When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

Psoriatic Arthritis Quality of Life Questionnaire: translation, cultural adaptation and validation into Brazilian Portuguese language

Abstract Introduction: Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that can cause joint destruction and impair quality of life. The Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) was the first disease-specific tool for determining the impact of the disease on the quality of life of people with PsA. Objectives: The primary objective was to develop and validate a Brazilian Portuguese version of the PsAQoL. Methods: The UK PsAQoL was translated into Brazilian Portuguese using two translation panels. This translation then checked for face validity and construct validity with new samples of patients. Finally, a test-retest validation study was conducted with 52 patients with PsA. The survey included the Nottingham Health Profile (NHP) as a comparator instrument. Results: Internal consistency and reproducibility were both excellent for the new adaptation (0.91 and 0.90 respectively Scores on the PsAQoL were found to correlate as expected with the comparator measure and the instrument was able to detect differences in score related to perceived severity of PsA, general health status and presence of a flare. Conclusions: The Brazilian PsAQoL was found easy to understand and complete and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine PsA practice and clinical trials.

Stakeholder influence and local government performance: a systematic literature review / Influencias de los stakeholders y desempeño de lo gobierno local: una revisión sistemática de la literatura / Influências dos stakeholders e desempenho do governo local: uma revisão sistemática da literatura

Abstract Although stakeholder theory has been on the academic agenda for more than 30 years, empirical evidence is still scant about stakeholders' influence as determinant factors of local governments' performance. Evidence from 82 empirical studies on stakeholder influence as a source of local government effectiveness is assessed in this article. The choice of studies was based in a systematic literature review, encompassing articles published in the period from 2007 to 2017 in which stakeholder influences are considered determinant factors of local government performance. This research contributes to this field of knowledge by synthesizing the pertinent publications and pointing out an agenda for future studies.

Resumen Si bien la teoría de los stakeholders ha estado en la agenda académica desde hace más de 30 años, las evidencias empíricas son escasas acerca de la influencia de los stakeholders como factores determinantes del desempeño de los gobiernos locales. Las evidencias de 82 estudios empíricos sobre las influencias de los stakeholders como fuentes de la efectividad del gobierno local se evalúan aquí. La elección de los documentos se basó en una revisión sistemática de la literatura, que abarca artículos publicados en el período de 2007 a 2017 en los que las influencias de los stakeholders se consideran factores determinantes del desempeño del gobierno local. Este trabajo contribuye a este campo de conocimiento sintetizando las publicaciones pertinentes y señalando una agenda para futuros estudios.

Resumo Embora a teoria dos stakeholders esteja na agenda acadêmica nos últimos 30 anos, até o momento, existe pouca evidência sobre influência de stakeholders como fator determinante do desempenho de governos locais. A investigação examina os fatores determinantes do desempenho de governos locais através de artigos publicados em periódicos ranqueados no Journal of Citation Report. A escolha dos artigos foi embasada em revisão sistemática de literatura em publicações do período de 2007 a 2017 nas quais influências de stakeholders tenha sido usada como variável explanatória de desempenho de governos locais. Este artigo contribui para o campo de conhecimento sintetizando as publicações mais relevantes, apontando lacunas na literatura e propondo uma agenda para estudos futuros.

Erratum: Structural and Functional Features on Quantitative Chest Computed Tomography in the Korean Asian versus the White American Healthy Non-Smokers

Structural and Functional Features on Quantitative Chest Computed Tomography in the Korean Asian versus the White American Healthy Non-Smokers

