Perception of the informed consent form by participants in clinical trials

To understand the perception of the participants in controlled clinical trials (CCTs) about the informed consent and describe the meaning of their participation in the research. Qualitative study using the focus group technique. The sample was composed of 19 patients who participated in clinical trials about hypertension and coronary disease in a specialized cardiologic hospital located in the city of Sao Paulo. The methodological framework used was the content analysis. Some of the participants were aware of the real objective of these studies while others had misperceptions. The reading of the informed consent is not always done and, when it is done, the patient does not understand it. The lack of understanding about the term ''placebo'' was mentioned by some participants. The motivation to participate was the personal benefit. This study shows that obtaining the informed consent in CCTs is complex and that there is the need to adapt the structure and application of this document, in order to protect the participants and improve the quality of clinical trials performed in the country.

An objective reconstruction of the chain of contagion

North's clustering method, which is based on a much used ecological model, the nearest neighbor distance, was applied to the objective reconstruction of the chain of household-to-household transmission of variola minor (the mild form of smallpox). The discrete within-household outbreaks were considered as points which were ordered in a time sequence using a 10-40 day interval between introduction of the disease into a source household and a receptor household. The closer points in the plane were assumed to have a larger probability of being links of a chain of household-to-household spread of the disease. The five defining distances (Manhattan or city-block distance between presumptive source and receptor dwellings) were 100, 200, 300, 400 and 500 m. The subchain sets obtained with the five defining distances were compared with the subchains empirically reconstructed during the field study of the epidemic through direct investigation of personal contacts of the introductory cases with either introductory or subsequent cases from previously affected households. The criteria of fit of theoretical to empirical clusters were: (a) the number of clustered dwellings and subchains, (b) number of dwellings in a subchain and (c) position of dwellings in a subchain. The defining distance closet to the empirical findings was 200 m, which fully agrees with the travelling habits of the study population. Less close but acceptable approximations were obtained with 100, 300, 400 and 500 m. The latter two distances gave identical results, as if a clustering ceiling had been reached. It seems that North's clustering model may be used for an objective reconstruction of the chain of contagious whose links are discrete within-household outbreaks. © 1984.

A multi-objective evaluation of the impact of the penetration of Distributed Generation

This paper proposes a methodology to consider the effects of the integration of DG on planning. Since DG has potential to defer investments in networks, the impact of DG on grid capacity is evaluated. A multi-objective optimization tool based on the meta-heuristic MEPSO is used, supporting an alternative approach to exploiting the Pareto front features. Tests were performed in distinct conditions with two well-known distribution networks: IEEE-34 and IEEE-123. The results combined minimization and maximization in order to produce different Pareto fronts and determine the extent of the impact caused by DG. The analysis provides useful information, such as the identification of futures that should be considered in planning. A future means a set of realizations of all uncertainties. MEPSO also presented a satisfactory performance in obtaining the Pareto fronts. © 2011 IEEE.

Medicinal plants in pregnancy and lactation: perception of the health risk and practical educational group in Araraquara, São Paulo State, Brazil

The use of medicinal plants among pregnant women and lactating is a common practice in diverse countries. However, many medicinal plants are contraindicated during pregnancy and lactating, due to various adverse effects, such as teratogenic, embryotoxic and abortive effects, exposing these women, their fetus and babies to health unknown risks. Thus, the purpose of this commentary, was to analyze the perception about the use of medicinal plants by pregnant women and lactating registered in the "baby on board" NGO, Araraquara, São Paulo state, Brazil, between 2010 at 2013. The group was constituted by 48 women, between the first and last trimester of pregnancy or whilst breastfeeding. Information was collected during group meetings by oral interview, using a questionnaire, as script. The nature of the study was a qualitative analysis. The results were based on reports about the use of medicinal plants by pregnant women during group meetings: use, indication of use, knowledge about risks. All participants received written and oral information about the study and they gave a written informed consent. The use of medicinal plants is a reality among pregnant and lactating women of the "baby on board" NGO. They reported that they feel that "natural" products are not harmful for their health. The primary information sources for the majority of women about medicinal plants during pregnancy are family, neighbors and herbalists. The plants most cited (in popular name in Brazil) were: senna, chamomile, boldo, lemon balm, lemon grass. They were used mainly for: nausea, heartburn, indigestion, flatulence, intestinal and abdominal pain, anxiety, intestinal constipation and low milk production. The pregnant and lactating women lacked knowledge about the health risks of the use of medicinal plants and herbal medicines in pregnancy and lactation. They also reported difficulties in clarifying some questions about the use of medicinal plants with their doctors. The results of the present study showed that educative actions about the rational use of medicinal plants in pregnancy and breastfeeding could be part of the operating protocols to promote the maternal and child health programs in Araraquara. Thus, our results also suggest the importance of creating institutionalized places, to the implementation of continued education programs about rational use of medicinal plants in pregnancy and lactation. These targeted programs are not only for health professionals, but also for community members, pregnant women and breastfeeding. Our results pointed out the importance of guidance of doctors and healthcare professionals on the scientific studies about medicinal plants and herbal medicines and the risk/benefit of using herbs during pregnancy. Finally, it is noted the importance of the health professionals to inform women of childbearing on risks to their health, as well as on possibilities of utilization of herbs during fertile period, giving special attention to the potential risk of self-medication.

