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The incidence of postoperative nausea and vomiting (PONV) is unknown in neuraxial anesthesia for orthopedic surgery. The effect on PONV of adding gabapentin to an evidence-based antiemetic regimen as part of an opioid-sparing analgesic protocol is also unknown in this population. A retrospective analysis of all adults undergoing hip and knee arthroplasty and receiving neuraxial anesthesia in 2017 was conducted. The overall incidence of PONV was assessed. Additionally, PONV incidence was assessed for all combinations of gabapentin, dexamethasone, and/or ondansetron (in addition to propofol infusion) and compared with propofol alone. The PONV risk ratios were estimated, adjusting for age and PONV risk score. The overall incidence of PONV was 14.0%. The addition of gabapentin to propofol was associated with reduced PONV (multivariable risk ratio [mRR], 0.6; 95% CI, 0.4-1.0) vs propofol alone. Dexamethasone with propofol was associated with reduced PONV (mRR 0.6; 95% CI, 0.4-1.1) vs propofol alone, although not statistically significant. The addition of both gabapentin and dexamethasone to propofol was associated with stronger reduction in PONV (mRR 0.3; 95% CI, 0.1-0.7) vs propofol alone. Adding ondansetron to propofol showed little benefit. Gabapentin and dexamethasone are effective in reducing PONV in patients undergoing knee and hip arthroplasty with neuraxial anesthesia.

No / Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). SETTING: Six general practices in the West Midlands, England. PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration >/= 7 mmol/L and antihypertensive prescribing only with blood pressure >/= 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures >/= 140/90 mm Hg and with 10-year cardiovascular risk. LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.

The global spread of HIV and Aids has greatly exceeded the most pessimistic projections. Infection rates are not declining and human tragedy is escalating. South Africa is a nation in mourning. If one is not infected, one is affected. Notwithstanding the catastrophic effects that are already being experienced, the full consequences of the pandemic seem yet to be felt. Developmental psychology and ecological systems theory were used in this study to examine the research problem. It has become necessary to determine the level of knowledge that adolescents have of HIV and Aids and whether Life Skills programmes stimulate any change in behaviour. This initially took the form of a quantitative study in which questionnaires were administered. A combination of quantitative and qualitative research (focus group interviews) was applied for verification. The goals of the research were achieved, providing valuable findings, confirming that there has been no behaviour change and adolescent knowledge remains inadequate. South African adolescents have insufficient knowledge of responsible sexual behaviour. Recommendations with regard to the content and course of the programme as well as further research are formulated as a result of the conclusions. / Educational Studies / M.Ed. (Socio-Education)

Text in English / The purpose of this study was to investigate the role and challenges of AIDS Councils in addressing HIV and AIDS in their communities with regard to community mobilization and advocacy within the broader advocacy function of the South African National AIDS Council (SANAC) and within the framework of the HIV & AIDS and STI Strategic plan for South Africa 2007-2011(NSP). A qualitative research design was applied. Individual face to face interviews were conducted with the respondents who were purposively sampled across the five local municipalities comprising Ehlanzeni District Municipality. Similar studies conducted previously suggest that many AIDS Councils stakeholders and members had a limited understanding of their role, and encountered more challenges in addressing HIV and AIDS in their communities. This study revealed that stakeholders and members seem to have steadily progressed in understanding their role as well as in weathering the various challenges they are confronted with within the AIDS councils. Be that as it may, there still exists some gaps between what is envisaged in both the NSPs (NSP 2000-2005 and NSP 2006-2011) and the current situation in many LACs. Many questions still need to be answered if South Africans are prepared to triumph over the AIDS pandemic. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV and AIDS))

Text in English / The purpose of this study was to investigate the role and challenges of AIDS Councils in addressing HIV and AIDS in their communities with regard to community mobilization and advocacy within the broader advocacy function of the South African National AIDS Council (SANAC) and within the framework of the HIV & AIDS and STI Strategic plan for South Africa 2007-2011(NSP). A qualitative research design was applied. Individual face to face interviews were conducted with the respondents who were purposively sampled across the five local municipalities comprising Ehlanzeni District Municipality. Similar studies conducted previously suggest that many AIDS Councils stakeholders and members had a limited understanding of their role, and encountered more challenges in addressing HIV and AIDS in their communities. This study revealed that stakeholders and members seem to have steadily progressed in understanding their role as well as in weathering the various challenges they are confronted with within the AIDS councils. Be that as it may, there still exists some gaps between what is envisaged in both the NSPs (NSP 2000-2005 and NSP 2006-2011) and the current situation in many LACs. Many questions still need to be answered if South Africans are prepared to triumph over the AIDS pandemic. / Sociology / M. A. (Sociology (Social Behaviour Studies in HIV and AIDS))

