Current legislation on medical cannabis in the European Union: historical background, movements, trends, and counter-trends lessons for Brazil / Legislação atual sobre cannabis medicinal na União Europeia: históricos, movimentos, tendências e contratendências. Lições para o Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: The growing interest in the medical use of cannabis and phytocannabinoids has led European Union (EU) countries to regulate the production and access to cannabis products for their citizens. This regulation is based on international conventions, the European Medicines Agency (EMA) guidelines and legal loopholes that grant autonomy to EU member countries to authorize the production and marketing of cannabis-based drugs and foods. This summary aims to present the current status of medical cannabis legislation in the EU, highlighting the authorization of drugs, regulatory processes and the autonomy of member states in the production of magistral formulas. CONTENTS: Most EU countries allow, in some form, the legal use of cannabis and its derivatives as a drug. Since 2019, three drugs containing nabiximols, dronabinol or nabilone have been authorized on the markets of EU member states. In addition to the EMA centralized procedure for marketing authorization, cannabinoid-based products can also be authorized through regional or national processes in EU countries. This autonomy extends to the production of magistral formulas in compounding pharmacies, allowing pharmacists to prepare formulas containing cannabis for use according to a specific medical prescription and, in some situations, at scale. CONCLUSION: While it is not possible to conclude which is the ideal approach to the regulation of medical cannabis that all countries should adopt, the experience of the EU provides valuable lessons. The autonomy granted to the member states allows the expansion of the medical use of cannabis through the authorization of drugs and the production of magistral formulas. These experiences can be used as a basis for reformulations in Brazilian regulations, aiming to expand access and medical use of cannabis in the country.

RESUMO JUSTIFICATIVA E OBJETIVOS: O crescente interesse no uso medicinal da cannabis e fitocanabinoides tem levado os países da União Europeia (UE) a regulamentarem a produção e acesso a produtos canábicos para seus cidadãos. Esta regulamentação se baseia em convenções internacionais, orientações da Agência Europeia de Medicamentos (EMA) e brechas legais que concedem autonomia aos países-membros da UE para autorizar a produção e comercialização de fármacos e alimentos à base de cannabis. Este estudo teve o objetivo de apresentar a situação atual da legislação sobre cannabis medicinal na UE, destacando a autorização de fármacos, os processos de regulamentação e a autonomia dos estados-membros na produção de fórmulas magistrais. CONTEÚDO: A maioria dos países da UE permite, de alguma forma, o uso legal da cannabis e seus derivados como fármaco. Desde 2019, três fármacos contendo nabiximols, dronabinol ou nabilona foram autorizados nos mercados dos estados-membros da UE. Além do procedimento centralizado da EMA para a autorização de comercialização, os produtos à base de canabinoides também podem ser autorizados por meio de processos regionais ou nacionais dos países da UE. Essa autonomia se estende à produção de fórmulas magistrais em farmácias de manipulação, permitindo que os farmacêuticos preparem fórmulas contendo cannabis para uso de acordo com prescrição médica específica e, em algumas situações, em escala. CONCLUSÃO: Embora não seja possível concluir qual é a abordagem ideal para a regulamentação da cannabis medicinal que deve ser adotada por todos os países, a experiência da UE fornece lições valiosas. A autonomia concedida aos estados-membros permite a ampliação do uso medicinal da cannabis por meio da autorização de fármacos e da produção de fórmulas magistrais. Essas experiências podem ser utilizadas como base para reformulações na regulamentação brasileira, visando ampliar o acesso e uso medicinal da cannabis no país.

Key points in pancreatic cancer： ESMO clinical practice guideline for diagnosis， treatment and follow-up （2023） / 临床肝胆病杂志

In September 2023， the European Society for Medical Oncology published Pancreatic cancer： ESMO Clinical Practice Guideline for diagnosis， treatment and follow-up in Annals of Oncology. The guideline provides recommendations on the epidemiology， diagnosis， and treatment of pancreatic cancer （PC）. The guideline highlights the high-risk populations of PC and recommended screening methods， clarifies the diagnostic process of PC and various radiological and molecular biology tests， and mentions the appropriate treatment methods for different types of PC. This article makes an excerpt of this guideline and introduces related recommendations for the clinical treatment of PC， in order to provide a reference for clinical practice.

