Nous prenons l’approche d’annonce des salaires avec la recherche d’emploi à étudier trois problèmes dans le marché du travail. Le premier problème concerne l’arrêt de travail prématuré des travailleurs. Tel arrêt de travail prématuré crée des risques de chiffre d’affaires pour les entreprises, donc les entreprises veulent proposer des profils de salaire pour minimiser ces risques. Dans ce problème, l’asymétrie de l’information joue un rôle important. Nous adoptons une approche du mécanisme design et considérons les différents timings auxquels l’information privée est réalisée. Dans un papier de suivi, nous proposons une politique d’Age spécifique par laquelle cette inefficacité peut être atténuée, et étudions son implication sur le bien-être et la production globale. Dans le deuxième problème, nous revisitons l’analyse du bien-être de l’impact de la discrimination sur le choix des compétences sous une norme d’embauche multidimensionnelle le long des caractéristiques qui sont soit liées à la productivité soit indépendantes de la productivité. Nous montrons comment l’investissement de compétences stratégique entre le groupe favorise et discrimine se pose. Nous comparons également deux mécanismes de détermination des salaires (salaire annoncé et négocié) pour vérifier la robustesse de résultats. Dans le troisième problème, nous considérons dans quelle mesure l’allocation de chômage et le salaire minimum peuvent corriger les répartitions inefficaces découlant du pouvoir de marche des firmes. Notre contexte concerne les petits marchés ou le ratio travailleurs/firmes ne soit pas grand. L’imperfection de marche vient du fait qu’au marché du travail à petite échelle les firmes paient un niveau de salaire moins que le niveau compétitif. Nous procédons à partir d’un point de vue d’organisation industrielle, et proposons en se concentrant sur la mauvaise répartition d’emploi et de surplus lors de l’analyse de l’efficacité de l’instrument de la politique. / We take the wage posting approach with search friction to study three issues in labor market. The first issue concerns the premature quitting of workers. Our framework is suitable for contexts such as disability shock, retirement, maternity leaves etc. Such premature quitting creates turnover risks for firms, hence the firms propose wage profiles to minimize or avoid it. In this issue, the asymmetric information plays an important role. We adopt an approach of mechanism design and consider different timings at which the private information is realized. In a follow-up paper, we propose an age-directed policy by which this inefficiency can be alleviated and study its implication on welfare and aggregate output. In the second issue, we revisit welfare analysis of impact of discrimination on skill choice under a multi-dimensional hiring norm along both productivity-related and -unrelated characteristics. We show how strategic skill investment between favored and discriminated group arise. We compare also two wage determination mechanisms (posted and bargained wage). In the third issue, we consider to which extent can the roles of unemployment benefit and minimum wage correct inefficient allocations arising from firms’ market power. Our context concerns small markets where the workers/firms ratio is not large. The market imperfection comes from the fact that in such a small market firms pay less than competitive level of wages. We proceed from an industrial organizational perspective and suggest focusing on both misallocation of labor and surplus when analyzing the effectiveness of the policy instrument.

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews of 20 individuals, who worked closely with the FAERS program and were familiar with the Sentinel Initiative. In-depth key-informant interviews had been conducted to determine the perceptions of the participants regarding the challenges and benefits of the Sentinel Initiative compared with FAERS. To analyze data, content analysis was used. The study concluded that the FAERS and Sentinel Initiative provided a systematic database, which included health data, that could be used to improve public health. Due to the FAERS and Sentinel Initiative, adverse effects of drugs will be recognized and the safety of the patients and the public will be prioritized. The findings of this study have potential social impact for positive change at the societal level, organizational level, and individual level in terms of overall safety of the drugs. Sentinel initiative at its present state complements the existing FAERS and leverage its benefits by connecting at a grass roots level patients to an organization level as well as stakeholders to make an impact in providing safer drugs on the market.

No description available.

No description available.

Introduction :Les anticoagulants oraux soulèvent des problématiques majeures en termes de risque hémorragique et de bon usage. L’informatisation du dossier médical offre la possibilité d’accéder à de grandes bases de données que l’on peut exploiter de manière automatisée. L’objectif de ce travail est de montrer comment la réutilisation de données peut permettre d’étudier des problématiques liées aux anticoagulants et accompagner une démarche d’assurance de la qualité des soins. MéthodesCe travail a été réalisé sur les données informatisées (97 355 séjours) d’un centre hospitalier général. Pour chaque séjour nous disposons des données diagnostiques, biologiques, médicamenteuses, administratives et des courriers de sortie. Ce travail est organisé autour de 3 axes :Axe I. L’objectif est d’évaluer la qualité de la détection des facteurs pouvant majorer l’effet anticoagulant des antivitamines K (AVK), à l’aide de règles développées au cours de du projet européen PSIP (convention de subvention n° 216130). Une revue des cas sur une année a permis de calculer la valeur prédictive positive et la sensibilité des règles. Axe II. Nous avons réalisé une étude de cohorte historique sur les données de 2007 à 2012 pour déterminer les éléments majeurs impliqués dans l’élévation du risque hémorragique sous AVK dans la réalité clinique. Les cas étaient les séjours présentant une élévation de l’INR au-delà de 5, les témoins n’en présentaient pas. Axe III. Nous avons mis la réutilisation de données au service de l’étude de la qualité des prescriptions. D’une part nous avons évalué le suivi des recommandations de traitement du risque thromboembolique dans la fibrillation atriale (FA) chez la personne âgée, d’autre part nous avons étudié les modalités de prescription des anticoagulants oraux directs (AOD).Résultats : Axe I : La valeur prédictive positive des règles de détection des facteurs favorisant l’élévation de l’INR sous AVK est de 22,4%, leur sensibilité est de 84,6%. Les règles les plus contributives sont les règles de détection d’un syndrome infectieux et de l’administration