OBJECTIVE: Considering the different prevalence rates of diseases such as asthma and chronic obstructive pulmonary disease in Asians relative to other races, Koreans may have unique airway structure and lung function. This study aimed to investigate unique features of airway structure and lung function based on quantitative computed tomography (QCT)-imaging metrics in the Korean Asian population (Koreans) as compared with the White American population (Whites). MATERIALS AND METHODS: QCT data of healthy non-smokers (223 Koreans vs. 70 Whites) were collected, including QCT structural variables of wall thickness (WT) and hydraulic diameter (Dh) and functional variables of air volume, total air volume change in the lung (ΔVair), percent emphysema-like lung (Emph%), and percent functional small airway disease-like lung (fSAD%). Mann-Whitney U tests were performed to compare the two groups. RESULTS: As compared with Whites, Koreans had smaller volume at inspiration, ΔVair between inspiration and expiration (p < 0.001), and Emph% at inspiration (p < 0.001). Especially, Korean females had a decrease of ΔVair in the lower lobes (p < 0.001), associated with fSAD% at the lower lobes (p < 0.05). In addition, Koreans had smaller Dh and WT of the trachea (both, p < 0.05), correlated with the forced expiratory volume in 1 second (R = 0.49, 0.39; all p < 0.001) and forced vital capacity (R = 0.55, 0.45; all p < 0.001). CONCLUSION: Koreans had unique features of airway structure and lung function as compared with Whites, and the difference was clearer in female individuals. Discriminating structural and functional features between Koreans and Whites enables exploration of inter-racial differences of pulmonary disease in terms of severity, distribution, and phenotype.

Well-differentiated liposarcoma of the breast arising in a background of malignant phyllodes tumor in a pregnant woman: A rare case report and review of literature

Pure mesenchymal sarcomas and phyllodes tumor with sarcomatous differentiation of the breast are rare tumors. Primary breast sarcomas are a heterogenous group of neoplasms which include malignant fibrous histiocytoma, fibrosarcoma, angiosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Sarcomatous differentiation in phyllodes tumor is seen in the form of angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Here, we report a case of a 28-year-old pregnant woman with a breast lump during her second trimester which drastically increased in size in the postpartum period. Wide local excision revealed a malignant phyllodes tumor with liposarcomatous differentiation. Later, the patient underwent completion mastectomy which showed residual tumor.

Increased Prevalence of Chronic Disease in Back Pain Patients Living in Car-dependent Neighbourhoods in Canada: A Cross-sectional Analysis / 예방의학회지

OBJECTIVES: Chronic diseases, including back pain, result in significant patient morbidity and societal burden. Overall improvement in physical fitness is recommended for prevention and treatment. Walking is a convenient modality for achieving initial gains. Our objective was to determine whether neighbourhood walkability, acting as a surrogate measure of physical fitness, was associated with the presence of chronic disease. METHODS: We conducted a cross-sectional study of prospectively collected data from a prior randomized cohort study of 227 patients referred for tertiary assessment of chronic back pain in Ottawa, ON, Canada. The Charlson Comorbidity Index (CCI) was calculated from patient-completed questionnaires and medical record review. Using patients’ postal codes, neighbourhood walkability was determined using the Walk Score, which awards points based on the distance to the closest amenities, yielding a score from 0 to 100 (0-50: car-dependent; 50-100: walkable). RESULTS: Based on the Walk Score, 134 patients lived in car-dependent neighborhoods and 93 lived in walkable neighborhoods. A multivariate logistic regression model, adjusted for age, gender, rural postal code, body mass index, smoking, median household income, percent employment, pain, and disability, demonstrated an adjusted odds ratio of 2.75 (95% confidence interval, 1.16 to 6.53) times higher prevalence for having a chronic disease for patients living in a car-dependent neighborhood. There was also a significant dose-related association (p=0.01; Mantel-Haenszel chi-square=6.4) between living in car-dependent neighbourhoods and more severe CCI scores. CONCLUSIONS: Our findings suggest that advocating for improved neighbourhood planning to permit greater walkability may help offset the burden of chronic disease.

Immunoglobulin G4-related sclerosing cholangitis

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition of which IgG4-related sclerosing cholangitis (IgG4-SC) is the biliary manifestation. In this review, we provide an overview of IgG4-RD, with a focus on the biliary manifestations. In particular, we describe the important differential diagnoses of IgG4-SC, namely, primary sclerosing cholangitis and cholangiocarcinoma, outline diagnostic criteria for IgG4-SC, provide insight into possible pathophysiological mechanisms underlying the disease and discuss short and long-term management options of this recently described disease.