O etanol de cana-de-açúcar se consolida como combustível renovável, o que promove nova expansão da cultura da cana-de-açúcar no Brasil e, principalmente, no Estado de São Paulo. Como a queima prévia controlada da palha de cana-de-açúcar ainda é considerada uma prática agrícola necessária para a viabilização econômica da colheita, em mais de 70% dos municípios do Estado de São Paulo a população é obrigada a conviver com essa poluição. Para estudar a distribuição desse fator de risco e sua relação com a saúde, realizei um estudo epidemiológico ecológico nos 645 municípios de São Paulo. Usei um modelo Bayesiano de regressão multivariada relacionando os efeitos na saúde com a exposição à queima prévia da palha de cana-de-açúcar, sendo controlados os efeitos das variações socioeconômicas (saneamento, educação e renda) e climáticas (temperatura máxima, umidade mínima e precipitação), através da inserção das mesmas no modelo. O efeito sobre a saúde foi medido por meio da Razão de Mortalidade e Morbidade Padronizada (RMP) dos desfechos: óbitos por doenças respiratórias nas faixas etárias acima de 65 anos e internações por doença respiratória, nas faixas etárias menores de 5 anos e acima de 65 anos de cada um dos municípios. Usei como medida de exposição à queima prévia dados obtidos no INPE: percentual da área de cana colhida com queima (PMQ), níveis médios de Aerossol e Focos de queima, testadas separadamente. Para resolver a autocorrelação entre os dados, estes foram considerados conforme sua disposição espacial, através da construção de uma matriz de vizinhança dos 645 municípios do Estado. Utilizei o método de simulação de Monte Carlo via Cadeias de Markov (MCMC) para \'suavizar\' as estimativas da RMP. A análise demonstrou que existe associação entre a queima prévia da palha de cana-de-açúcar e a ocorrência de doenças respiratórias, porque o aumento nos focos de queima (Focos) esteve associado significativamente com o aumento das internações por doenças respiratórias, na faixa etária de menores de cinco anos. Os resultados mostraram que a queima prévia da palha da cana-de-açúcar oferece efetivamente risco à saúde da população e, adicionados aos mapas coropléticos gerados, oferecem subsídios para a vigilância epidemiológica e contribuem para o estabelecimento de políticas públicas para controle da poluição do ar, que contemplem além dos grandes centros urbanos, os pequenos municípios. A eliminação desse fator de risco deve fazer parte das medidas primordiais de prevenção à saúde a serem adotadas no Estado / Ethanol from sugarcane is consolidated as a renewable fuel which promotes further expansion of the culture of sugarcane in Brazil and especially in the State of São Paulo. As the controlled pre-harvest burning of sugarcane straw is still considered an agricultural practice necessary for the economic viability of this crop in more than 70% of municipalities in the State of São Paulo the population is forced to live with this pollution. To study the distribution of this risk factor and its relationship with the health of the population, I conducted an ecological study in the 645 municipalities of São Paulo. I used a Bayesian multivariate regression model relating the health effects and the exposure to previous straw burning of sugarcane, controlling the effects of socioeconomic factors (sanitation, education and income) and climate (maximum temperature, minimum humidity and precipitation) by the insertion of these variables in the model. The effect on health was measured by Standardized Mortality and Morbidity Ratio (SMR) of the outcomes: deaths from respiratory diseases in the age group above 65 years old and admissions for respiratory disease in children less than 5 years old and above 65 years old of each of the municipalities. I used as a measure of exposure to the pre-harvest burning data obtained at INPE: percent of sugarcane area harvest with burning (PMQ), levels of Aerosol and Spotlights of burning, tested separately. To solve the autocorrelation in the data these were considered as their spatial arrangement, by building a neighborhood matrix of the 645 municipalities in the state. I used the Markov Chain-Monte Carlo simulation method (MCMC) to \'soften\' the estimates of the SMR. The analysis showed that there is an association between previous straw burning of sugarcane and respiratory diseases, because the increase in outbreaks of burning (Spotlights) was significantly associated with increased hospital admissions for respiratory diseases in children aged under five years old. The results show that the previous straw burning of sugarcane effectively offers health risk to the population and added to the choropleth maps generated provide valuable information for epidemiological surveillance and contribute to the establishment of public policies for the control of air pollution, which should contemplate beyond the major urban centers, the small towns. The elimination of this risk factor should be part of a primordial prevention measure to be taken in the state

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.

The global spread of HIV and Aids has greatly exceeded the most pessimistic projections. Infection rates are not declining and human tragedy is escalating. South Africa is a nation in mourning. If one is not infected, one is affected. Notwithstanding the catastrophic effects that are already being experienced, the full consequences of the pandemic seem yet to be felt. Developmental psychology and ecological systems theory were used in this study to examine the research problem. It has become necessary to determine the level of knowledge that adolescents have of HIV and Aids and whether Life Skills programmes stimulate any change in behaviour. This initially took the form of a quantitative study in which questionnaires were administered. A combination of quantitative and qualitative research (focus group interviews) was applied for verification. The goals of the research were achieved, providing valuable findings, confirming that there has been no behaviour change and adolescent knowledge remains inadequate. South African adolescents have insufficient knowledge of responsible sexual behaviour. Recommendations with regard to the content and course of the programme as well as further research are formulated as a result of the conclusions. / Educational Studies / M.Ed. (Socio-Education)