d’amiodarone. Axe II : Les facteurs majeurs d’élévation du risque hémorragique sous AVK mis en évidence par l’étude de cohorte sont le syndrome infectieux, le cancer, l’hyprotidémie et l’insuffisance hépatique. Axe III : Le taux de suivi des recommandations dans la fibrillation atriale chez le sujet âgé est de 47.8%. Seuls 45% des patients reçoivent des anticoagulants oraux, 22,9% ne reçoivent aucun traitement antithrombotique et 32,1% reçoivent des antiagrégants plaquettaires. Les AOD sont quant à eux prescrits à des posologies inadaptées chez 15 à 31,4% des patients, respectivement pour le dabigatran et le rivaroxaban. Ces erreurs sont principalement des sous-dosages en AOD dans la FA de la personne âgée (82.6%). Discussion : L’informatisation des dossiers médicaux a permis la constitution de grandes bases de données médico-administratives, qui peuvent être utilisées à des fins variées comme nous le montrons dans ce travail. Dans le premier axe nous avons montré que des systèmes d’aide à la décision à base de règles permettent de caractériser les facteurs impliqués dans les surdosages en AVK avec une bonne sensibilité mais avec une faible valeur prédictive positive. Le second axe a montré que l’on pouvait utiliser ces données à des fins exploratoires pour identifier les facteurs liés à l’élévation de l’INR chez les patients recevant des AVK en pratique réelle. Le troisième axe montre que les systèmes à base de règles peuvent aussi être utilisés pour identifier des prescriptions inappropriées à des fins d’amélioration de la qualité des soins. Dans le domaine de l’anticoagulation ce travail ouvre des perspectives innovantes en vue de l’amélioration de la qualité des soins. / Introduction :Oral anticoagulants raise major issues in terms of bleeding risk and appropriate use. The computerization of medical records offers the ability to access large databases that can be explored automatically. The objective of this work is to show how routinely collected data can be reused to study issues related to anticoagulants in a supportive approach to quality of care.MethodsThis work was carried out on the electronic data (97,355 records) of a community hospital. For each inpatient stay we have diagnostic, biological, drug and administrative data, and the discharge letters. This work is organized around three axes:Axis I. The objective is to evaluate the accuracy of the detection of factors that may increase the anticoagulant effect of vitamin K antagonists (VKA), using rules developed in the PSIP european project (grant agreement N° 216130). A case review on one year enabled the calculation of the positive predictive value and sensitivity of the rules. Axis II. We conducted a cohort study on data from 2007 to 2012 to determine the major elements involved in raising the risk of bleeding related to VKA in clinical reality. Cases were the stays with an elevation of the INR beyond 5, the controls did not have.Axis III. We made data reuse serve a study of the quality of the prescriptions. On the one hand we assessed treatment of the thromboembolic risk recommendations in atrial fibrillation (AF) in the elderly, on the other hand we investigated the prescription of direct oral anticoagulants.Results : Axis I : The positive predictive value of the rules intended to detect the factors favoring the elevation of INR in case of treatment with VKA is 22.4%, the sensitivity is 84.6%. The main contributive rules are the ones intended to detect an infectious syndrome and amiodarone.Axis II : The major factor increasing the INR with VKA treatment highlighted by the cohort study are infectious syndrome, cancer, hepatic insufficiency and hypoprotidemia. The recommendations compliance rate in atrial fibrillation in the elderly is 47.8%. Only 45% of patients receive oral anticoagulants, 22.9% do not receive antithrombotic treatment at all and 32.1% received platelet aggregation inhibitors. Direct oral anticoagulants are prescribed at inadequate dosages in 15 to 31.4% of patients, respectively for dabigatran and rivaroxaban. These errors are mainly underdosages in the elderly with atrial fibrillation (82.6%).Discussion : The computerization of medical records has led to the creation of large medical databases, which can be used for various purposes as we show in this work. In the first work axis we have shown that rule-based decision support systems detect the contributing factors for VKA overdose with a good sensitivity but a low positive predictive value. The second line shows that we could use the data for exploratory purposes to identify factors associated with increased INR in patients receiving VKA in “real life practice”. The third line shows that the rule-based systems can also be used to identify inappropriate prescribing for the purpose of improving the quality of care. In the field of anticoagulation this work opens up innovative perspectives for improving the quality of care.

Chan, Wai Kiu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 233-256). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

目的：本研究主要目的是建立預測模型來判定矽肺發生的累積風險從而推薦適宜的胸片照射年限並從而評估常規監測和推薦監測策略的成本效益。此外，本研究還評價了常規診斷和驗證性診斷的符合度以及在驗證性診斷中邀請的三位專家之間的符合度。 / 方法：總計有3492男性接塵工人在1964年1月1日到1974年12月31日期間進入本隊列並隨訪至2008年12月31日。不同閱片專家根據中國最新塵肺病診斷標準 （GBZ70-2009））分別閱片總計9084張。對專家之間閱片結果的兩兩比較和兩種診斷結果的比較均采用Cohen’s Kappa檢驗。應用三種篩選方法（強制所有變量同時進入模型，後退逐步篩選，以及Least Absolute Shrinkage and Selection Operator (LASSO)篩選。LASSO模型作為最優模型，以分數量表的方式來表達。根據分數，把工人分成高、中、低危險組，並估計這三組不同危險水平工人的累積危險度。運用0.1% 累積危險度來判定不同危险的工人及不同期別的矽肺病人的射線照射年限。多狀態Markov模型用於計算矽塵暴露工人不同狀態的年轉移概率，並應用Markov成本效益分析方法來估計每獲得一個生命年的成本效益。 / 結果：截至2008年底，本矽塵暴露隊列共計發現298例矽肺病人（累計發病率為8.53%），死亡1347例（死亡比例為38.57%）。本研究發現常規診斷和驗證性診斷有很好的符合度 （Kappa值為0.89， 95%可信區間為0.88-0.91）。基於LASSO模型的分數量表具有很好的診斷識別能力 （ROC曲線下面積為0.83， 95%可信區間為0.81-0.86）。根據0.1%累積危險度標準，我們判定低危險組工人第一次射線照射的時間為第11年，推薦每兩年隨訪一次；中等危險組工人和高危險組工人的第一次射線照射時間分別為第11年和第5年，推薦每年隨訪一次。矽肺病人未晉級到三期以前均一年隨訪一次。矽塵暴露工人的年轉移概率為：從健康狀態向疑似病例轉移的概率為0.0198，從疑似病例向一期矽肺轉移的概率為0.038，從一期矽肺向二期矽肺轉移的概率為0.0516，從二期矽肺向三期矽肺轉移的概率為0.059，從三期矽肺向死亡轉移的概率為0.18。在1964到2008年間，診斷一例矽肺病例平均花費醫療成本為21853.11美元，非醫療成本為5993.30美元。模擬10,000矽塵暴露工人在未來40年按照當前的狀態轉移概率，應用常規的職業健康檢查為手段獲得一個生命年的成本效益為43.60美元，應用推薦的職業健康檢查為手段獲得一個生命年的成本效益為46.99美元。 / 結論：本研究在最優預測模型的基礎上為不同矽肺危險度的矽塵暴露工人首次提供了科學的證據來判定射線照射的適宜年限，亦為未來矽塵暴露工人的職業健康監測提供了科學理論依據，雖然本研究推薦的監測策略獲得同常規策略相類似的成本和效益。 / Objectives: The primary objective was to develop prediction models for determining the optimal intervals of chest radiographic surveillance for workers exposed to silica dust; the second primary objective is to assess the cost per case identification and compare the cost per life year gained under routine medical surveillance program with that under the recommended program for workers exposed to silica dust in China. In addition, the inter-rater agreement amongst three invited radiologists on rereading the chest radiographs and the agreement between the original diagnoses of silicosis (from routine reports) and the verified diagnoses reassessed by the three experts were also evaluated. / Methods: A total of 3492 male workers exposed to silica dust in an iron ore during the period 1964 - 1974 were recruited into this retrospective cohort study. All cohort members were followed up through the end of 2008 to observe the occurrence of silicosis and overall profile of mortality. All 9084 chest X-ray films were reread by three radiologists who had been qualified as experts at the national level according to the Chinese National Diagnostic Criteria of Pneumoconiosis (GBZ70-2009). The diagnosis of silicosis made by the panel of these three invited experts was referred to the “verified diagnosis“. Cohen’s Kappa test was used to test inter-rater agreements of three invited readers on chest radiographs and the agreement on the diagnosis of silicosis obtained from routine medical surveillance (i.e., the original routine diagnosis) was compared with those verified by the 3 qualified readers (i.e., the verified diagnosis). The multivariate Cox’s proportional hazard regression models were developed to predict the silicosis occurrence based on three selection approaches entry of all predictors at the same time, backward stepwise selection, and Least Absolute Shrinkage and Selection Operator (LASSO) selection. The LASSO model showed the best model fit which was thus regarded as the final model for predicting a score chart. / Based on this practically used score chart, we then classified workers into three groups of different risk levels of silicosis (low, moderate, and high). We estimated the cumulative risk of silicosis over years of follow-up for these three groups of workers at different risk levels. We used 1 per thousand of cumulative risk for developing silicosis as a “benchmark“ to determine the intervals of radiologic surveillance for workers with different risks of silicosis. Multi-state Markov model was used to calculate the transition probabilities of different states of silicosis and the analysis on cost and effectiveness was performed. / Results: By the end of 2008, the cumulative incidence rate of silicosis was 8.53% (298 silicosis cases) and a total of 1347 deaths (38.57%) were observed. / Good inter-rater agreements were observed amongst three invited radiologists for rereading all the chest films. Kappa value for the agreement between the original diagnoses and the verified diagnoses was 0.89 (95% confidence interval [95%CI], 0.88-0.91). / The model with the best fit was LASSO Cox model which showed a good discrimination with an area of 0.83 (95%CI, 0.81-0.86) under the receiver operating characteristic (ROC) curve. We classified workers into 3 risk groups according to the score chart obtained from the LASSO Cox model, and found the observed probabilities matched well to the predictions. According to 1 per thousand “benchmark“, we can determine that the initial interval of radiographic surveillance for workers in the low risk group was 11 years and a subsequent biyearly examination was recommended. The initial examination interval was 11 years and 5 years respectively for workers in the middle and high risk group, and then a yearly examination was recommended. For patients with silicosis, an annual radiological surveillance program was recommended regardless of the stage of pneumoconiosis. / According to results from multi-state model, we estimated that the yearly transition probability was 0.0198 for silica dust exposed workers from healthy state to the suspected silicosis cases (sojourn time = 47 years), 0.0338 from suspected silicosis cases to silicosis stage one (sojourn time = 23 years), 0.0516 from silicosis stage one to stage two (sojourn time = 9 years), 0.059 from silicosis stage two to stage three (sojourn time = 6 years), and 0.18 from silicosis stage three to death (sojourn time = 5 years). / During the period 1964 to 2008, the average direct medical cost spent on identifying one silicosis case was US$ 21853.11 and the non-medical cost for identifying one case was US$ 5993.30 per case. The estimated medical cost regarding per life year gained was US$ 43.60 under the routine medical surveillance program and it would be US$ 46.99 if the newly recommended surveillance program is adopted. / Conclusion: This study is the first to provide scientific evidence on determining the optimal intervals of radiographic surveillance for workers at different risk levels of silicosis based on the ‘best’ prediction model. Although our study revealed similar cost and effectiveness for using the recommended occupational health examination strategy compared with the routine program, this study is the first to provide scientific theory for guiding evidence-based occupational medical surveillance on workers exposed to silica dust in the world. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chen, Minghui. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 195-210). / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.v / Acknowledgements --- p.vii / List of contents --- p.ix / List of tables --- p.xv / List of figures --- p.xviii / List of main abbreviations --- p.xx / Chapter Section I --- Introduction and Literature Review --- p.1 / Chapter Chapter 1 --- Introduction --- p.2 / Chapter Chapter 2 --- Literature Review of Medical Examination, Prediction model and Economic Evaluation in Silicosis --- p.7 / Chapter 2.1 --- The aims of this literature review --- p.7 / Chapter 2.2 --- Search strategies and selection criteria --- p.7 / Chapter 2.3 --- Searching results --- p.8 / Chapter 2.4 --- Critical appraisal criteria and quality of selected studies --- p.9 / Chapter 2.4.1 --- Critical appraisal criteria --- p.9 / Chapter 2.4.2 --- Quality of selected studies --- p.10 / Chapter 2.5 --- Overview of effectiveness of chest radiography in medical surveillance of silicosis for workers exposed to silica dust --- p.15 / Chapter 2.5.1 --- Occupational medical surveillance for workers exposed to silica dust --- p.15 / Chapter 2.5.2 --- Comparison of CT or HRCT and chest radiography --- p.16 / Chapter 2.5.3 --- Comparison of digital radiography (DR) and chest radiography --- p.17 / Chapter 2.5.4 --- Other tests to be relevant to silicosis diagnosis --- p.23 / Chapter 2.5.5 --- The effectiveness of chest radiography in medical surveillance and diagnosis of silicosis --- p.24 / Chapter 2.5.6 --- Comparison between the ILO Classification and the Chinese Diagnostic criteria of pneumoconiosis --- p.25 / Chapter 2.6 --- Overview of application of prediction model in silicosis and a review on methodology in prediction model --- p.32 / Chapter 2.6.1 --- Application of prediction model in occupational diseases --- p.32 / Chapter 2.6.2 --- Overview of application of predicting model in pneumoconiosis including silicosis in China in recent 10 years --- p.34 / Chapter 2.6.3 --- Development of prediction model and the applications from practical perspectives --- p.35 / Chapter 2.7 --- A review on economic evaluation in occupational diseases and the screening interval analyses --- p.42 / Chapter 2.7.1 --- An overview on economic evaluation in pneumoconiosis --- p.42 / Chapter 2.7.2 --- Overview of economic evaluation in occupational health and safety and screening interval analyses --- p.44 / Chapter 2.7.3 --- Overview for methodology of performing CEA --- p.45 / Chapter 2.8 --- Research gaps were found from this literature review --- p.52 / Chapter Section II --- Objectives and Methods --- p.53 / Chapter Chapter 3 --- General aims and objectives --- p.54 / Chapter 3.1 --- General aims --- p.54 / Chapter 3.2 --- Primary objectives --- p.54 / Chapter 3.3 --- Secondary objective --- p.54 / Chapter Chapter 4 --- Methodology and Research Plans --- p.55 / Chapter 4.1 --- Study Design --- p.55 / Chapter 4.2 --- The cohort --- p.55 / Chapter 4.3 --- Follow-up --- p.58 / Chapter 4.4 --- Data Collection --- p.58 / Chapter 4.4.1 --- Baseline information --- p.58 / Chapter 4.4.2 --- Diagnosis of silicosis and the verification --- p.59 / Chapter 4.4.3 --- Occupational hygiene monitoring data --- p.60 / Chapter 4.4.4 --- Cost data of medical examination --- p.61 / Chapter 4.5 --- Data Entry and Data Analyses --- p.62 / Chapter Section III --- Results and Discussions --- p.65 / Chapter Chapter 5 --- Description of the cohort --- p.66 / Chapter 5.1 --- Cohort recruitment --- p.66 / Chapter 5.2 --- Baseline characteristics --- p.69 / Chapter 5.3 --- Change of respirable silica dust concentration over time --- p.71 / Chapter 5.5 --- Occurrence of silicosis --- p.73 / Chapter 5.5.1 --- Basic characteristics of silicosis patients --- p.73 / Chapter 5.5.2 --- Trend of silicosis occurrence with calendar year --- p.78 / Chapter 5.5.3 --- Trend of silicosis occurrence with age of entering the cohort --- p.78 / Chapter 5.5.4 --- Trend of silicosis occurrence with cumulative exposure to respirable silica dust --- p.78 / Chapter 5.6 --- Survival distribution at different respirable silica dust exposure levels --- p.79 / Chapter 5.7 --- A summary of the results in Chapter 5 --- p.82 / Chapter Chapter 6 --- Agreement between the routine diagnosis of silicosis and the verified ‘new panel’ diagnosis --- p.83 / Chapter [Summary] --- p.83 / Chapter 6.1 --- Background --- p.85 / Chapter 6.2 --- Methodology --- p.86 / Chapter 6.2.1 --- The routine and the verified diagnosis of silicosis --- p.86 / Chapter 6.2.2 --- Inter-rater agreement --- p.87 / Chapter 6.3 --- Results --- p.89 / Chapter 6.3.1 --- Technical quality of chest X-ray films --- p.89 / Chapter 6.3.2 --- Inter-rater agreement amongst readers --- p.89 / Chapter 6.3.3 --- Agreement between the routine and the verified diagnosis of silicosis --- p.93 / Chapter 6.3.4 --- Agreement of the progression of silicosis between the routine and verified diagnosis --- p.95 / Chapter 6.4 --- Discussion --- p.97 / Chapter Chapter 7 --- Developing prediction model for determining the optimal intervals of chest radiographic examinations for workers at different risks of silicosis --- p.100 / Chapter [Summary] --- p.100 / Chapter 7.1 --- Background --- p.102 / Chapter 7.2 --- Methods --- p.104 / Chapter 7.2.1 --- The cohort and outcome determination --- p.104 / Chapter 7.2.2 --- Developing prediction models for silicosis --- p.107 / Chapter 7.2.3 --- Coding of Predictors --- p.113 / Chapter 7.3 --- Results --- p.118 / Chapter 7.3.1 --- Model Specifications --- p.118 / Chapter 7.3.2 --- Stepwise Selection and LASSO selection --- p.119 / Chapter 7.3.3 --- Model Validations: Stability and Optimism --- p.119 / Chapter 7.3.4 --- Model Presentations --- p.126 / Chapter 7.3.5 --- Cut-off point of follow up year for determining examination intervals --- p.130 / Chapter 7.4 --- Discussions --- p.136 / Chapter Chapter 8 --- Transition probabilities of multi-states for workers with silica dust exposure --- p.141 / Chapter [Summary] --- p.141 / Chapter 8.1 --- Background --- p.143 / Chapter 8.2 --- Methodology of multi-state model --- p.145 / Chapter 8.2.1 --- Survival data and multi-state model --- p.145 / Chapter 8.2.2 --- Markov model and transition states --- p.151 / Chapter 8.2.3 --- Model assessment --- p.153 / Chapter 8.3 --- Results --- p.154 / Chapter 8.3.1 --- Initial values specification and estimates of intensity matrix --- p.154 / Chapter 8.3.2 --- Transition probability matrix, mean sojourn times, and survival situation --- p.159 / Chapter 8.3.3 --- Observed and expected prevalence of each state for Model assessment --- p.163 / Chapter 8.4 --- Discussion --- p.165 / Chapter Chapter 9 --- Cost effectiveness analysis of occupational medical surveillance for workers exposed to silica dust --- p.168 / Chapter [Summary] --- p.168 / Chapter 9.1 --- Background --- p.170 / Chapter 9.2 --- Methodologies --- p.171 / Chapter 9.2.1 --- Costs and effectiveness --- p.171 / Chapter 9.2.2 --- Cost per silicosis identification estimation in the iron ore during 1964 to 2008 --- p.172 / Chapter 9.2.3 --- Cost effectiveness analysis in the Markov model --- p.173 / Chapter 9.3 --- Results --- p.176 / Chapter 9.3.1 --- Cost estimation and cost per silicosis identification in the iron ore cohort --- p.176 / Chapter 9.3.2 --- Cost effectiveness analysis in the Markov model --- p.181 / Chapter 9.4 --- Discussion --- p.187 / Chapter Section IV --- Conclusions and Implications --- p.191 / Chapter Chapter 10 --- Conclusions, implications, and recommendations --- p.192 / Chapter 10.1 --- Conclusions --- p.192 / Chapter 10.2 --- Implications and recommendations --- p.193 / Reference list --- p.195 / Chapter Appendix I --- Chest Radiographic Imaging of Different Diagnostic Criteria for Pneumoconiosis in China --- p.211 / Chapter Appendix II --- Diagnosis Stages among Different Diagnostic Criteria for Pneumoconiosis in China --- p.212 / Chapter Appendix III --- Publications in journals and international conferences during the PhD study --- p.213 / Chapter Supplement I --- Syntax for test proportionality of Cox model in R survival package and LASSO model in R penalized package --- p.215 / Chapter Supplement II --- Guideline of applying the prediction model in practice --- p.216 / Chapter Supplement III --- Syntax for multi-state model in R msm package --- p.221 / Chapter Supplement IV --- An example for cost estimation of adjusting inflation and exchanging --- p.222 / Chapter Supplement V --- Cost estimation of workers, suspected silicosis cases and silicosis patients in the iron ore during 1964 - 2008 --- p.223 / Chapter Supplement V (Continued) --- Cost estimation of workers, suspected silicosis cases and silicosis patients in the iron ore during 1964 - 2008 --- p.224 / Chapter Supplement VI --- Number of deaths for all cause of death in the iron ore cohort until 2008 --- p.225 / Chapter Supplement VII --- Decision tree of Markov model in the study --- p.226 / Chapter Supplement VII (Continued) --- Decision tree of Markov model in the study --- p.227