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.

Left Ventricular Hypertrophy and Incidence of Acute Coronary Heart Disease and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS).

Objective: To examine the relationship between left ventricular hypertrophy (LVH) and the incidence of acute coronary heart disease (CHD) and mortality in the modern era. Methods: We studied 16, 390 black and white participants free of clinical CHD from a US national sample. The independent prognostic value of ECG-LVH was determined by Cornell voltage (CV) for risk of incident acute CHD and total mortality overall and by race and sex. Results: 410 incident acute CHD events and 993 deaths occurred over a median follow-up of 4.8 years. CV LVH was associated with outcomes: more common in blacks (4.1%) than whites (1.2%) and in women (3.9%) than men (1.3%). However, men with CV LVH (HR 2.12 [95% CI 1.02-4.42) had greater risk for incident acute CHD than women (HR 1.29 [95% CI 0.79-2.11]) after adjusting for demographic, behavioral and clinical variables. By contrast, CV LVH conferred similar hazards for incident acute CHD among blacks (HR 1.63 [1.00-2.68; p=0.050]) and whites (HR 1.58 [95% CI 0.76-3.28; p=0.22]). Mortality associated with CV LVH was elevated overall (HR 1.31 [95% CI 1.00- 1.71]) and for blacks (HR 1.36 [95% CI 1.00-1.86]) but not whites (HR 1.16 [95% CI 0.70-1.94]), with similar risk for women (HR 1.24 [95% CI 0.92-1.67] and for men (HR 1.30 [95% CI 0.72-2.35]). Conclusion: In this contemporary cohort, CV LVH was significantly prognostic for incident acute CHD for men but not women and there was no evidence of race differences. However, CV LVH was significantly prognostic for total mortality for blacks but not whites without evidence of sex differences.

Aspirin as Primary Prevention of Acute Coronary Heart Disease Events.

Background/Objective: Aspirin for primary prophylaxis is controversial. This study evaluated associations between prophylactic aspirin use and incident acute coronary heart disease (CHD) events. Methods and Results: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study was accessed for aspirin use examining black and white hazards for incident CHD, for men and women, each adjusting incrementally for sampling, sociodemographics, and CHD risk factors. Stratified models examined risks across strata of the Framingham risk score, and all-cause mortality. 23,949 participants (mean 64 yo), had 503 incident events over a 3.5 year follow-up. Prophylactic aspirin use was not associated with incident acute CHD, HR 1.05 (95% CI 0.86, 1.29). Modeling had little impact on the HR (1.09 {95% CI 0.89, 1.33) nor did the addition of risk factors (HR 1.00 {95% CI 0.81, 1.23). Aspirin use was not associated with incident CHD for any Framingham risk level. Findings were similar when including all aspirin users (not just those taking aspirin prophylactically), and when examining associations with all-cause mortality. There was no excess hospitalized bleeding in the aspirin users. Conclusion: Aspirin was not associated with lower risk for incident acute CHD overall, or within race, gender, or Framingham Risk Score.

Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: a qualitative study

Introduction :In 2002; the West-African nation of Gabon established an emergency medical system (EMS); Service d'Aide Medicale Urgente (SAMU); in Libreville; yet few people access it. Our objective was to describe Libreville residents' knowledge and attitudes toward the SAMU in an effort to understand why this service is underutilized. Methods :Qualitative interviews consisting of nine open-ended questions were conducted on a convenience sample of twenty patients; three visitors and two patient/visitor dyads at the Jeanne Ebori Hospital Emergency Centre in October 2009. Eligible subjects arrived in vehicles other than the SAMU and were ill enough to require hospital admission. Exclusion criteria were: under 21years old; unable to speak French; or medically unstable. A bilingual team member audio-recorded the interviews in French and transcribed them into eng. Investigators organized text into codes; then into themes and theoretical constructs. Intercoder agreement was excellent. Data were collected until theoretical saturation was achieved. Results: Analysis of data revealed no difference in response between patients and visitors. People underused SAMU because of financial costs; lack of awareness of the program; use of traditional modes of transportation; infrastructure flaws; perceived response times and other misconceptions. Conclusion: We identified remediable barriers to EMS (SAMU) access in Libreville; Gabon: lack of awareness; misperceptions; established alternatives; and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas

Population Screening for Colorectal Cancer Means Getting FIT: The Past, Present, and Future of Colorectal Cancer Screening Using the Fecal Immunochemical Test for Hemoglobin (FIT)

Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.