Key points of EASL Clinical Practice Guidelines on hepatitis delta virus （2023） / 临床肝胆病杂志

‍Due to significant innovations in the diagnosis and treatment of hepatitis D virus （HDV）， the European Society of Hepatology （EASL） published its first international clinical practice guidelines on the management of individuals with HDV infection in July 2023. The guidelines mainly focus on the six aspects of HDV screening， diagnosis， clinical features and influencing factors， patient monitoring and selection for treatment， therapeutic methods and treatment endpoints. The guidelines give recommendations by answering and elaborating on 13 questions covering these six aspects. In addition， the guidelines also provide the prospect of the future treatment of HDV. The author’s team makes an excerpt of the guidelines and systematically introduces various evaluation points in recommendations and clinical management suggestions， in order to promote the development of clinical management and decision-making for individuals with HDV infection in China.

An excerpt of EASL clinical practice guidelines on acute－on－chronic liver failure （2023） / 临床肝胆病杂志

Acute－on－chronic liver failure （ACLF） is a serious form of acute decompensation of liver cirrhosis， which is characterized by multiple organ failure， systemic inflammatory response， and a high short－term mortality rate. In 2023， the European Association for the Study of the Liver gave recommendations to clinicians， aiming to help them with the diagnosis of ACLF， the decision of triage （whether it is necessary to transfer a patient to the ICU for treatment）， the identification and management of acute predisposing factors， the identification of organs that need support or replacement therapy， the definition of potential criteria for ineffective ICU treatment， and the determination of potential indications for liver transplantation. This article gives an excerpt of the above main contents in the guidelines.

Role of nuclear medicine in the European guidelines for prostate cancer / 中华核医学与分子影像杂志

Prostate cancer is the most common malignancy of the male genitourinary system. In 2022, the European Association of Urology (EAU) published an update of the guidelines for prostate cancer, following the updating of evidence. The clinical application of nuclear medicine diagnostic and therapeutic techniques in the staging and grading, screening and assessment of prostate cancer, especially metastatic castration-resistant prostate cancer, is becoming more and more valuable. This article aims to introduce the application of nuclear medicine recommended in the 2022 edition of EAU guidelines for prostate cancer based on the latest clinical evidence.

Relación docente-estudiante y compromiso escolar: percepción de estudiantes secundarios con necesidades educativas especiales / Teacher-student relationship and student engagement: perceptions of secondary students with special educational needs / Relação professor-aluno e compromisso escolar: percepção de jovens com necessidades educacionais especiais

Resumen (analítico) Investigaciones previas sostienen que la relación docente-estudiante es un factor relevante para el compromiso escolar y rendimiento académico. Sin embargo, su impacto ha sido poco explorado en estudiantes con necesidades educativas especiales. Este estudio examina la influencia de la relación docente-estudiante en el compromiso escolar según la percepción de estudiantes de primer año medio con necesidades educativas especiales de una Región de Chile. Se realizó un estudio cualitativo, de tipo fenomenológico y de alcance descriptivo-analítico. Se desarrollaron diez entrevistas en profundidad a estudiantes con necesidades educativas especiales, las que se analizaron mediante el método de comparación constante de la teoría fundamentada. Los resultados revelan el rol clave de los/as docentes en el compromiso escolar a través de la satisfacción de las necesidades de vinculación y competencia de sus estudiantes, pero no de su autonomía.

Abstract (analytical) The results of existing research studies show that the teacher-student relationship is a relevant factor that affects academic engagement and school performance. However, there is limited evidence of its impact on students with special educational needs. This study examines the influence of the teacher-student relationship on school engagement based on the perceptions of students with special educational needs in their first year of high school education in Chile. The study used a qualitative, phenomenological, and descriptive-analytical design. A total of ten indepth interviews were conducted with students with special educational needs. The data was analysed using the methodological guidelines of grounded theory. The results highlight the key role of teachers in academic engagement by satisfying students' psychological needs in the areas of connection and competence, but not satisfying students' need for autonomy.

