The participation of the nutritionist in Primary Health Care in a large urban center

Nutritionists are important professionals for ensuring the implementation of health promotion, treatment and rehabilitation. However, their participation in primary healthcare from a quantitative standpoint is limited. The city of Sao Paulo has experienced an uneven urbanization process triggering new problems of insecurity in terms of food and nutrition. This article analyzes the performance of the primary healthcare nutritionist in a large urban center. It is a quantitative study that used data from the Municipal Health Department, population data of Sao Paulo and a semi-structured questionnaire applied in individual interviews. All regions of the city are found to have fewer nutritionists than the recommendation of the Federal Council of Nutritionists. There are 123 nutritionists in the basic healthcare network and 51 in the Family Health Support Nuclei (FHSN) (57.3%). Each nutritionist from the FHSN accompanies 7.1 family health strategy teams on average. The age groups corresponding to children are less frequently seen by nutritionists. Comparing the activities, the transition from a model of primary health care focused on individual care to a model that prioritizes group care was observed.

Quantum entanglement of bound particles under free center of mass dispersion

On the basis of the full analytical solution of the overall unitary dynamics, the time evolution of entanglement is studied in a simple bipartite model system evolving unitarily from a pure initial state. The system consists of two particles in one spatial dimension bound by harmonic forces and having its free center of mass initially localized in space in a minimum uncertainty wavepacket. The existence of such initial states in which the bound particles are not entangled is discussed. Galilean invariance of the system ensures that the dynamics of entanglement between the two particles is independent of the wavepacket mean momentum. In fact, as shown, it is driven by the dispersive center of mass free dynamics, and evolves in a time scale that depends on the interparticle interaction in an essential way.

Single Center Experience With Elective Surgical Patients as Living Kidney Donors

Purpose. To report a single center experience with elective surgical patients as living kidney donors. Methods. We retrospectively analyzed a prospective database of 458 living kidney donors from September 2005 to May 2011. Fifteen (3.2%) of them were elective surgical patients simultaneously undergoing living donor nephrectomy. We reviewed age, gender, operative time, intraoperative blood transfusion, intra- and postoperative complications, as well as length of hospital stay. Recipients were evaluated for delayed graft function. Four hundred forty-three patients undergoing living donor nephrectomy alone composed the control group. Results. Among the elective surgical patients group, the mean (range) operative time was 155 (90 to 310) minutes and mean (range) length of hospital stay was 3 (2 to 9) days. One (6.7%) recipient displayed delayed graft function. Among the regular living kidney donors group, the mean (range) operative time was 100 (70 to 150) minutes, mean (range) length of hospital stay was 3 (2 to 5) days, and delayed graft function was observed in 5.6% of recipients. Only operative time (P = .03) was significantly different between the groups. Conclusions. Elective surgical patients are potential donors who may be treated at the same time as the living donor nephrectomy.

Evaluation of the micro-hardness and fracture toughness of amorphous and partially crystallized 3CaO center dot P2O5-SiO2-MgO bioglasses

In this work, the effect of the indentation load on the results of hardness and fracture toughness, determined by Vickers micro-hardness measurements, of some glasses and glass-ceramics has been investigated. Furthermore, in order to verify the effect of crystallinity on the results, glasses of composition 52.75 wt.% 3CaO center dot P2O5, 30 wt.% SiO2 and 17.25 wt.% MgO were fused at 1600 degrees C for 4 h and annealed at 700 degrees C for 2h, and further heat-treated at 700, 775, 800 and 900 degrees C for 4h. The obtained materials were analyzed by high resolution X-ray diffraction, HRXRD, to determine the crystallization degree in function of the heat-treatment temperature. The hardness of the different specimens was determined by Vickers' micro-hardness measurements under various loads. It has been observed that with increasing crystallization of the materials their hardness increased. Furthermore, it has been possible to verify the so-called indentation size effect (ISE), i.e. hardness decreases as the indentation depth, under higher loads, increases. This effect has been more pronounced in the glass-ceramic samples. Fracture toughness has been determined by the crack length induced by the Vickers indentations and relating them to the applied loads. Glass materials presented a fracture pattern with characteristics of cleavage, forming cracks of the half-penny shaped type, while the glass-ceramic materials exhibited crack bridging effects and Palmqvist type cracks. (C) 2011 Elsevier B.V. All rights reserved.