Os sistemas de farmacovigilância fundamentam as decisões sobre segurança no uso de medicamentos regulamentados por autoridades de saúde. Estudá-los e propor estratégias de melhorias contribuem para fortalecer os sistemas de saúde, aperfeiçoando a qualidade da assistência à saúde e assegurando a segurança do paciente e coletividade. A Tese objetivou analisar a evolução e desempenho do sistema brasileiro de farmacovigilância, denominado de SINAF, e as notificações dos pacientes com suspeitas de reações adversas a medicamentos (RAMs) registradas no Notivisa-medicamento no período de 2008 a 2013 e propor uma lista-referência de códigos da CID-10 para vigilância de RAMs e intoxicações medicamentosas (IMs). A Tese compreende seis artigos científicos organizados para publicação. No primeiro, uma revisão de escopo apresentou uma perspectiva histórica para caracterizar a evolução do SINAF e lacunas identificadas no processo, como a ausência de comissão de farmacovigilância que atenda aos requisitos mínimos de um sistema de farmacovigilância propostos pela Organização Mundial da Saúde. Os artigos 2, 3 e 4 analisaram características relacionadas com o desempenho do SINAF. O artigo 2 revelou que não há preferência digital da idade na base de dados das notificações de eventos adversos a medicamentos (EAMs) do Notivisa-medicamento. Mediante uma análise comparativa, o artigo 3 mostrou diferenças entre o formulário para notificação de EAMs utilizado no SINAF e de outros doze países latinoamericanos (Argentina, Bolívia, Chile, Colômbia, Costa Rica, Cuba, Guatemala, México, Panamá, Peru, Uruguai e Venezuela), sobretudo na quantidade de variáveis para preenchimento, podendo contribuir com a subnotificação de casos. No artigo 4 – um estudo de avaliação de sistemas de vigilância de saúde pública –, revelou que o desempenho do Notivisa-medicamento foi considerado satisfatório para três atributos (flexibilidade, validade e erro preditivo positivo) e deficitário para a maioria deles (simplicidade, aceitabilidade, representatividade, completude, consistência, oportunidade e clareza metodológica). O artigo 5, mediante estudo descritivo e retrospectivo, encontrou uma taxa de notificação de RAMs de 22,8/ 1 milhão de habitantes/ano. Trata-se de taxa bastante inferior a países de alta renda como Nova Zelândia, Suécia, Austrália e Suíça que possuem mais de 300 notificações por milhão, como em relação a países de média renda, como a África do Sul, com taxa de 77 por milhão de habitantes. A população feminina (60,5%) prevaleceu no total de pacientes (26.554), assim como, a raça/cor branca (58,1%). A idade variou de 0 a 112 anos (mediana = 46 anos). Quase 1/3 (32,5%) das suspeitas de RAMs ocorreram em populações vulneráveis (idosos e crianças). Foram avaliados 54.288 pares de medicamento-reação adversa, onde prevaleceram as reações adversas graves (59,2%), com destaque para as que resultaram em efeito clinicamente importante (83,1%). O estudo 6 propôs uma lista-referência com 691 códigos da CID-10, sendo 360 (52,1%) relacionados com RAMs e 331 (47,9%) com IMs. Um total de 511 (73,9%) códigos estão relacionados com casos de admissão hospitalar e/ou óbito. Os achados da Tese evidenciam a necessidade de mudanças em diferentes aspectos estudados do SINAF, como forma de contribuir na produção de informações completas, fidedignas e mais representativas sobre danos ocasionados por medicamentos comercializados no país. / The pharmacovigilance systems support the decisions on safety when using medications regulated by health authorities. Analyzing them and proposing improvement strategies are ways to make healthcare systems stronger, improving the quality of healthcare assistance, making sure the patient is safe and that the population is ensured. The dissertation was aimed at analyzing the evolution and performance of the Brazilian pharmacovigilance system, SINAF, and the notification of patients with suspected adverse drug reactions (ADRs) registered with the notification system NOTIVISA/medication from 2008 through 2013, as well as proposing a reference list of ICD-10 codes for surveillance of ADRs and intoxication due to medication (IDM). The dissertation is comprised of six scientific articles ready to be published. The first one, a scoping review, presents a historical perspective to demonstrate the development process of SINAF and the gaps identified during the process, such as the absence of a pharmacovigilance commission that complies with the minimum requirements of a pharmacovigilance system as proposed by World Health Organization. Articles 2, 3 and 4 presents an analysis of the performance-related characteristics of SINAF. Article 2 reveals that there is no digital age preference in the adverse drug events (ADEs) database belonging to NOTIVISA/medication. Using a comparative analysis, article 3 shows differences between the form for ADEs notification using SINAF and in other twelve Latin-American countries (Bolivia, Chile, Colombia, Costa Rica, Cuba, Guatemala, Mexico, Panama, Peru, Uruguay and Venezuela), highlighting the number of variables to complete, and it may collaborate with the sub-notification of cases. Article 4 – a study on the evaluation of public health surveillance systems over time – reveal that the performance of NOTIVISA/medication was considered satisfactory regarding three attributes (flexibility, validity and positive predictive error) and deficient regarding most of the others (simplicity, acceptability, representability, integrality, consistency, opportunity and methodological clarity). Article 5, by means of a descriptive and retrospective study, found an ADR notification rate of 22.8/million inhabitants/year. This is a much lower rate than in high income countries, such as New Zealand, Sweden, Australia and Switzerland, which have over 300 notifications per million, when compared against average income, such as South Africa, with a rate of 77/million inhabitants. Female population (60.5%) prevailed in the total number of patients (26,554), as well as white race/color (58.1%). Age was between 0 - 112 years old (median = 46 years). Almost 1/3 (32.5%) of the suspected ADRs occurred in vulnerable populations (elderly and children). 54,288 pairs of medication/adverse reactions were assessed. Severe adverse reactions prevailed (59.2%), and attention is drawn to those resulting in clinically important effect (83.1%). Study 6 proposes a reference list with 691 ICD-10 codes; 360 (52.1%) out of them are ADRs-related and 331 (47.9%) out of them are IDM. A total of 511 (73.9%) codes are related to cases of hospital admission and/or death. The dissertation findings prove the need of changes across different aspects in SINAF as a way to contribute to production of complete, reliable and representative information on damages caused by commercially available drugs in Brazil.