Inequalities in Care-seeking for Febrile Illness of Under-five Children in Urban Dhaka, Bangladesh.

Fever is an easily-recognizable primary sign for many serious childhood infections. In Bangladesh, 31% of children aged less than five years (under-five children) die from serious infections, excluding confirmed acute respiratory infections or diarrhoea. Understanding healthcare-seeking behaviour for children with fever could provide insights on how to reduce this high rate of mortality. Data from a cross-sectional survey in the catchment areas of two tertiary-level paediatric hospitals in Dhaka, Bangladesh, were analyzed to identify the factors associated with the uptake of services from trained healthcare providers for under-five children with reported febrile illness. Health and demographic data were collected in a larger study of 7,865 children using structured questionnaires. Data were selected from 1,290 of these under-five children who were taken to any healthcare provider for febrile illness within two months preceding the date of visit by the study team. Certified doctors were categorized as ‘trained’, and other healthcare providers were categorized as ‘untrained’. Healthcare-seeking behaviours were analyzed in relation to these groups. A wealth index was constructed using principal component analysis to classify the households into socioeconomic groups. The odds ratios for factors associated with healthcare-seeking behaviours were estimated using logistic regression with adjustment for clustering. Forty-one percent of caregivers (n=529) did not seek healthcare from trained healthcare providers. Children from the highest wealth quintile were significantly more likely [odds ratio (OR)=5.6, 95% confidence interval (CI) 3.4-9.2] to be taken to trained healthcare providers compared to the poorest group. Young infants were more likely to be taken to trained healthcare providers compared to the age-group of 4-<5 years (OR=1.6, 95% CI 1.1-2.4). Male children were also more likely to be taken to trained healthcare providers (OR=1.5, 95% CI 1.2-1.9) as were children with decreased level of consciousness (OR=5.3, 95% CI 2.0-14.2). Disparities across socioeconomic groups and gender persisted in seeking quality healthcare for under-five children with febrile illness in urban Dhaka. Girls from poor families were less likely to access qualified medical care. To reduce child mortality in the short term, health education and behaviour-change communication interventions should target low-income caregivers to improve their recognition of danger-signs; reducing societal inequalities remains an important longterm goal.

Estimating the Effect of Recurrent Infectious Diseases on Nutritional Status: Sampling Frequency, Sample-size, and Bias.

There is an ongoing interest in studying the effect of common recurrent infections and conditions, such as diarrhoea, respiratory infections, and fever, on the nutritional status of children at risk of malnutrition. Epidemiological studies exploring this association need to measure infections with sufficient accuracy to minimize bias in the effect estimates. A versatile model of common recurrent infections was used for exploring how many repeated measurements of disease are required to maximize the power and logistical efficiency of studies investigating the effect of infectious diseases on malnutrition without compromising the validity of the estimates. Depending on the prevalence and distribution of disease within a population, 15-30 repeat measurements per child over one year should be sufficient to provide unbiased estimates of the association between infections and nutritional status. Less-frequent measurements lead to a bias in the effect size towards zero, especially if disease is rare. In contrast, recall error can lead to exaggerated effect sizes. Recall periods of three days or shorter may be preferable compared to longer recall periods. The results showed that accurate estimation of the association between recurrent infections and nutritional status required closer follow-up of study participants than studies using recurrent infections as an outcome measure. The findings of the study provide guidance for choosing an appropriate sampling strategy to explore this association.

Infectious diseases and vaccine sciences: strategic directions.

