Hospitales Nisa

Å ivareta velferdsgoder er en sentral oppgave i helhetlig arealplanlegging og arealforvaltning. Jordbrukslandskapet leverer fellesgoder eller såkalte økosystemtjenester som bidrag til menneskelig velferd. I denne artikkelen ser vi på jordbrukets bidrag til kulturelle økosystemtjenester og hvordan kulturarvsverdier inngår i dette. Kulturelle økosystemtjenester bidrar til stedsidentitet, estetiske verdier og friluftsliv og betegnes gjerne som opplevelses- og kunnskapstjenester. At store deler av kulturarvsverdien ligger på jordbruksareal som antas å være ute av drift, tilsier en utvikling som kan få konsekvenser for forvaltningen av kulturarven. Vi foreslår derfor en nyansert forvaltning av kulturarv i jordbrukslandskapet, basert på tre kategorier kulturarv, og kobler disse til hvilket forvaltningsnivå som synes nødvendig for å ivareta kulturhistoriske elementer på ulike nivåer.

Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.

Prevention has become a main factor in the management of cardiovascular diseases. There are many options to control the LDL-Cholesterol levels, which reduction has been widely proved to diminish cardiovascular events rate. Despite the many pharmacological options, an important percentage of the patients do not reach the control target. Among other factors, the available drugs present tolerance problems that limit their use, emerging the necessity to develop new options of treatment that combine efficacy and security. In this field arise the nutraceuticals, which may become an alternative, in selected patients, especially in primary prevention, where the necessity of LDL-cholesterol reduction is not so ambitious, and tolerance and security are essential to achieve the patient adherence to the treatment. 
 The objective of the study is to demonstrate that the new formulation of Lipok®(a nutraceutical based in red yeast rice and berberine) adapting the concentration of monacolines to the new European regulation, is effective in the lipidic profile control.
 97 patients in primary prevention that present LDL-Cholesterol levels over the guidelines objective (116mg/dL) where included. Security and effectiveness of adding Lipok® 6 months to the treatment was evaluated. We observed a statistically significant reduction in the TCH values (-34.3mg/dL), LDL-C (-33,8mg/dL) and triglycerides (-29,3mg/dL) at 6 months’ treatment. No variation in the levels of HDL-C was observed. No relevant side effects were reported (constipation <2%, no myalgias). There were mild reductions (that even reached statistical significance) in creatinine, GPT and glycosylated hemoglobin. No patient discontinued treatment in the 6 months. NO patient discontinued the treatment during the study. 
 New formulation of Lipok® has proved to be effective in the control of the LDL-Cholesterol levels without relevant side effects. Considering the significant reduction shown in this study, it may become an alternative to other pharmacological treatments in the management of dyslipidaemia in primary prevention where adherence to the treatment is fundamental.

The intestinal microbiota is altered in patients with atopic dermatitis (AD) when compared with those of the healthy population. Some interventions with specific probiotic preparations already demonstrate a change in composition of this microbiota accompanied by improvement in the disease. This research work was designed to evaluate clinical efficacy of the probiotic preparation, and to measure the effect of the intervention on the total dose of corticosteroids administered to subjects. This double-blind, randomized, placebo-controlled clinical trial including 70 participants with AD aged 4-17 years was designed to evaluate the clinical effect, compared with placebo, of a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum and Lactobacillus casei at a total daily consumption of 1 × 109 colony-forming units per capsule, over 12 weeks. After randomization and exclusion, 35 patients were allocated to probiotic and 35 to placebo. Clinical variables analysed were SCORAD (SCORing of Atopic Dermatitis) and Investigator Global Assessment (IGA) indices; effect on the amount of topical corticosteroids used; and assessment of safety. Mean SCORAD index at 12 weeks showed a statistically significant difference of -5.43 (95% confidence interval -10.65 to -0.21) between probiotic (SCORAD 13.52) and placebo groups (SCORAD 18.96); P = 0.04. Comparison between groups showed a statistically significant difference in the number of patients with IGA score improvement over the 12-week intervention: 29 of 32 (90.5%) in the probiotic group vs. 17 of 30 (56.7%) in the placebo group (P < 0.002). A comparison between groups of the proportions of days using corticosteroids and the total dose (g) of corticosteroids between baseline and end of study showed no significant difference, but between weeks 6 and 12 there was a statistically significant reduction in the probiotic group when compared with the placebo group in both variables. Numbers of adverse events were similar in both groups of treatment. The probiotic mix used in this clinical trial demonstrated efficacy on the change in activity index of AD compared with placebo. Furthermore, the total number of days and total amount of topical corticosteroids required by participants in the probiotic group showed a significant reduction compared with placebo between 6 and 12 weeks.