Predictors of first-year survival in patients with advanced COPD treated using long-term oxygen therapy

Little evidence-based guidance is available to aid clinicians in determining short-term prognoses in very severe COPD patients. Therefore, the present study was designed to provide a prospective assessment (1) of the mortality rates and (2) whether the baseline measurements may be determinants of 1-year mortality in hypoxemic COPD patients receiving long-term oxygen therapy (LTOT).Seventy-eight clinically stable patients with advanced COPD treated using LTOT were enrolled in a prospective cohort study. Outcome variable: first-year mortality. Baseline measurements: categorical variables: age (<60 or >= 60 years); gender; body mass index (<20 or >= 20 kg/m(2)); fat-free mass (FFM) index (<16 [men] and <15kg/m(2) [women]; baseline dyspnea index (BDI) (<= 3 or >3); and corticosteroid use. Continuous variables: smoking history; lung function; FFM; fat mass; hemoglobin; hematocrit; arterial blood gases; forearm muscle strength; St. George's Respiratory Questionnaire (SGRQ); and comorbidity score. By the end of 1-year of follow-up, 12 patients (15.4%) had died. Kaplan-Meier curves showed that BDI <= 3 was the only variable associated with higher mortality. Cox proportional hazards analysis revealed that tower PaO2 and SPO2, higher PaCO2 and SGRQ scores were associated with reduced survival. In the multivariate analysis, BDI remained predictive of mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.31-0.81), as did PaO2 (HR, 0.49; 95% CI, 0.26-0.95). These data suggest that readily available parameters as dyspnea intensity and hypoxemia severity may be useful in predicting first-year survival rates in advanced COPD patients receiving LTOT (C) 2007 Elsevier Ltd. All rights reserved.

Seasonal metabolic depression, substrate utilisation and changes in scaling patterns during the first year cycle of tegu lizards (Tupinambis merianae)

The tegus increase in body mass after hatching until early autumn, when the energy intake becomes gradually reduced. Resting rates of oxygen consumption in winter drop to 20% of the values in the active season (Vo(2)=0.0636 ml g(-1) h(-1)) and are nearly temperature insensitive over the range of 17-25degreesC (Q(10)=1.55). During dormancy, plasma glucose levels are 60% lower than those in active animals, while total protein, total lipids and beta-hydroxybutyrate are elevated by 24%, 43% and 113%, respectively. In addition, a significant depletion of liver carbohydrate (50%) and of fat deposited in the visceral fat bodies (24%) and in the tail (25%) and a slight loss of skeletal muscle protein (14%) were measured halfway through the inactive period. Otherwise, glycogen content is increased 4-fold in the brain and 2.3-fold in the heart of dormant lizards, declining by the onset of arousal. During early arousal, the young tegus are still anorexic, although Vo(2) is significantly greater than winter rates. The fat deposits analysed are further reduced (62% and 45%, respectively) and there is a large decrease in tail muscle protein (50%) together with a significant increase in glycogen (2-3-fold) and an increase in plasma glucose (40%), which suggests a role for gluconeogenesis as a supplementary energy source in arousing animals. No change is detectable in citrate synthase activity, but beta-hydroxyacyl CoA dehydrogenase activities are strongly affected by season, reaching a Mold and 5-fold increase in the liver tissue of winter and arousing animals, respectively, and becoming reduced by half in skeletal muscle and heart of winter animals compared with late fall or spring active individuals. From hatching to late autumn, the increase of the fat body mass relatively to body mass is disproportionate (b=1.44), and the mass exponent changes significantly to close to 1.0 during the fasting period. The concomitant shift in the Vo(2) mass exponent in early autumn (b=0.75) to values significantly greater than 1.0 in late autumn and during winter dormancy indicates an allometric effect on the degree of metabolic depression related to the size of the fat stores and suggests greater energy conservation in the smaller young.

Association between breast-feeding practices and sucking habits: A cross-sectional study of children in their first year of life

In addition to providing nutrition and immunological protection, breast-feeding has positive effects on the development of the infant's oral cavity. The aim of the present study is to assess breast-feeding patterns and to analyze the influence of breast-feeding practices and maternal sociodemographic variables on the prevalence of non-nutritive sucking habits in a sample of Brazilian infants. This cross-sectional study was carried out in Southern Brazil. A random sample of 100 mothers of infants up to 12 months of age was interviewed during the National Vaccination Campaign Day. The prevalence and median duration of breast-feeding were assessed. Breast-feeding practice, the exposure factor, was categorized as exclusive breast-feeding, predominant breast-feeding, complementary breast-feeding, or weaning. Maternal sociodemographic variables included age, race, marital status, educational level, profession, and family income. The outcome investigated was the prevalence of sucking habits (pacifier use and thumb sucking). We used two-sample tests, the chi-square test and Fisher exact test0 for statistical analyses of the data. The study revealed that 75% of infants were being breast-fed. Pacifier use and thumb sucking were common in 55%. Bottle-feeding was prevalent in 74% of infants. Breast-feeding was negatively correlated with pacifier use and thumb sucking (OR = 0.11; 95% CI: 0.03 to 0.4). Bottle-feeding was strongly associated with weaning (p = 0.0003). Among the sociodemographic variables, only marital status showed a statistical association with sucking habits (p = 0.04). These findings suggest that breast-feeding can prevent the occurrence of sucking habits. Although we could not evaluate causality assessment, malocclusion prevention seems to be yet one more reason for promoting breast-feeding practices.