Introdução. As hemisferectomias são cirurgias utilizadas há décadas para se tratar epilepsias refratárias à medicação anticonvulsivante. Embora o controle das crises seja satisfatório, a morbidade, per e pós-operatória, ainda é considerada um importante fator limitante à sua utilização. Dessa maneira, compreender as complicações mais comuns do procedimento, e os fatores que as influenciam, é essencial para se estabelecer o melhor uso para a técnica. Métodos. Foram coletados dados de 30 pacientes, operados por seis cirurgiões no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período entre 1980 e 2003. Foram realizadas 11 hemisferectomias com a abordagem de Rasmussen, três hemisferectomias anatômicas, nove hemisferectomias funcionais extraventriculares e sete hemisferotomias. Foram estudados cinco grupo de pacientes de acordo com a fisiopatologia da doença de base: Dezesseis pacientes eram portadores de Síndrome de Rasmussen, dois da Síndrome de Sturge-Weber, quatro de malformações corticais, dois de lesões sequelares e seis de cistos porencefálicos. Os fatores de morbidade foram avaliados dentro de rês perspectivas: 1- da doença de base; 2- da técnica utilizada; e 3- do fator humano. Resultados. Nossos dados mostraram ausência de diferença estatisticamente significativa entre as técnicas cirúrgicas empregadas nos itens: tempo cirúrgico; tempo de internação na unidade de terapia intensiva; queda da hemoglobina; volume de hemoderivados transfundidos e febre no pós-operatório. Presença de leucograma acima de 15.000 leucócitos/mm3 no pós-operatório imediato foi associada a estadias mais longas na unidade de terapia intensiva A média diária de temperatura dos pacientes, mostrou temperaturas acima de 38º C entre o terceiro e sexto dia pós-operatório. Pacientes com hemimegalencefalia apresentaram temperaturas mais elevadas quando comparados com os portadores de cistos porencefálicos. Doenças com maior manto cortical contribuíram para aumentar o tempo cirúrgico, embora o fator humano tenha sido decisivo nesse item. Ao comparar nossos achados com os da literatura, vimos que os pacientes submetidos à hemisferectomia anatômica apresentaram no pós-operatório temperaturas mais elevadas e reação inflamatória liquórica mais intensa que os submetidos a técnicas de desconexão hemisférica, no entanto, a importância desse dado necessita ser estabelecida. Conclusões: O principal fator de morbidade nas hemisferectomias é a doença de base, assim, os dados presentes na literatura, incluindo nossa casuística, não nos permite concluir que uma técnica seja superior à outra ou que as técnicas desconectivas sejam melhores que as ressectivas / Hemispherectomy has been the treatment of choice in some sorts of refractory epilepsies for decades. Although surgery results in satisfactory control of seizures, its morbidity remains a major concern. Thus, understanding most common complications, as well as the factors that contribute to it, becomes an essential step to learn the limits on technique applications. Methods. Hospital charts from 30 patients operated on by six different surgeons at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from 1980 to 2003 were reviewed. Eleven functional hemispherectomies using Rasmussen approach, three anatomical hemispherectomies, nine extraventricular functional hemispherectomies, and seven hemispherotomies were included in this study. Sixteen patients presented with Rasmussen Syndrome, two Sturge-Weber Syndrome, four cortical malformations, two hemispheric lesions, and six porencephalic cysts. Morbidity was evaluated from three different perspectives 1- background disease, 2- employed technique, and 3- human factor. Results: our data presented no statistical difference among the employed techniques regarding 1- surgical time, 2- intensive care unit time, 3- per and postoperative fall of hemoglobin, 4- blood transfusion volume, and 5- postoperative axilar temperature variation. Patients that presented over 15,000 leucocytes per mm3 stayed longer at the intensive care unit, regardless of the surgical technique employed. Daily average temperatures varied around 38 degrees Celsius from the third to the sixth postoperative day. Patients with hemimegalencephaly had higher postoperative axilar temperatures when compared to those with porencephaly. Thicker cortical mantle contributed to increase surgical time, though human factor also showed to be important in this item. Comparing data from this study and the literature disclosed that patients undergoing anatomical hemispherectomies presented an inflammatory response in the cerebrospinal fluid more evident than those submitted to cerebral disconnection, although the importance of this finding is still elusive. Conclusions: The main factors of morbidity in the hemispherectomy are the background disease and patient\'s peculiarities, therefore, it is not reasonable to infer that there is a superior technique or that hemisphere disconnection is better than removal

Hin-Chung Chu. / Thesis submitted in: July 2002. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 281-306). / Abstracts in English and Chinese. / Cover (English & Chinese version) --- p.I / 中文封面 --- p.II / Abstract (English version) --- p.III-IV / 中藥不良反應論文摘要 --- p.V / Acknowledgements --- p.VI / Abbreviations --- p.VII-VIII / Publication in press --- p.IX / Content --- p.X-XV / Lists of Table --- p.XVI / Chapter Chapter 1 --- Introduction --- p.1-3 / Chapter Chapter 2 --- Chinese herbal medicines used in Hong Kong. --- p.4-15 / Chapter 2.1 --- Overview --- p.4-5 / Chapter 2.2 --- The Policy In Hong Kong -- Past And Present --- p.5-1 / Chapter 2.3 --- The Preparatory Committee on Chinese Medicine (PCCM) --- p.7-8 / Chapter 2.4 --- The Chinese Medicine Council of Hong Kong --- p.8-10 / Chapter 2.5 --- Development of Standards --- p.10 / Chapter 2.6 --- Development of Centres of Good Clinical Practice --- p.10-11 / Chapter 2.7 --- Establishment of a Good System of Education and Training --- p.11 / Chapter 2.8 --- Investigation of Suspected Herbal Toxicity Cases --- p.12-13 / Chapter 2.8.1 --- Herbal Safety Surveillance --- p.13-14 / Chapter 2.9 --- Conclusion --- p.14-15 / Chapter Chapter 3 --- Herbal medicines used in other countries --- p.16-45 / Chapter 3.1 --- Overview --- p.16 / Chapter 3.2 --- China --- p.16-19 / Chapter 3.3 --- Macau --- p.22-23 / Chapter 3.4 --- Taiwan --- p.23-26 / Chapter 3.5 --- Japan --- p.27-30 / Chapter 3.6 --- Singapore --- p.30-31 / Chapter 3.7 --- Australia --- p.31-34 / Chapter 3.8 --- Others Asian countries --- p.35 / Chapter 3.9 --- USA --- p.35-39 / Chapter 3.10 --- United Kingdom --- p.39-41 / Chapter 3.11 --- Europe --- p.41-43 / Chapter 3.12 --- Germany --- p.43-45 / Chapter Chapter 4 --- Adverse reaction -- General Aspect --- p.46-63 / Chapter 4.1 --- Overview --- p.46 / Chapter 4.2 --- Traditional Chinese medicine --- p.47-49 / Chapter 4.2.1 --- Compound Prescriptions to Reduce Toxicity --- p.50 / Chapter 4.2.2 --- Processing Of Chinese Herbs --- p.50-51 / Chapter 4.2.2.1 --- The Aims of Herbal Drug Processing --- p.51-52 / Chapter 4.2.2.2 --- The Methods of Herbal Drug Processing --- p.52 / Chapter 4.2.2.3 --- External processing (simple treatment by trimming) --- p.52-53 / Chapter 4.2.2.4 --- Water processing --- p.53-54 / Chapter 4.2.2.5 --- Fire processing --- p.54 / Chapter 4.2.2.6 --- Water-fire processing --- p.54-55 / Chapter 4.2.2.7 --- Other methods --- p.55 / Chapter 4.3 --- Practical Problem in Traditional Chinese Medicine --- p.55-57 / Chapter 4.4 --- Evaluation of herbal adverse reactions --- p.57 / Chapter 4.4.1 --- Type A reactions --- p.57 / Chapter 4.4.2 --- Type B reactions --- p.58 / Chapter 4.4.3 --- Type C reactions --- p.58 / Chapter 4.4.4 --- Type D reactions --- p.58 / Chapter 4.5 --- Chinese Proprietary medicine --- p.58-59 / Chapter 4.6 --- Potential Risks for Herbal Adverse Reaction --- p.59 / Chapter 4.6.1 --- Misidentification --- p.59-60 / Chapter 4.6.2 --- Lack of standardisation --- p.60 / Chapter 4.6.3 --- Contamination --- p.60 / Chapter 4.6.4 --- Incorrect preparation / dosage --- p.60 / Chapter 4.6.5 --- Excessive dosage --- p.60-61 / Chapter 4.6.6 --- Individual errors --- p.61 / Chapter 4.6.7 --- Individual response --- p.61 / Chapter 4.6.8 --- Unqualified Herbal Practitioner with Wrong Prescription --- p.61-62 / Chapter 4.6.9 --- Interaction with Western medicine --- p.62 / Chapter 4.6.10 --- Prolonged Usage --- p.62 / Chapter 4.6.11. --- Coexisting disease --- p.62-63 / Chapter 4.7 --- Conclusion --- p.63 / Chapter Chapter 5 --- "Substitution, Adulteration or Misusing with Toxic Herbs" --- p.64-84 / Chapter 5.1 --- Overview --- p.64-65 / Chapter 5.2 --- Adulteration by Guijiu --- p.65-68 / Chapter 5.3 --- Anticholinergic reactions Caused by <Yangjinhua> --- p.69-74 / Chapter 5.4 --- Overdosage --- p.74 / Chapter 5.4.1 --- Overdose of Aconitine --- p.74-78 / Chapter 5.4.2 --- Overdose of Liquorice ('Gancao') --- p.78-80 / Chapter 5.4.3 --- Overdose of <Chansu> --- p.80 / Chapter 5.5 --- Misusing - Personal abuse --- p.80 / Chapter 5.5.1 --- <Banmao> --- p.80-81 / Chapter 5.6 --- Discussion --- p.81-84 / Chapter 5.7 --- Conclusion --- p.84 / Chapter Chapter 6 --- Chinese Patent Medicine - General Aspect --- p.85-112 / Chapter 6.1 --- Chinese Patent Medicine --- p.85 / Chapter 6.1.1 --- Introduction --- p.85-87 / Chapter 6.1.2 --- Herbal Injection and Infusion --- p.87-88 / Chapter 6.1.2.1 --- Variety & Processing --- p.88 / Chapter 6.1.2.2 --- Stabilization --- p.88-89 / Chapter 6.1.2.3 --- The Molecular Size --- p.89-90 / Chapter 6.1.3 --- Adverse Reactions Caused by Chinese Proprietary Medicines --- p.90 / Chapter 6.1.3.1 --- Aconitine poisoning --- p.90 / Chapter 6.1.3.2 --- Nan Lien Chui Fong Toukuwan' --- p.90-91 / Chapter 6.1.3.3 --- Jin Bu Huan' --- p.91 / Chapter 6.1.3.4 --- Baoyingdan' --- p.91 / Chapter 6.1.4 --- Heavy metals in CPM --- p.91 / Chapter 6.1.5 --- The Necessarity to Develop Randomise Herbal Clinical Trial. --- p.91-92 / Chapter 6.1.6 --- Recommendation --- p.92-93 / Chapter 6.1.7 --- Conclusion --- p.93-94 / Chapter 6.2 --- Adulteration by synthetic therapeutic substances --- p.95-104 / Chapter 6.2.1 --- The Experiences in China --- p.91-99 / Chapter 6.2.2 --- The Experiences in Hong Kong --- p.99-101 / Chapter 6.2.3 --- The Experience in Taiwan --- p.101-102 / Chapter 6.2.4 --- Discussion --- p.102-104 / Chapter 6.3 --- Oil of Wintergreen (Methyl salicylate) --- p.104-112 / Chapter 6.3.1 --- Overview --- p.104-111 / Chapter 6.3.2 --- Prevention --- p.111-112 / Chapter Chapter 7 --- Adverse effects of Ginseng. --- p.113-123 / Chapter 7.1 --- Overview --- p.113 / Chapter 7.2 --- Botany --- p.113-114 / Chapter 7.3 --- Pharmacological Effects --- p.114-115 / Chapter 7.4 --- Adverse reaction of Ginseng --- p.115 / Chapter 7.4.1 --- Overdosage --- p.115-116 / Chapter 7.4.2 --- Substitution with cheaper and more toxic herbs --- p.116-121 / Chapter 7.5 --- Drug - herb Interaction --- p.121-122 / Chapter 7.6 --- Conclusion --- p.123 / Chapter Chapter 8 --- Herbal Medicines With Cardiovascular Adverse Reactions --- p.124-123 / Chapter 8.1 --- Overview --- p.124 / Chapter 8.2 --- Hypertension --- p.124 / Chapter 8.3 --- Atherosclerosis --- p.124-125 / Chapter 8.4 --- Arrhythmias --- p.125-126 / Chapter 8.5 --- Cardic Failure --- p.126 / Chapter 8.6 --- Angia Pectoris --- p.126 / Chapter 8.7 --- Thromboembolic Disorders --- p.126-127 / Chapter 8.8 --- Discussion --- p.127-128 / Chapter 8.8.1 --- Herbal Medicine Used in Cardiovascular System --- p.131 / Chapter 8.8.1.1 --- Ginseng --- p.131-133 / Chapter 8.8.1.2 --- Ma huang (Ephedra sinica) --- p.133-136 / Chapter 8.8.1.3 --- Yellow oleander (Thevetia neriifolia) --- p.136-137 / Chapter 8.8.1.4 --- Stephania tetrandra --- p.137-138 / Chapter 8.8.1.5 --- Danshen (Salvia miltiorrhiza) --- p.138 / Chapter 8.8.1.8 --- Ginkgo biloba --- p.138-140 / Chapter 8.8.1.9 --- Dong Quai (Angelicae Sinensis) --- p.140-141 / Chapter 8.8.1.10 --- Licorice (Glycyrrhiza Glabra) --- p.141-143 / Chapter 8.8.1.11 --- Berberine --- p.143 / Chapter 8.8.2 --- Potential Problem Caused by Chinese Proprietary Medicine --- p.143-144 / Chapter 8.9 --- Other Herbal Adverse Effects And Drug Interaction --- p.144-145 / Chapter 8.10 --- Conclusion --- p.145 / Chapter Chapter 9 --- Review of the Adverse Reactions to herbal treatments of Obesity --- p.146-150 / Chapter 9.1 --- Overview --- p.146 / Chapter 9.2 --- Combined With Unknown medication --- p.146-147 / Chapter 9.3 --- Dietary Supplements and Herbal Preparations --- p.147-149 / Chapter 9.4 --- Conclusion --- p.149-150 / Chapter Chapter 10 --- Adverse Effects of CHM used for Diabetes --- p.151-159 / Chapter 10.1 --- Introduction --- p.151 / Chapter 10.2 --- Traditional Chinese medicine used in Diabetes --- p.151 / Chapter 10.3 --- Adverse Reaction of Alternative Diabetic Treatment --- p.152-158 / Chapter 10.4 --- Conclusion --- p.159 / Chapter Chapter 11 --- Review of Herbal Hepatotoxicity --- p.160-194 / Chapter 11.1 --- Introduction --- p.160-161 / Chapter 11.2 --- Drug-induced hepatic injury --- p.161-163 / Chapter 11.3 --- Types of Liver Injury --- p.163 / Chapter 11.3.1 --- Pyrrolizidine alkaloid (PA) --- p.163 / Chapter 11.4 --- Hepatotoxicity Herbs --- p.163 / Chapter 11.4.1 --- Tripterygium wilfordii --- p.163-164 / Chapter 11.4.2 --- Rhizoma Discoreae Bulbiferae --- p.164-165 / Chapter 11.5 --- Consumption of Insect herbs --- p.165 / Chapter 11.6 --- Hepatotoxicity Cause by Chinese Proprietary Medicine --- p.165-166 / Chapter 11.6.1 --- Jin Bu Huan --- p.166-168 / Chapter 11.6.2 --- Chi R