接受標準型愛滋病自願檢測諮詢）中。分別於干預後的3個月和6個月回訪進行干預結果的評估。在本次研究中，運用了卡方检验和logistic回歸等統計學方法。 / 結果：在橫斷面調查中發現，男男性接觸者同固定性伴的無保護肛交發生率為52.4%。影響與固定性伴無保護肛交的因素包括：健康行為理論（TPB）相關的認知，信任，親密以及抑鬱和焦慮。在隨機對照試驗中發現，在3個月隨訪中干預組的男男性接觸者與固定性伴發生無保護肛交的比例較對照組明顯降低（36.1% vs. 49.1%）。 / 結論：本研究結果顯示中國男男性接觸者的固定性伴的比例很高，同時幾乎一半的有固定性伴的的男男性接觸者同時有多個性伴，這就有增加感染愛滋病及其他性病的風險。一項針對有固定性伴的男男性接觸者設計的提高型愛滋病自願檢測諮詢方法在降低其危險性行為上的可接受性和有效性已經被證實。提示在今後的愛滋病干預項目中可以進一步的推廣應用。 / Li, Chunrong. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 149-178). / Abstracts and appendixes also in Chinese. / Title from PDF title page (viewed on 05, October, 2016). / Li, Chunrong. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

O presente estudo teve como objetivo avaliar os compostos carbonílicos na atmosfera da cidade de São Paulo. Para tal medidas de carbonílicos foram feitas empregando metodologia analítica já existente. A influência do ozônio na geração de artefatos durante a amostragem de compostos carbonílicos empregando sorventes sólidos, como C18 e sílica, observada em amostragens diurnas e noturnas ( ausência de O3) permitiu estabelecer um protocolo de amostragem que recomenda a utilização de um coletor de O3 na entrada do cartucho de sílica impregnado com 2,4-dinitro-fenil-hidrazina (DNPH) para evitar possíveis artefatos de amostragem. Os compostos carbonílicos presentes na fase gasosa da atmosfera da cidade de São Paulo foram medidos durante o inverno de 1999, em dois sítios distintos, Cidade Universitária (CID) e Água Funda (AF). Semelhante a outras regiões urbanas do mundo, os carbonílicos majoritários foram formaldeído (0,6-46,7 ppbv) e acetaldeído (1,2-75,3 ppbv). Os carbonílicos de peso molecular maior (>C2) tiveram abundância relativa de 20-40%, sendo acetona (0,3-13,0 ppbv), acroleína (0,1-5,2 ppbv), propionaldeído (0,5-8,5 ppbv), isômeros C4 (0,1-2,4 ppbv), benzaldeído (0,1-5,4 ppbv), valeraldeído (0,1-3,5 ppbv), m-tolualdeído (0,1-2,4 ppbv) e hexaldeído (0,1-4,5 ppbv). As razões de concentração para acetaldeído/formaldeído > l em julho sugerem que a contribuição das emissões diretas é predominante. Já no mês de agosto, foi observada uma diminuição das razões médias, 1,1-1,3 (manhã), 0,7-0,8 (meio-dia) e 0,6 (tarde), indicando que há contribuição de emissões diretas na manhã e nos outros períodos prevalece a formação fotoquímica in situ. Neste trabalho, a influência de parâmetros meteorológicos nos níveis dos compostos carbonílicos foi verificada em alguns eventos. Foram propostas fontes de emissão através de correlações com CO e O3. As correlações no sítio CID em agosto mostraram que a contribuição das emissões veiculares é muito importante pela manhã, mas a influência dos processos fotoquímicos foi observada nos períodos seguintes. Finalmente, considera-se que este trabalho contribuiu para uma compreensão atual sobre o panorama dos carbonílicos na cidade e para o estudo em grande escala que permitirá diagnosticar e prever os episódios de poluição na cidade de São Paulo. / The goals of this study were to evaluate the carbonylic compounds in the atmosphere of São Paulo City. To accomplish this, measures were carried out using the pre-existent analytical methodology. The ozone influence in artifacts generation during carbonyls sampling using solid sorbents such as C18 and silica, observed through day and night samples, allowed to establish a sampling protocol which recommends the utilization of an ozone scrubber at the upstream end of the DNPH-impregnated silica cartridge to avoid eventual sarnpling artifacts. Carbonyl compounds present in the gaseous phase of São Paulo atmosphere were measured during winter, 1999, at two different sites, Cidade Universitária (CID) and Água Funda (AF). As observed in other urban regions of the world, the major carbonyls were formaldehyde (0,6-46, 7 ppbv) e acetaldehyde (1,2-75,3 ppbv). Toe higher molecular weight carbonyls (>C2) showed relative abundances of 20-40%, being acetone (0,3-13,0 ppbv), acrolein (0,1-5,2 ppbv), propionaldehyde (0,5-8,5 ppbv), isomers C4 (0,1-2,4 ppbv), benzaldehyde (0,1-5,4 ppbv), valeraldehyde (0,1-3,5 ppbv), m-tolualdehyde (0,1-2,4 ppbv) and hexaldehyde (0,1-4,5 ppbv). The acetaldehyde/formaldehyde (A/F) ratio >1 in July suggests that direct emissions influence is predominant. In August, a decrease in average concentration was observed, 1,1-1,3 (morning), 0,7-0,8 (midday) and 0,6 (evening), indicating the direct emissions contribution in the morning, while for the other periods the in situ photochemical formation prevails. At the present work, the influence of meteorological parameters in carbonyls levels was also pointed out for some events. The emission sources are proposed by calculating the correlations between carbonyls and CO and O3. The correlations found for the CID site in August showed that the vehicular emissions are very important in the morning, but the influence of photochemical processes was observed in the subsequent periods. Finally, this work contributed to a current comprehension of the carbonyls panorama in the city and for the large scale study that will allow the diagnosis and mimic of the urban chemical environment in São Paulo City.