Resumo (analítico) Pesquisas anteriores afirmam que a relação professor-aluno é um fator relevante para o engajamento e desempenho acadêmico. No entanto, seu impacto tem sido pouco explorado em alunos com necessidades educacionais especiais. Este estudo examina a influência da relação professor-aluno no compromisso escolar segundo a percepção dos alunos com alunos com necessidades educacionais especiais do primeiro ano do ensino médio, da Chile. O desenho foi qualitativo, fenomenológico, descritivo-analítico em escopo. Foram realizadas 10 entrevistas em profundidade com alunos com necessidades educacionais especiais. Os dados foram analisados segundo as diretrizes metodológicas da teoria fundamentada nos dados. Os resultados apontam para o papel fundamental do professor no comprometimento escolar, por meio da satisfação das necessidades de vinculação e competência de seus alunos, mas não de sua autonomia.

An excerpt of the EASL clinical practice guidelines on haemochromatosis / 临床肝胆病杂志

In March 2022, EASL released a new version of the clinical practice guidelines on haemochromatosis. Haemochromatosis is characterized by elevated transferrin saturation (TSAT) and progressive iron overload mainly involving the liver, and early diagnosis and venesection can prevent liver cirrhosis, hepatocellular carcinoma, diabetes, arthritis, and other complications. For patients with p.Cys282Tyr homozygous mutation of the hemochromatosis gene HFE , haemochromatosis can be diagnosed if serum iron parameters show TSAT > 45% and ferritin > 200 μg/L in female patients, or TSAT > 50% and ferritin > 300 μg/L in male patients and postmenopausal female patients. If a patient has elevated TSAT and ferritin and belongs to other HFE genotypes, magnetic resonance or liver biopsy is needed to confirm iron overload in the liver. Liver fibrosis stage and damage to other organs should be carefully assessed at the time of diagnosis, which will help to determine management strategies. Hepatocellular carcinoma should be screened for patients with progressive liver fibrosis. The goal of venesection is to achieve ferritin < 50 μg/L during the induction stage and ferritin < 100 μg/L during the maintenance stage.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study / Experiência de enfermeiros migrantes e de minorias étnicas em trabalho em serviços de saúde europeus: estudo qualitativo / Experiencia de trabajo de enfermeras inmigrantes y de minorías étnicas en los servicios de salud europeos: un estudio cualitativo

ABSTRACT Objective: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed Results: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

RESUMO Objetivo: Analisar a percepção da cultura e experiência de trabalho em serviços de saúde europeus de uma amostra intencional de enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente na Bélgica, Portugal, Espanha e Turquia. Método: Optou-se pelo método fenomenológico qualitativo. Realizaram-se entrevistas individuais com 8 enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente em quatro países europeus. A análise temática foi realizada por meio das etapas de Braun e Clark após os dados qualitativos terem sido transcritos na íntegra, traduzidos para o inglês e analisados. Resultados: Quatro temas e 4 subtemas emergiram da análise temática das transcrições. Conclusão: Enfermeiros migrantes e de minorias étnicas que trabalham na União Europeia vivenciam e testemunham discriminação e preconceito de pacientes e colegas devido a diferenças culturais. Os serviços de saúde europeus devem acompanhar de perto e combater a discriminação e o preconceito contra os trabalhadores e pacientes migrantes e de minorias étnicas, e tomar iniciativas para os reduzir e, em seguida, erradicá-los.

RESUMEN Objetivo: Analizar la percepción de la cultura y la experiencia de trabajar en los servicios de salud europeos de una muestra intencional de enfermeros calificados de minorías étnicas y migrantes que actualmente viven en Bélgica, Portugal, España y Turquía. Método: Se decidió utilizar un método cualitativo fenomenológico. Se realizaron entrevistas individuales con 8 enfermeros calificados inmigrantes y de minorías étnicas que actualmente viven en cuatro países europeos. El análisis temático se realizó utilizando las etapas de Braun y Clark después de que los datos cualitativos fueran transcritos palabra por palabra, traducidos al inglés y analizados. Resultados: Del análisis temático de las transcripciones surgieron 4 temas y 4 subtemas. Conclusión: Los enfermeros de minorías étnicas y migrantes que trabajan en la Unión Europea experimentan y son testigos de la discriminación y de los prejuicios de los pacientes y colegas sobre la base de la diferencia cultural. Los servicios de salud europeos deben monitorear de cerca y abordar la discriminación y los prejuicios hacia el personal y los pacientes de minorías étnicas y migrantes, y tomar iniciativas para reducirlos y, eventualmente, erradicarlos.