Synthesis, crystal structure and magnetic properties of the helical oxalate-bridged copper(II) chain {[(CH3)(4)N](2)[Cu(C2O4)(2)] center dot H2O}(n)

The preparation, crystal structure and magnetic properties of a new oxalate-containing copper(II) chain of formula {[(CH3)(4)N](2)]Cu(C2O4)(2)] center dot H2O}(n) (1) [(CH3)(4)N+ = tetramethylammonium cation] are reported. The structure of 1 consists of anionic oxalate-bridged copper(II) chains, tetramethylammoniun cations and crystallization water molecules. Each copper(II) ion in 1 is surrounded by three oxalate ligands, one being bidentate and the other two exhibiting bis-bidenate coordination modes. Although all the tris-chelated copper(H) units from a given chain exhibit the same helicity, adjacent chains have opposite helicities and then an achiral structure results. Variable-temperature magnetic susceptibility measurements of 1 show the occurrence of a weak ferromagnetic interaction through the oxalate bridge [J = +1.14(1)cm(-1), the Hamiltonian being defined as H = -J Sigma nm S-i . S-j]. This value is analyzed and discussed in the light of available magnetostructural data for oxalate-bridged copper(H) complexes with the same out-of-plane exchange pathway. (C) 2012 Academie des sciences. Published by Elsevier Masson SAS. All rights reserved.

Epidemiologic surveillance of postoperative endophthalmitis in a specialized ophthalmologic center in Sao Paulo, Brazil

This article describes a postoperative endophthalmitis (POE) surveillance system in place in a specialized ophthalmologic center in Sao Paulo, Brazil. The study involved a review of medical records from 2004-2009, during which a total of 31,999 intraocular surgeries were performed. Nineteen of these cases fulfilled the criteria for POE, for an infection rate of 0.06%. The main etiologic agent causing POE was Pseudomonas aeruginosa, identified in 42.1% of the cases (8/19). Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Transplantation for Autoimmune Diseases in North and South America: A Report of the Center for International Blood and Marrow Transplant Research

Hematopoietic cell transplantation (HCT) is an emerging therapy for patients with severe autoimmune diseases (AID). We report data on 368 patients with AID who underwent HCT in 64 North and South American transplantation centers reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2009. Most of the HCTs involved autologous grafts (n = 339); allogeneic HCT (n = 29) was done mostly in children. The most common indications for HCT were multiple sclerosis, systemic sclerosis, and systemic lupus erythematosus. The median age at transplantation was 38 years for autologous HCT and 25 years for allogeneic HCT. The corresponding times from diagnosis to HCT were 35 months and 24 months. Three-year overall survival after autologous HCT was 86% (95% confidence interval [CI], 81%-91%). Median follow-up of survivors was 31 months (range, 1-144 months). The most common causes of death were AID progression, infections, and organ failure. On multivariate analysis, the risk of death was higher in patients at centers that performed fewer than 5 autologous HCTs (relative risk, 3.5; 95% CI, 1.1-11.1; P = .03) and those that performed 5 to 15 autologous HCTs for AID during the study period (relative risk, 4.2; 95% CI, 1.5-11.7; P = .006) compared with patients at centers that performed more than 15 autologous HCTs for AID during the study period. AID is an emerging indication for HCT in the region. Collaboration of hematologists and other disease specialists with an outcomes database is important to promote optimal patient selection, analysis of the impact of prognostic variables and long-term outcomes, and development of clinical trials. Biol Blood Marrow Transplant 18: 1471-1478 (2012) (C) 2012 Published by Elsevier Inc. on behalf of American Society for Blood and Marrow Transplantation

Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center

Background: Adjuvant chemoradiotherapy is part of a multimodality treatment approach in order to improve survival outcomes after surgery for gastric cancer. The aims of this study are to describe the results of gastrectomy and adjuvant chemoradiotherapy in patients treated in a single institution, and to identify prognostic factors that could determine which individuals would benefit from this treatment. Methods: This retrospective study included patients with pathologically confirmed gastric adenocarcinoma who underwent surgical treatment with curative intent in a single cancer center in Brazil, between 1998 and 2008. Among 327 patients treated in this period, 142 were selected. Exclusion criteria were distant metastatic disease (M1), T1N0 tumors, different multimodality treatments and tumors of the gastric stump. Another 10 individuals were lost to follow-up and there were 3 postoperative deaths. The role of several clinical and pathological variables as prognostic factors was determined. Results: D2-lymphadenectomy was performed in 90.8% of the patients, who had 5-year overall and disease-free survival of 58.9% and 55.7%. The interaction of N-category and N-ratio, extended resection and perineural invasion were independent prognostic factors for overall and disease-free survival. Adjuvant chemoradiotherapy was not associated with a significant improvement in survival. Patients with node-positive disease had improved survival with adjuvant chemoradiotherapy, especially when we grouped patients with N1 and N2 tumors and a higher N-ratio. These individuals had worse disease-free (30.3% vs. 48.9%) and overall survival (30.9% vs. 71.4%). Conclusion: N-category and N-ratio interaction, perineural invasion and extended resections were prognostic factors for survival in gastric cancer patients treated with D2-lymphadenectomy, but adjuvant chemoradiotherapy was not. There may be some benefit with this treatment in patients with node-positive disease and higher N-ratio.

Outcomes of Epileptic Spasms in Patients Aged Less Than 3 Years: Single-Center United States Experience

Retrospective review was performed of children aged <3 years with epileptic spasms at our center from 2004-2010. Short-term (<6 months) and long-term (>= 6 months) outcomes were assessed. We included 173 children (104 boys; median age of onset, 6.8 months) with epileptic spasms of known (62%) and unknown (38%) etiology. Treatments included adrenocorticotropic hormone (n = 103), vigabatrin (n = 82), phenobarbital (n = 34), and other agents (n = 121). Short-term treatment with adrenocorticotropic hormone and vigabatrin provided better epileptic spasm control in groups with known and unknown etiology than other agents. At follow-up (6-27 months), 54% of children manifested seizures, and 83% manifested developmental delay. Known etiology was a predictor of poor developmental outcome (P = 0.006), whereas bilateral/diffuse brain lesions predicted both poor development and seizures (P = 0.001 and 0.005, respectively). Initial presentations of epileptic spasms with hypotonia or developmental delay most strongly predicted both seizures and neurodevelopmental outcomes (P < 0.001). In a child presenting with epileptic spasms with developmental delay or hypotonia, no specific treatment may offer superior benefit. (c) 2012 Elsevier Inc. All rights reserved.

Comparative Analysis of the Complications of 5347 Endomyocardial Biopsies Applied to Patients After Heart Transplantation and With Cardiomyopathies: A Single-center Study

Introduction. Endomyocardial biopsy (EMB) plays an important role in allograft surveillance to screen an acute rejection episode after heart transplantation (HT), to diagnose an unknown cause of cardiomyopathies (CMP) or to reveal a cardiac tumor. However, the procedure is not risk free. Objective. The main objective of this research was to describe our experience with EMB during the last 33 years comparing surgical risk between FIT versus no-HT patients. Method. We analyzed retrospectively the data of 5347 EMBs performed from 1978 to 2011 (33 years). For surveillance of acute rejection episodes after HT we performed 3564 (66.7%), whereas 1777 (33.2%) for CMP diagnosis, and 6 (1.0%) for cardiac tumor identification. Results. The main complications due to EMB were divided into 2 groups to facilitate analysis: major complications associated with potential death risk, and minor complications. The variables that showed a significant difference in the HT group were as follows: tricuspid Injury (.0490) and coronary fistula (.0000). Among the no-HT cohort they were insufficient fragment (.0000), major complications (.0000) and total complications (.0000). Conclusions. EMB can be accomplished with a low risk of complications and high effectiveness to diagnose CMP and rejection after HT. However, the risk is great among patients with CMP due to their anatomic characteristics. Children also constitute a risk group for EMB due to their small size in addition to the heart disease. The risk of injury to the tricuspid valve was higher among the HT group.