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

INTRODUÇÃO: A incapacidade física e psicológica, incluindo o medo de quedas, está relacionada à diminuição da satisfação com a vida na osteoporose (OP). O impacto de um programa de treino de equilíbrio para melhorar a qualidade de vida não está bem estabelecido. O objetivo deste estudo, portanto, foi investigar a eficácia que um programa de treino de equilíbrio, realizado durante um período de 12 meses, pôde provocar na qualidade de vida, no equilíbrio funcional e nas quedas em mulheres idosas com osteoporose. MÉTODOS: Sessenta mulheres com OP senil (idade: 65 a 85 anos) do Ambulatório de Doenças Osteometabólicas foram randomizadas e divididas em 2 grupos: Grupo Equilíbrio (GE) 30 pacientes que realizaram intervenção e Grupo Controle (GC) 30 pacientes sem intervenção. O programa de treino de equilíbrio incluiu técnicas para melhorar o equilíbrio durante o período de 12 meses (1sessão de 1h/semana de exercícios complementados com exercícios feitos em casa). A qualidade de vida foi avaliada antes e no final do estudo utilizando o questionário Osteoporosis Assessment Questionnaire (OPAQ), o equilíbrio funcional foi avaliado pela escala Berg Balance Scale (BBS). As quedas no ano anterior foram anotadas e comparadas durante o período de estudo. RESULTADOS: A comparação dos domínios do OPAQ (INICIAL - FINAL) revelou uma melhora significativa da qualidade de vida em todos os parâmetros do GE em relação ao GC: bem-estar geral (1,61 ± 1,44 vs. -1,46 ± 1,32, p <0,001), função física (1,30 ± 1,33 vs. -0,36 ± 0,82, p<0,001), estado psicológico (1,58 ± 1,36 vs. -1,02 ± 0,83, p <0,001), sintomas (2,76 ± 1,96 vs. -0,63 ± 0,87, p <0,001), interação social (1,01 ± 1,51 vs. 0,35 ± 1,08, p <0,001). Esse benefício global foi acompanhado por uma melhora da escala de equilíbrio BBS (-5,5 ± 0,5 vs. 5,67 ± 4,88 p <0,001) e da redução das quedas em 50% no GE vs. 26,6% para o GC (RR: 1,88, p <0,025). CONCLUSÃO: O programa de treino de equilíbrio para mulheres com OP, realizado por 12 meses, proporcionou uma melhor qualidade de vida e uma melhora no estado de saúde global paralelamente aos benefícios no equilíbrio funcional e na redução das quedas / INTRODUCTION: Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise programs on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women. METHODS: Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study. RESULTS: The comparison of OPAQ variations (INITIAL-FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61 ± 1.44 vs. -1.46 ± 1.32, p<0001), physical function (1.30 ± 1.33 vs. 0.36 ± 0.82, p<0.001), psychological status (1.58 ± 1.36 vs. 1.02 ± 0.83, p<0.001), symptoms (2.76 ± 1.96 vs. 0.63 ± 0.87, p<0.001), social interaction (1.01 ± 1.51 vs. 0.35 ± 1.08, p<0.001). Of note, this overall benefit was paralleled by an improvement of BBS (-5.5 ± 5.67 vs. +0.5 ± 4.88 p<0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p<0.025). CONCLUSION: The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls

This thesis examines the Schultz Fire as a case study to explain the complex history of fire suppression management in America’s forests, and to gain further understanding of how management practices have affected the increase in fire severity levels and how forests respond to such a disturbance. The thesis objectives were: (1) to analyze the causes of the fire severity of the Schultz Fire, especially: topography, fuels, or weather; (2); to examine the possible correlation between fire severity and tree density; (3) to investigate whether post-fire species richness was related to fire severity two years after the Schultz Fire; (4) to investigate whether post-fire plant species richness, plant cover, and tree regeneration was related to fire severity two years after the Schultz Fire; and (5) to interlink and convey how these factors relate to the history of fire management and policy and public perception. The history of fire related policy and management has significantly changed the dynamics of America's national parks and forests. Understanding the larger context of this history, both of national fire management and of the effects of language and perception on policy and public reaction, is part of understanding the Schultz Fire as a whole. Based on modeling, high winds combined with the presence of high surface fuel load were the main causes of the Schultz Fire's high fire severity levels. As fire severity increased there was a statistically significant increase in species richness. Severity level had little variation on percentage of cover by plants. No statistically significant relationship between tree density and fire severity levels was found. These findings underline the need for fuel treatments in southwest Ponderosa Pine forests, and effective cooperation between communities, managers, and ecologists. The Schultz Fire serves as an example in understanding the intricacies of how history affects the present and future of fire management. How fire has been managed and portrayed in the past has left an indelible mark on how fire is presently viewed. Without a clear understanding of the history of fire management and the role of fire in the ecology, future policies towards fire will be unable to account for and manage for the diversity of ecosystems and fires effects on those ecosystems across the United States. / Graduation date: 2013