Interpretation of acute abdomen in the immunocompromised patients: WSES/SIS-E/WSIS/AAST/GAIS guideline / 中华危重病急救医学

World Society of Emergency Surgery (WSES), in conjunction with Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) developed guideline about the management of acute abdomen in immunocompromised patients, which was published in the World Journal of Emergency Surgery (WJES) on August 9, 2021. The guidelines elaborate on the definition, classification, diagnosis and treatment of immunocompromised patients. In addition, based on evidence-based medicine, it provides guidance and suggestion on the management of specific acute abdominal infections in immunocompromised patients, common acute abdominal infections in transplanted patients, patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), as well as perioperative steroid management. An interpretation of the guideline was performed to accomplish a better understanding the current status and recommendations for the management of acute abdominal conditions in immunocompromised patients, and to make forward suggestions on its limitations.

Development status and cooperation strategy of Traditional Chinese Medicine in Germany, France, the UK and Netherlands / 国际中医中药杂志

This paper analyzes and compares the development of Traditional Chinese Medicine (TCM) in Germany, France, the UK and Netherlands, considering the economic and social situation of countries. The SWOT strategic analysis is carried out on the basis of the proposittion of China-Europe cooperation in TCM, which encourage to carry out joint tackling of TCM for common diseases, jointly promoting the legislation with the guidance of the government and the participation of the public, speeding up the registration and listing of Chinese patent medicine with the focus on the Netherlands and the UK, and optimizing the perspective and strength of TCM publicity with the help of new media. In this way, TCM should be promoted in Europe.

Tracking the onset date of the community spread of SARS-CoV-2 in western countries

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread around the world during 2020, but the precise time in which the virus began to spread locally is difficult to trace for most countries. Here, we estimate the probable onset date of the community spread of SARS-CoV-2 for heavily affected countries from Western Europe and the Americas on the basis of the cumulative number of deaths reported during the early stage of the epidemic. Our results support that SARS-CoV-2 probably started to spread locally in all western countries analysed between mid-January and mid-February 2020, thus long before community transmission was officially recognised and control measures were implemented.

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts / 대한소아소화기영양학회지

Updated key points of the 2019 EASL guidelines for drug-induced liver injury and its practice in China / 临床肝胆病杂志

To further understand the 2019 EASL Guidelines for drug-induced liver injury (DILI), this article outlined the updated key points of the guidelines and analyzed these points with reference to the reality of China, including the type of DILI, DILI induced by herbs and dietary supplements, prospective versus retrospective studies, diagnosis and causality assessment, risk factors, special phenotypes of DILI, management of DILI induced by immune checkpoint inhibitors, indication for the withdrawal of antitubercular agents, new biomarkers for DILI under clinical research, and therapeutic drugs for DILI. It is pointed out that the new version of the EASL guidelines redefined the diagnosis of acute and chronic DILI, provided detailed management strategies for DILI induced by immune checkpoint inhibitors and criteria for the withdrawal of antitubercular agents, and summarized several special phenotypes of DILI, with an emphasis on DILI induced by herbs and dietary supplements. Therefore, these guidelines have a good reference value for the diagnosis and treatment of DILI in China.

Comparative Study on Regulatory Measures of Biosimilars in China ，the United States ，Japan and Europe / 中国药房

OBJECTIVE：To provi de reference for drug admini stration supervision of biosimilars in China. METHODS ： Referring to the authoritative documents of the official websites of National Medical Products Administration of China ，FDA of the United States ，European Drug A dministration and Japan ’s D rug and M edical Devices Agency ，and comparing their regulatory measures on the definition ，effectiveness，safety and clinical application of biosimilars，the suggestions were put forward for the improvement of regulatory measures of biosimilars in China. RESULTS & CONCLUSIONS ：Although the definitions biosimilars in different countries/regions were different ，they all required that biosimilars should have the same drug quality ，safety and effectiveness as their corresponding reference drugs. The United States ，the European Union and Japan required enterprises to provide studies on the similarity of early pharmacy ，non-clinical studies such as pharmacology and toxicology ，and clinical studies on immunogenicity ，pharmacokinetics and pharmacodynamics of biosimilars and reference drugs. However ，the similarity between biosimilars and reference drugs had not been required in China. All countries/regions supported the extrapolation of indications of biosimilars. Among which the United States and the European Union required manufacturers to provide detailed data ；Japan only mentioned the relevant concepts of indications extrapolation of biosimilars，but did not mention the specific data requirements. The relevant description of the conditions for the extrapolation of biosimilars in China was not clear enough ，and its application in China was still facing great challenges. In terms of drug interchangeability ，although the United States allowed the use of interchangeable biosimilars to replace reference drugs under the conditions permitted by state laws ，no relevant biosimilars had been approved；European countries had different regulations on the interchangeability of biosimilars；but there was no document explicitly mentioned in China and Japan on the interchangeability of biosimilars. It is suggested that the principle of comparison should be further improved and strict requirements should be appropriately enforced in ensuring the effectiveness and safety of biosimilars；in the field of indication extrapolation ，more detailed data requirements should be put forward ，and the possible risks after extrapolation should be evaluated scientifically ；in terms of the interchangeability of biosimilars ，it is suggested to try to implement the principle of conversion of biosimilars ，but it should be used after consultation among doctors ，pharmacists and patients，and drug use safety should be monitored timely. Meanwhile ，a sound traceability system should be established to ensure drug safety of patients.