Nursing care practices at an outpatient care center from an integrative perspective

Aim: to analyze nursing care practices at a Specialized Outpatient Care Center from the perspective of an integrative health care activity. Method: Interviews with 24 nursing professionals were undertaken. For data analysis, Thematic Content Analysis as proposed by Bardin was applied, resulting in the following themes: the team size and its commitment to health care; professional practices and activity of the nursing team. Results: The size of the nursing team was considered insufficient, which compromises the quality of care and results in work overload and dissatisfaction of the nursing professionals. On the other hand, they were satisfied with the tasks performed day-to-day and related integrality to individual care, considered it essential and usually practiced it daily. Conclusion: It is considered that the nursing team has the potential and commitment to develop their care practice combined with the integrative perspective, and therefore providing quality health care to the population.

VVV DR1: The first data release of the Milky Way bulge and southern plane from the near-infrared ESO public survey VISTA variables in the Via Lactea

Context. The ESO public survey VISTA variables in the Via Lactea (VVV) started in 2010. VVV targets 562 sq. deg in the Galactic bulge and an adjacent plane region and is expected to run for about five years. Aims. We describe the progress of the survey observations in the first observing season, the observing strategy, and quality of the data obtained. Methods. The observations are carried out on the 4-m VISTA telescope in the ZYJHK(s) filters. In addition to the multi-band imaging the variability monitoring campaign in the K-s filter has started. Data reduction is carried out using the pipeline at the Cambridge Astronomical Survey Unit. The photometric and astrometric calibration is performed via the numerous 2MASS sources observed in each pointing. Results. The first data release contains the aperture photometry and astrometric catalogues for 348 individual pointings in the ZYJHK(s) filters taken in the 2010 observing season. The typical image quality is similar to 0 ''.9-1 ''.0. The stringent photometric and image quality requirements of the survey are satisfied in 100% of the JHK(s) images in the disk area and 90% of the JHK(s) images in the bulge area. The completeness in the Z and Y images is 84% in the disk, and 40% in the bulge. The first season catalogues contain 1.28 x 10(8) stellar sources in the bulge and 1.68 x 10(8) in the disk area detected in at least one of the photometric bands. The combined, multi-band catalogues contain more than 1.63 x 10(8) stellar sources. About 10% of these are double detections because of overlapping adjacent pointings. These overlapping multiple detections are used to characterise the quality of the data. The images in the JHK(s) bands extend typically similar to 4 mag deeper than 2MASS. The magnitude limit and photometric quality depend strongly on crowding in the inner Galactic regions. The astrometry for K-s = 15-18 mag has rms similar to 35-175 mas. Conclusions. The VVV Survey data products offer a unique dataset to map the stellar populations in the Galactic bulge and the adjacent plane and provide an exciting new tool for the study of the structure, content, and star-formation history of our Galaxy, as well as for investigations of the newly discovered star clusters, star-forming regions in the disk, high proper motion stars, asteroids, planetary nebulae, and other interesting objects.

KRONBERGER 49: A NEW LOW-MASS GLOBULAR CLUSTER OR AN UNPRECEDENTED BULGE WINDOW?

We employ optical and near-infrared photometry to study the stars in the direction of the star cluster candidate Kronberger 49. The optical color-magnitude diagrams (V, I, and Gunn z photometry obtained with the Galileo Telescope) are tight and present evidence of a main-sequence turnoff. We may be dealing with a low-mass, metal-rich globular cluster located in the bulge at a distance from the Sun of d(circle dot) = 8 +/- 1 kpc. Alternatively, it may be a dust hole through which we are sampling the bulge stellar population affected by a very low amount of differential reddening.

