Comparison of the Associations of Different Socio-economic Indices with Various Indicators of Child Malnutrition in the Philippines.

Objectives: To compare associations between different indices of socio-economic status (SES) and child malnutrition. Methods: A cross-sectional survey in poor urban areas in the Philippines collected information on child wasting, stunting, anemia, iron deficiency, and vitamin A deficiency, as well as data to calculate three measures of SES: household income; a Philippines government measure using housing conditions, income, education, and occupation; and a wealth index calculated from ownership of durable goods and other factors. Results: All forms of malnutrition were associated with all three SES measures; however, the government measure and the wealth index were more strongly associated. The odds ratios for anemia comparing the poorest group to the richest group were 1.7 for household income, 3.3 for the government measure, and 3.5 for the wealth index. Similarly, for iron deficiency, the odds ratios were 1.5 for household income, 2.9 for the government measure, and 2.4 for the wealth index. The odds ratios for vitamin A deficiency were 3.4 for income, 3.4 for the government measure, and 11.9 for the wealth index. In addition, the correlations with anthropometric z-scores, hemoglobin, ferritin, and retinol binding protein concentrations were higher for wealth index than for household income when analyzed as continuous variables. Conclusions: In this study, measurements of wealth based on a broader variety of household characteristics were better correlated with malnutrition than household income alone. Estimates of SES in surveys assessing nutritional status should thus be based on a broader mix of data than just household income.

A função do debriefing psicológico no tratamento de vítimas de trauma / The role of psychological debriefing in the treatment of victims of trauma

A aplicaçäo do chamado debriefing psicológico (DP) tornou-se uma intervençäo disseminada e esperada após a exposiçäo ao trauma. Este artigo avalia a validade desse enfoque e relata o consenso entre os especialistas em relaçäo ao seu uso. Revisöes sistemáticas e narrativas säo resumidas e as áreas de acordo e desacordo säo delineadas. Em resumo, conclui-se que a maioria das pessoas näo fica traumatizada devido a eventos estressantes; que o DP parece ter pequeno impacto; que uma forma de DP chamada de "debriefing sobre o incidente crítico (DICE)" pode exercer efeitos nocivos em certos indivíduos e que aqueles com efeitos mais negativos devido ao DP parecem ser os que mais sofreram com o trauma inicial. Näo há ensaios clínicos randomizados que sustentem a validade do DP em grupo. A intervençäo precoce Cognitivo-Comportamental parece ser o enfoque mais promissor em pacientes com apresentaçöes clínicas bem definidas. É oferecido um conjunto genérico de diretrizes para a intervençäo pós-trauma

Pemphigus

Pemphigus is a group of organ-specific autoimmune disorders with an established immunologic basis. The presence of intraepithelial blisters and erosions of the skin and variable involvement of the mucous menbranes characterize its three major variants, pemphigus vulgaris, pemphigus follaceus, and paraneoplastic pemphigus. Prior to the use of corticosteroids in the 1950s, the natural history of pemphigus vulgaris was relentless progression, with a 50% mortality at 2 years, and almost 100% at 5 years. Today, with mortality rates less than 5% the focus has changed towards reducing corticosteroid side effects and maintaining optional quality of life under treatment. this can be achived by the appropriate use of steroid-spating agents. This article addresses the comprehensive management of patients with pemphigus