¿Cosmopolitismo o subordinación? La participación de científicos latinoamericanos en programas europeos: motivaciones y dinámicas analizadas desde el punto de vista de los líderes europeos / Cosmopolitanism or subordination? Latin American scientists' participation in European programs: motivations and dynamics analyzed from the European scientific leaders' point of view

Resumen Partiendo de un enfoque cualitativo, pretendemos dar cuenta de las motivaciones de grupos científicos y sus dinámicas de cooperación internacional. Consideramos la participación de científicos latinoamericanos en consorcios europeos y analizamos el punto de vista de los líderes europeos. Dentro de la cooperación científica "Norte-Sur", planteamos tres niveles de análisis: a nivel institucional, comprender el interés de Europa en cooperar con Latinoamérica; en relación con las estrategias cognitivas, averiguar las motivaciones de líderes europeos para enrolar latinoamericanos en sus investigaciones; a nivel de las prácticas, conocer la organización del trabajo en el interior de esos consorcios. Hacia el final, proponemos una tipología de algunas configuraciones de cooperación científica de grupos latinoamericanos.

Abstract Using a qualitative approach, we explore the motivations of scientific groups and their dynamics in international cooperation. We consider the participation of Latin American scientists in European consortia and analyze the European hosts' point of view. Within the framework of "North-South" scientific cooperation, we propose three levels of analysis: on the institutional level, understanding Europe's interest in cooperating with Latin America; in terms of cognitive strategies, tracing what motivates European group leaders to include Latin Americans in their research projects; and in terms of practices, figuring out how work within these consortia is allotted. Towards the end, we propose a typology of some of the modalities of scientific cooperation by Latin American groups.

Equidad y educación de la primera infancia en la agenda educativa mundial / Equality and early childhood education in the global education agenda / Equidade e educação na primeira infância na agenda mundial de educação

Resumen (descriptivo): El presente trabajo se inspira en la necesidad de abordar un análisis de la equidad en la etapa de educación infantil desde un enfoque holístico, para contribuir al debate actual sobre la importancia de la equidad en la nueva agenda educativa y sus metas para la primera infancia. Parte de fundamentos del estudio teórico de la equidad en educación desde un enfoque holístico que permita aplicar este análisis a la educación de la primera infancia en las sociedades iberoamericanas, en aras de aportar una perspectiva más amplia en la discusión de sus logros y desafíos. Finalmente, este entendimiento posibilita la interpretación de los límites y posibilidades de los objetivos globales establecidos para la educación de la primera infancia y la medición de los progresos e implicaciones para la equidad educativa.

Abstract (descriptive): The present paper is inspired by the need to carry out an analysis of equality in early childhood education using a holistic approach and contribute to the current debate regarding the importance of equality in the new education agenda and its goals for early childhood. This analysis is based on the foundations of the theoretical study of educational equality from a holistic perspective, which facilitates its application to early childhood education in Ibero-American societies. This will provide a broader perspective on the discussion of the achievements and challenges in the area of equality. Finally, the understandings reached as a result of this analysis facilitate the interpretation of the limits and possibilities of global education targets for early childhood, the measurement of progresses and implications for educational equality.