Despite substantial progress, infectious diseases remain important causes of ill-health and premature deaths in Bangladesh. Bangladesh has experienced a > 90% reduction in the incidence of deaths due to childhood diarrhoea over the last 25 years. Further reductions can be achieved through the introduction of effective vaccines against rotavirus and improvements in home hygiene, quality of drinking-water, and clinical case management, including appropriate use of oral rehydration solution and zinc. Pneumonia is now the leading cause of childhood deaths in Bangladesh, and the pneumonia-specific child mortality is largely unchanged over the last 25 years. Reductions in mortality due to pneumonia can be achieved through the introduction of protein conjugate vaccines against Haemophilus influenza type b and Streptococcus pneumoniae, improvements in case management, including efforts to prevent delays in providing appropriate treatment, and the wider use of zinc. Tuberculosis is responsible for an estimated 70,000 deaths each year in Bangladesh. Although services for directly-observed therapy have expanded markedly, improved case finding and involvement of private practitioners will be important to reduce the burden of disease.

Distribución vertical de haemagogus janthinomys (dyar) (diptera: culicidae) en bosques de la amazonía peruana / Vertical distribution of the mosquito Haemagogus jantinomys (Dyar) (Diptera: Culicidae) in forests of the Peruvian Amazon

Objetivos: Determinar si la abundancia del mosquito Haemagogus janthinomys está relacionada con la temperatura y lahumedad relativa, y si varía entre el dosel y el sotobosque en tres tipos de bosques de la selva Amazónica, medido porcebo humano. Materiales y métodos: Se colectó Hg. janthinomys al mismo tiempo en dos estratos de tres sitios en trestipos de bosques -bosque que se desarrolla sobre suelo arcilloso, sobre arena blanca (varillal), y bosques inundables(bajiales) cerca de Iquitos, Perú. Se midió la temperatura y la humedad relativa cada 15 minutos durante el tiempo decolecta. Resultados: No se encontró Hg. janthinomys en los bajiales mostrados. Su abundancia fue igual en el montealto que en los varillales (Z = 1, 48; p = 0,14), pero fue mayor en el dosel (2,9; ± 0,89) que en el sotobosque (0,4; ±0.23) (Z = 2,80; p = 0,005). No se encontró una relación entre la abundancia de Hg. janthinomys y la temperatura y lahumedad relativa (F1, 14 < 0,33; p > 0057; r2 < 0,03). Conclusiones: Estos resultados preliminares indican que alrededorde Iquitos, como en otras regiones, Hg. janthinomys es más abundante en el dosel. También, los resultados sugieren quela probabilidad de encontrar Hg. janthinomys puede depender del tipo de bosque en la selva amazónica peruana, perono depende en la variación de la temperatura ni la humedad relativa que es típica para los bosques tropicales.

Objectives: Our goals were to determine if the abundance of the mosquito Haemagogus janthinomys is correlated with environmental variables, and if it differs between the canopy and understory in three different Amazonian forest types. Materials and methods: Adult Hg. janthinomys mosquitoes were collected via human landings simultaneously in the canopy and understory of three replicate high forest, white sand forest, and seasonally flooded forest sites near Iquitos, Peru. Temperature and relative humidity were recorded every 15 min. during the collection periods. Results: No Hg. janthinomys were collected in seasonally flooded forest. Their abundance was similar between high forest and white sand forest (Z = 1, 48; p = 0,14), but more individuals were encountered in the canopy (2.9; ± 0.89) than in the understory (0,4; ± 0.23) (Z = 2.80; p = 0,005). Hg. janthinomys abundance was not correlated with temperature or humidity (F1, 14 < 0.33; p > 0057; r2 < 0.03). Conclusions: These preliminary results show that around Iquitos as in other regions, Hg. janthinomys are most abundant in the forest canopy. They also suggest that the probability of encountering Hg. janthinomys it can depends both on forest type and height of sampling within forests, but is not a function of temperature and humidity within the ranges commonly encountered in tropical forests.