Percutaneous laser ablation under ultrasound guidance for fetal hyperechogenic microcystic lung lesions with hydrops: a single center cohort and a literature review

Objective To evaluate the perinatal outcomes in hydropic fetuses with congenital microcystic pulmonary lesions that underwent percutaneous, invasive, laser therapy. Method This retrospective study reviews the literature and our experience between 2004 and 2010. Characteristics of the cystic lung lesions, liquor volume (presence of polyhydramnios or not), localization of ablation (vascular vs interstitial) and gestational age at which the procedure was performed were related to outcome (survival). Results In total, 16 fetuses with congenital lung lesions underwent invasive percutaneous laser ablation, seven performed in our center and nine published cases. Survival rate was higher in fetuses with a subsequent postnatal diagnosis of bronchopulmonary sequestration (87.5%) compared with congenital adenomatoid malformation (28.6%; p?=?0.04). The technique of vascular ablation was more successful (100%) than interstitial ablation (25.0%, p?<?0.01). Conclusion Percutaneous vascular laser ablation seems to be effective for bronchopulmonary sequestration in hydropic fetuses. Outcomes were worst following interstitial ablation for microcystic congenital adenomatoid with hydrops. (C) 2012 John Wiley & Sons, Ltd.

THE INTERSTELLAR MAGNETIC FIELD CLOSE TO THE SUN. II.

The magnetic field in the local interstellar medium (ISM) provides a key indicator of the galactic environment of the Sun and influences the shape of the heliosphere. We have studied the interstellar magnetic field (ISMF) in the solar vicinity using polarized starlight for stars within 40 pc of the Sun and 90 degrees of the heliosphere nose. In Frisch et al. (Paper I), we developed a method for determining the local ISMF direction by finding the best match to a group of interstellar polarization position angles obtained toward nearby stars, based on the assumption that the polarization is parallel to the ISMF. In this paper, we extend the analysis by utilizing weighted fits to the position angles and by including new observations acquired for this study. We find that the local ISMF is pointed toward the galactic coordinates l, b = 47 degrees +/- 20 degrees, 25 degrees +/- 20 degrees. This direction is close to the direction of the ISMF that shapes the heliosphere, l, b = 33 degrees +/- 4 degrees, 55 degrees +/- 4 degrees, as traced by the center of the "Ribbon" of energetic neutral atoms discovered by the Interstellar Boundary Explorer (IBEX) mission. Both the magnetic field direction and the kinematics of the local ISM are consistent with a scenario where the local ISM is a fragment of the Loop I superbubble. A nearby ordered component of the local ISMF has been identified in the region l approximate to 0 degrees -> 80 degrees and b approximate to 0 degrees -> 30 degrees, where PlanetPol data show a distance-dependent increase of polarization strength. The ordered component extends to within 8 pc of the Sun and implies a weak curvature in the nearby ISMF of +/- 0 degrees.25 pc(-1). This conclusion is conditioned on the small sample of stars available for defining this rotation. Variations from the ordered component suggest a turbulent component of +/- 23 degrees. The ordered component and standard relations between polarization, color excess, and H-o column density predict a reasonable increase of N(H) with distance in the local ISM. The similarity of the ISMF directions traced by the polarizations, the IBEX Ribbon, and pulsars inside the Local Bubble in the third galactic quadrant suggest that the ISMF is relatively uniform over spatial scales of 8-200 pc and is more similar to interarm than spiral-arm magnetic fields. The ISMF direction from the polarization data is also consistent with small-scale spatial asymmetries detected in GeV-TeV cosmic rays with a galactic origin. The peculiar geometrical relation found earlier between the cosmic microwave background dipole moment, the heliosphere nose, and the ISMF direction is supported by this study. The interstellar radiation field at +/- 975 angstrom does not appear to play a role in grain alignment for the low-density ISM studied here.