Yun (Breynia officinalis) --- p.168 / Chapter 11.6.3 --- Sho-saiko-to --- p.168-169 / Chapter 11.6.4 --- Shou-Wu-Pian --- p.169-171 / Chapter 11.7 --- Importance of Drug-Herb and Herb-Herb Interactions --- p.171-172 / Chapter 11.8 --- Diagnosis of Herbal Hepatotoxicity --- p.172-173 / Chapter 11.9 --- Recomandation --- p.173-174 / Chapter 11.10 --- Conclusion --- p.175 / Table --- p.176-180 / Chapter Chapter 12 --- Review of Herbal Nephropathy --- p.181-194 / Chapter 12.1 --- Introduction --- p.181 / Chapter 12.2 --- Aristolochia acids (AA) --- p.181-183 / Chapter 12.2.1 --- Intoxication of Aristolochia in Worldwide --- p.183-184 / Chapter 12.2.2 --- Morphological findings --- p.184-185 / Chapter 12.2.3 --- Carcinogenic --- p.185-187 / Chapter 12.3 --- MuTong (Aristolochia manshuriensis) --- p.187-188 / Chapter 12.4 --- Ma-dou-ling (Fructus Aristolochiae) --- p.188 / Chapter 12.5 --- Tripterygium wilfordii --- p.188-189 / Chapter 12.6 --- Gastrodia Elata --- p.189 / Chapter 12.7 --- Licorice (Glycyrrhiza glabra) --- p.190-191 / Chapter 12.8 --- Hippocampus (Sea Horse) --- p.191 / Chapter 12.9 --- Milabris Phanalerata --- p.191-192 / Chapter 12.10 --- Chinese Proprietary Medicine --- p.192-193 / Chapter 12.11 --- Conclusion --- p.193-194 / Chapter Chapter 13 --- Adverse Reaction of Herbal Medicine in Dermatology. --- p.195-217 / Chapter 13.1 --- Overview --- p.195-196 / Chapter 13.2 --- Chinese Herbal Medicine Used in Psoriasis --- p.196 / Chapter 13.2.1 --- Tripterygium wilfordii --- p.197 / Chapter 13.2.2 --- Radix Angelicae pubescentis and Radix Angelicae dahuricae --- p.197-198 / Chapter 13.2.3 --- Radix macrotomiae seu Lithospermi Injection --- p.198 / Chapter 13.3 --- Chinese Herbal Decoction For Atopic Dermatitis --- p.198-200 / Chapter 13.3.1 --- Tea Extracts --- p.200-201 / Chapter 13.4 --- Potential Adverse Effect with Herbal Medicine --- p.201 / Chapter 13.4.1 --- Allergic skin reactions --- p.201-202 / Chapter 13.4.2 --- Stevens-Johnson syndrome --- p.202 / Chapter 13.4.3 --- Photosensitization --- p.202-204 / Chapter 13.4.4 --- Pellagra --- p.204 / Chapter 13.4.5 --- Hepatotoxic Effects --- p.204-205 / Chapter 13.4.6 --- Others Adverse Reaction --- p.205 / Chapter 13.4.7 --- Potential Adverse Reaction Caused by Interactions --- p.205 / Chapter 13.5 --- Potential Adverse Reaction Caused by Contamination of Herbal Product --- p.206 / Chapter 13.5.1 --- Herbal creams adulterated with corticosteroids --- p.206-207 / Chapter 13.5.2 --- Arsenic dermatoses --- p.207 / Chapter 13.5.3 --- Mercury poisoning --- p.207-208 / Table --- p.208-211 / Chapter 13.6 --- Dermatological Adverse Reaction Caused by Herbs --- p.211 / Chapter 13.7 --- Contact Dermatitis Caused by CPM --- p.211-212 / Chapter 13.7.1 --- Liushenwan' --- p.211-212 / Chapter 13.7.2 --- Heiguiyou' --- p.212 / Chapter 13.7.3 --- 101 Hair Regrowth Liniment' --- p.212-213 / Chapter 13.7.4 --- Zhenggushui' --- p.213 / Chapter 13.7.5 --- Tiedayaoiing' --- p.213-214 / Table --- p.214-215 / Chapter 13.8 --- Non-dermatological adverse effects of systemic herbal treatments used for dermatological conditions --- p.215-216 / Chapter 13.9 --- Conclusion --- p.216-217 / Chapter Chapter 14 --- "Chinese Herbal Medicine in Pregnancy, Infants & Children," --- p.218-229 / Chapter 14.1 --- Overview --- p.218-219 / Chapter 14.2 --- Asian Cultures for Pregnancy --- p.219-223 / Chapter 14.3 --- Teratogenic Herbs --- p.224-225 / Chapter 14.4 --- Chinese proprietary medicines --- p.225 / Chapter 14.4.1 --- "“Tse Koo Choy""" --- p.225-226 / Chapter 14.4.2 --- "“Lu Shen Wan""" --- p.226 / Chapter 14.4.3 --- "“Po Ying Pills""" --- p.226-227 / Chapter 14.4.4 --- """Jin Bu Huan Toxicity"" in Children" --- p.227 / Chapter 14.6 --- Topical Preparations --- p.227-228 / Chapter 14.7 --- Dietary supplement --- p.228-229 / Chapter 14.8 --- Conclusion --- p.229 / Chapter Chapter 15 --- Heavy metals poisoning in traditional Chinese medicines. --- p.230-251 / Chapter 15.1 --- Introduction --- p.230-232 / Chapter 15.2 --- LEAD --- p.232 / Chapter 15.2.1 --- Overview --- p.232 / Chapter 15.2.2 --- Poisoning Cases of Boa Ning Dan --- p.233-235 / Chapter 15.2.3 --- Lead Poisoning in Worldwide --- p.235-238 / Chapter 15.3 --- MERCURY --- p.238 / Chapter 15.3.1 --- Overview --- p.238-239 / Chapter 15.3.2 --- Cinnabar --- p.239-240 / Chapter 15.3.3 --- Presentation --- p.240-241 / Chapter 15.3.4 --- Poisoning Cases --- p.241-242 / Chapter 15.4 --- ARSENIC --- p.242 / Chapter 15.4.1 --- Overview --- p.242-243 / Chapter 15.4.2 --- Arsenic toxicity --- p.243-244 / Chapter 15.4.3 --- The toxicologic mechanisms of inorganic arsenic --- p.244-246 / Chapter 15.4.4 --- Poisoning Cases --- p.246 / Chapter 15.4.5 --- Discussion --- p.247-248 / Chapter 15.5 --- Conclusion --- p.248 / Table --- p.249-251 / Chapter Chapter 16 --- Herb - Drug Interactions --- p.252-269 / Chapter 16.1 --- Overview --- p.252-254 / Chapter 16.2 --- Effects of Herb-drug interactions --- p.255 / Chapter 16.2.1 --- Gastrointestinal system --- p.255-256 / Chapter 16.2.2 --- Cardiovascular system --- p.256 / Chapter 16.2.3 --- Central nervous system --- p.257 / Chapter 16.2.4 --- Endocrine system --- p.257 / Chapter 16.3 --- Reason regard to herb-drug interactions --- p.257 / Chapter 16.3.1 --- Lack of Knowledge About Herbs --- p.257 / Chapter 16.3.2 --- Mislabelling or Adulteration --- p.258 / Chapter 16.3.3 --- Lack of Patient Communication About Use of Botanicals --- p.258 / Chapter 16.3.4 --- Lack of Practitioner Knowledge About Potential Interactions --- p.258 / Chapter 16.4 --- Metabolism of Herb-Drug Interaction --- p.258-259 / Chapter 16.5 --- Pharmacologic Interactions --- p.259-260 / Chapter 16.5.1 --- Interaction with Antibiotics --- p.260 / Chapter 16.5.2 --- Interaction with Nonsteroidal Anti-inflammatory Drugs --- p.260-261 / Chapter 16.5.3 --- Interaction with Sedatives --- p.261-262 / Chapter 16.5.4 --- Interaction with Anticoagulants --- p.262-263 / Chapter 16.5.5 --- Interaction with Anti-hypertensives and Diuretics --- p.263 / Chapter 16.5.6 --- Interaction with Spironolactone --- p.264 / Chapter 16.5.7 --- Interaction with Corticosteroids and Cyclosporine --- p.264-265 / Chapter 16.5.8 --- Interaction with Estrogen Replacement Therapy --- p.265 / Chapter 16.5.9 --- Interactions Between Natural Product and Drug --- p.265-266 / Chapter 16.6 --- Herb-to-Herb Interactions --- p.266-267 / Chapter 16.7 --- Conclusion --- p.268-269 / Chapter Chapter 17 --- Recommendation --- p.270-264 / Chapter 17.1 --- Overview --- p.270 / Chapter 17.2 --- The need to evaluate the clinical effectiveness of traditional Chinese medicine --- p.270-271 / Chapter 17.3 --- For the Pharmaceutical Industries --- p.211-212 / Chapter 17.4 --- For the physicians & patient --- p.272-274 / Conclusion --- p.274 / Chapter Chapter 18 --- Conclusion --- p.275-280 / Chapter Chapter 19 --- Reference --- p.281-306