Prevalence and risk factors associated with wheezing in the first year of life

Objective: to investigate the prevalence and risk factors associated with wheezing in infants in the first year of life.Methods: this was a cross-sectional study, in which a validated questionnaire (Estudio Internacional de Sibilancias en Lactantes - International Study of Wheezing in Infants - EISL) was applied to parents of infants aged between 12 and 15 months treated in 26 of 85 primary health care units in the period between 2006 and 2007. The dependent variable, wheezing, was defined using the following standards: occasional (up to two episodes of wheezing) and recurrent (three or more episodes of wheezing). The independent variables were shown using frequency distribution to compare the groups. Measures of association were based on odds ratio (OR) with a confidence interval of 95% (95% CI), using bivariate analysis, followed by multivariate analysis (adjusted OR [aOR]).Results: a total of 1,029 (37.7%) infants had wheezing episodes in the first 12 months of life; of these, 16.2% had recurrent wheezing. Risk factors for wheezing were family history of asthma (OR = 2.12; 95% CI: 1.76-2.54) and six or more episodes of colds (OR = 2.38; 95% CI: 1.91-2.97) and pneumonia (OR = 3.02; 95% CI: 2.43-3.76). For recurrent wheezing, risk factors were: familial asthma (aOR = 1.73; 95% CI: 1.22-2.46); early onset wheezing (aOR = 1.83; 95% CI: 1.75-3.75); nocturnal symptoms (aOR = 2.56; 95% CI: 1.75-3.75), and more than six colds (aOR = 2.07; 95% CI 1.43-.00).Conclusion: the main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies. (C) 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

First-year nest growth in the leaf-cutting ants Atta bisphaerica and Atta sexdens rubropilosa

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A dental caries preventive program applied to children aged 5 to 8 years attending since the first year of age at the Baby Clinic of the Araçatuba Dental School, Brazil

Objective: Tooth decay is one of the more common diseases of childhood. Several studies recommend that early preventive measures must be implemented since the first years of life and continue throughout childhood and adolescence. The aim of the this study was to present results of a preventive dental program considering oral health maintenance, dental caries experience and the prevalence of dental caries relation with follow-up compliance visits. Material end method: Intraoral and interproximal radiographic exams were performed on 171 patients participants of a preventive dental program. Data regarding age, gender, previous caries experience and the frequency at which the patients attended return visits were obtained from the records. The data were analyzed statistically by the McNemar test, with the level of significance set at 1%. Result: Clinical and radiographic examination revealed that most children participating in the program had sound teeth (77.2 and 84.8%, respectively). The past dental history of the dental caries from patients included in this study showed statistical relevance when associated with the present dental caries experience and a statistical relationship was found from the absence of compliance to clinical visits and the dental caries presence. Conclusion: The preventive strategy had a positive influence on oral health maintenance in the children examined. Previous caries experience and the lack of compliance with return visits influenced the clinical oral condition of the children during participation in the preventive program.

Teaching in the community: Changing and implementing a new curriculum

The Faculdade de Medicina de Botucatu is changing to, and implementing a new curriculum aimed at integrating teaching and learning in the community. Emphasis is on preparing the community settings for teaching, learning and providing health care. A particular task is staff development with emphasis on problem-based learning (PBL) and training medical and nursing students in the leadership to participate in this process. The new curriculum includes the gradual introduction of clinical practice during First Year, integration of the basic sciences with clinical sciences, through integrated modules studied in small groups, and maintenance of the two year clerkship. The undergraduates are introduced gradually to the community: 8% of the total curriculum during First Year, 10% during Second Year, 10% during Third Year, 20% during Fourth Year, 30% during Fifth and Sixth Years. The basic health units at primary care level, and the regional specialty outpatients and hospitals at the second level, are the main teaching sites. An Education Development Committee was established to discuss the strategies for supporting the changes and to structure the planning for promoting the gradual transformation of staff development. After 18 months of implementation of the curriculum, there followed discussions and monitoring of the objectives of changes in medical education at our school. Successful implementation of the new curriculum would fail, if the objectives were not absorbed by every member of the implementation Committee.

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.

Predicting academic success of engineering students in technical drawing from working memory

Tests on spatial aptitude, in particular Visualization, have been shown to be efficient predictors of the academic performance of Technical Drawing stu-dents. It has recently been found that Spatial Working Memory (a construct defined as the ability to perform tasks with a figurative content that require si-multaneous storage and transformation of information) is strongly associated with Visualization. In the present study we analyze the predictive efficiency of a bat-tery of tests that included tests on Visualization, SpatialWorking Memory, Spatial Short-term Memory and Executive Function on a sample of first year engineering students. The results show that Spatial Working Memory (SWM) is the most important predictor of academic success in Technical Drawing. In our view, SWM tests can be useful for detecting as early as possible those students who will require more attention and support in the teaching-learning process.

Reflexões visuais...Um portofolio do artista

Pós-graduação em Artes - IA

Análise e implementação da nova proposta pedagógica estadual para o ensino de língua inglesa no ensino fundamental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Um retrato do primeiro ano do ensino fundamental: o que revelam crianças, pais e professoras

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Sucessão ecológica: análise das concepções de estudantes ingressantes em um curso de Biologia por meio da história e transposição deste conceito

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)