Resumo (descritivo): O presente trabalho tem como inspiração analisar a equidade na educação infantil a partir de um enfoque holístico. Busca contribuir para o debate sobre a importância da equidade na nova agenda educativa tendo em vista as metas a serem alcançadas para a educação na primera infância. Apresenta os fundamentos da equidade a partir de um estudo teórico com enfoque holístico e, desde aí, amplia-se para a análise da equidade em educação, mais especificamente na Educaçao Infantil das sociedades iberoamericanas, no intuito de aportar uma perspectiva mais ampla na discussão de suas conquistas e desafios. Conclusivamente, este estudo ajuda para a interpretação dos limites e possibilidades dos objetivos globais estabelecidos para a educação na primeira infância e para a mediação dos progressos e implicações considerando o alcance de metas de equidade educativa.

Posgrados en odontología: propuesta internacional / Postgraduate education in dental medicine: an international proposal

Introducción: Los posgrados en Odontología son parte del perfeccionamiento profesional que permiten adquirir competencias específicas del más alto nivel, aplicadas a la salud oral en la atención clínica, organización de servicios odontológicos, que reúna aspectos técnicos y especializados en la docencia e investigación. Objetivo: Exponer las tendencias del desarrollo de posgrados odontológicos a nivel internacional que se ofertan en Europa y América. Métodos: Estudio descriptivo en el área de la educación médica realizado mediante la búsqueda de posgrados odontológicos ofertados en sitios webs de instituciones de Europa y América, durante el periodo de julio a diciembre del 2017, en las categorías de especialidad, maestría profesionalizante, maestría en investigación y el nivel de PhD. El método de análisis y síntesis de la bibliografía consultada se realizó a partir de Google académico, Pubmed, SciElo, Lilacs. Resultados: Se encontraron 967 programas de posgrados de odontología en los niveles de maestrías, especialidades y doctorados, en 226 instituciones de educación superior. En Latinoamérica más de la mitad de los posgrados de odontología se enmarcan en los criterios de especialidades, a diferencia de Europa y América Anglosajona, que se inclinan en la oferta de maestrías dirigidas a la investigación y programas doctorales. En los resultados de la tendencia de Programas de Posgrados en Odontología se evidencia que ortodoncia es el más ofertado; seguido de endodoncia, pediatría odontológica y periodoncia. Conclusiones: Es necesario incrementar la oferta de posgrados en países latinoamericanos que integren la investigación, tecnología, docencia, administración y la ciencia a fin de generar profesionales capaces de ejercer internacionalmente a la par de países desarrollados(AU)

Introduction: Postgraduate courses in Dental Medicine are part of the professional development that allows to acquire specific competences of the highest level, applied to dental health in clinical care, organization of dental services, which brings together technical and specialized aspects in teaching and research. Objective: To expose the tendencies of the development of postgraduate in dental medicine offered in Europe and America. Method: Descriptive study in the area of medical education carried out through the search of postgraduate dental programs offered on websites of institutions in Europe and America, during the period from July to December 2017, in the categories specialty, professional master course, master's degree in research, and the PhD level. The method of analysis and synthesis was used to work with the consulted bibliography, mainly from Google Academic, Pubmed, SciElo, Lilacs. Results: 967 postgraduate dental programs were found at the masters, specialties and PhD levels and in 226 institutions of higher education. In Latin America, more than half of the postgraduate programs in dental can be characterized within the criteria of a specialty, unlike in Europe and Anglo-Saxon America, where the tendency is to offer master's degrees aimed at research and to offer PhD programs. Analyzing the results regarding the tendency of postgraduate programs in dental medicine, it is evident that Orthodontics is the most offered, followed by Endodontics, Dental Pediatrics and Periodontics. Conclusions: It is necessary to increase the offer of postgraduate courses in Latin American countries, integrating research, technology, teaching, management and science, in order to generate professionals capable of working worldwide at the level of developed countries(AU)

Practical Exploration of Introducing PCNE Classification System to Develop MTM in Type 2 Diabetic Patients / 中国药房

OBJECTIVE： To introduce Pharmaceutical Care Network Europe （PCNE） classification system to develop medication therapy management （MTM）， and to investigate the application of PCNE classification system in solving drug-related problems （DRPs） in type 2 diabetic patients and the effect of it on clinical outcomes. METHODS： The patients with type 2 diabetes diagnosed in endocrinology department of our hospital from Jul. 10， 2018 to Oct. 31， 2018 were randomly divided into clinical pharmacist-led intervention （“physician-pharmacist-nurse” mode） group and control group receiving only traditional medical services （“physician-nurse” mode）. According to PCNE classification， the number of DRPs found in the pharmaceutical intervention group， the types of problems， causes， the types of interventions， acceptance for interventions and outcomes were analyzed and evaluated. Drug compliance （the highest score is 8） and HbA1c compliance （＜7％） were compared between 2 groups during hospitalization （or at the discharge） and 3 months after discharge. RESULTS： Totally 76 cases were included （40 cases in pharmaceutical intervention group and 36 cases in control group）. During hospitalization， 51 DRPs were found in the pharmaceutical intervention group， among which 42 problems were related to the effectiveness of treatment， mainly due to improper usage and dosage （23 problems）； the types of intervention was mainly aimed at the patient level （24 problems）. 38 problems received intervention （acceptance rate was 74.51％） and 32 problems （62.75％） were completely solved. Compared with those at admission， after following up for 3 months patients with low score （6 points） in the drug compliance of the pharmaceutical intervention group decreased from 26 to 8 （P＜0.000 1）， patients with medium score （6-8 points） increased from 10 to 22 （P＝0.006 2）， patients with high score （8 points） increased from 4 to 10， and drug compliance improved significantly， while there was no significant change in drug compliance in the control group. Compared with those at the discharge， after 3 months’ follow-up， the HbA1c compliance rate of the pharmaceutical intervention group increased from 25.00％ to 77.50％， and that of the control group increased from 25.00％ to 55.56％. There were statistical differences （P＜0.000 1）， and HbA1c compliance rate of the pharmaceutical intervention group was significantly higher than that of the control group. CONCLUSIONS： In the practice of MTM service， clinical pharmacists use PCNE classification system to collect， analyze， intervene， solve and evaluate DRPs systematically. The service mode can provide reference for standardizing pharmaceutical care mode.

Sickness Presenteeism among the Self-employed and Employed in Northwestern Europe-The Importance of Time Demands

BACKGROUND: European policymakers encourage individuals to become self-employed because it is a way to promote innovation and job creation. It can be assumed that health and well-being among the self-employed and managers in small-scale enterprises are particularly crucial in this enterprise group because the smallness of the enterprise makes its members vulnerable. Earlier studies have indicated that the self-employed have a high working pace and work for long and irregular hours, indicating that it can be difficult to stay at home because of sickness. The purpose of this study is to investigate the occurrence of sickness presenteeism among the self-employed in relation to the organizationally employed and to analyze whether any differences can be explained by higher work demands among the self-employed. METHODS: The study is based on the fifth European survey on working conditions (2010) and includes the northwestern European countries in the survey. The questions cover a wide range of topics designed to meet the European Union's political needs. The main variables in this study are sickness presenteeism and several indicators of time demands. RESULTS: The results show that the self-employed report a higher level of sickness presenteeism than the employed: 52.4 versus 43.6%. All indicators of time demands are significantly related to the risk for sickness presenteeism, also when controlling for background characteristics. CONCLUSION: The results confirm that the level of sickness presenteeism is higher among the selfemployed and that high time demands are a major explanation to this.

Uma Europa inventada pelo futebol / An Europe invented by football / Una Europa inventada por el fútbol

O presente ensaio procura desenvolver uma sugestão de Detlev Claussen, a de que uma ideia de Europa se forma com o futebol. Para tanto, recorre a diferentes posições de teóricos e literatos europeus sobre esse esporte, cruzando-as nos termos de sua materialização em torno das origens das copas europeias e da circulação de jogadores e formas de jogo. Argumenta, neste sentido, por uma constituição continental por meio de um elemento cultural popular e que concorre com as narrativas tradicionais

This essay elaborates on Detlev Claussen's original view that an idea of Europe is formed by football. It resorts to various views by European theorists and scholars on football and analyzes them in the context of the origins of European Football Cups and the circulation of players and playing styles. Then it points to continental constitution through a popular cultural element that dissents from traditional narratives

El presente ensayo pretende desarrollar una sugerencia de Detlev Claussen, según la cual una idea de Europa se forma con el fútbol. Para ello, recurre a diferentes posturas de teóricos y literatos europeos sobre ese deporte, cruzándolas en términos de su materialización en torno a los orígenes de las copas europeas y de la circulación de jugadores y formas de juego. Argumenta, en este sentido, por una constitución continental por medio de un elemento cultural popular y que concurre con las narrativas tradicionales