The Impact of Domestic Politics and International Changes on the Brazilian Perception of Regional Integration

This article aims to analyze the impact of domestic politics and international changes that influence Brazilian positions regarding regional integration processes in South America, particularly the Southern Common Market, Mercosur. The dynamics of the international system and their impact on the evolution of the elite's perception of the role the country should play in the world are important variables for understanding these positions. The state's postures in relation to integration were and are based on a real interest, but this interest is also linked with the objective of ensuring better conditions for participation in other international arenas. Starting with the hypothesis that transformations in the international setting have strongly influenced Brazil's positioning, the elements of continuity and change in the country's behavior toward Mercosur are identified, with domestic politics as the main explanation.

Multi-objective evolutionary particle swarm optimization in the assessment of the impact of distributed generation

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

Care to terminal patients. Perception of nurses from the intensive care unit of a hospital

Objective. To identify the perception of nurses with regard to the process of providing care to patients in the context of hospice care. Method. Qualitative study using the methodological framework Collective Subject Discourse. A total of 18 nursing professionals of the adult intensive care unit of a public hospital in São Paulo, Brazil were interviewed between June and August 2012. Results. The process of providing care to terminal patients is permeated by negative, conflictive and mixed feelings. As regards communication, while the participants acknowledge its importance as a therapeutic resource, they also admit a lack of professional qualification. Conclusion. The interviewees have difficulties to deal with care provided to terminal patients. The qualification of these professionals needs to be improved, starting in the undergraduate program.

Identification of the Communicative Abilities of Brazilian Children With Cerebral Palsy in the Family Context

This article highlights the importance of the information obtained from the family in the implementation of the augmentative and alternative communication (AAC) system. The objective was to investigate the communicative abilities of children with severe communication deficit through their parents' reports within the family routine. Eleven parents of children affiliated with a rehabilitation program in a public university in Brazil participated in this research. Per their parents' reports, the children demonstrated a variety of communication skills related to comprehension, expressive skills, and vocabulary. Parents further reported their children's daily communication routines including social partners, communication environment, and the materials the children enjoyed the most. These results emphasize the importance of family involvement in planning AAC so that it is functional within the family context.

Environmental diagnosis in areas with different use and occupation using the perception of diverse biological activity

In Brazil, the degradation of soil and landscape by urban and agricultural frontiers expansion leads to the need for comprehensive studies and consider the diverse biological activities generated from different interventions in the landscape, becoming an instrument for assessing the impacts and the decision for its environmental management. The objective of this study was to evaluate the influence of different forms of occupation of the landscape, considering ecological elements and their interactions. The work was carried out on the Instituto Agronômico in the county of Jundiai, in the state of Sao Paulo, Brazil. The area under study has been subjected to different use and occupancy for a period of about 40 years. During this period the landscape has been transformed, with the current scenario can be classified as a degraded area mining; grassy area; Araucaria forest and pasture. These areas were evaluated by means of a transect, from which ten sampling sites were selected for the description of diverse biological activities, which included: evaluation and description of ground cover, identifying the presence of fungus and insect species. Furthermore, we evaluated in these points the pH, fertility and porosity of the topsoil (0-0.10 m). The results showed a variation of the elements analyzed and a relationship between the use and occupation of land in the different scenarios of the current landscape. The biological activity was more diverse in the Araucaria forest, reflected by the abundance of litter, higher content of organic matter and soil nutrients, demonstrating the effectiveness of the technique for assessing the level of degradation of the landscape used, which is expeditious and inexpensive.

Influence of maxillary incisor edge asymmetries on the perception of smile esthetics among orthodontists and laypersons

Introduction: Our objective was to determine the perception of smile esthetics among orthodontists and laypeople with respect to asymmetries on the maxillary incisor edges in a frontal smile analysis. Methods: Two frontal close-up smile photos of 2 women, 1 white and 1 Afro-Brazilian, were selected for this study. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to create tooth wear on the maxillary left central and lateral incisors in 0.5-mm increments. The final images were randomly assembled into a photo album that was given to 120 judges, 60 orthodontists and 60 laypersons. Each rater was asked to evaluate the attractiveness of the images with visual analog scales. The data collected were statistically analyzed with 1-way analysis of variance with the Tukey post-hoc test and the unpaired Student t test. Results: The most attractive smiles in both types of smiles were those without asymmetries and the 0.5-mm wear in the lateral incisor. In general, tooth wear was considered unattractive by both groups of raters following a pattern: the more tooth wear, the more unattractive the smile; tooth wear in the central incisor was considered more unattractive than in the lateral incisor. For both group of raters, 0.5 mm of wear in the central incisor was considered unattractive, whereas the thresholds for lateral incisor discrepancies were 0.5 mm for orthodontists and 1.0 mm for laypersons. Conclusions: The result of this study corroborates the clinical assumption that symmetry between the maxillary central incisors is a paramount goal for esthetic treatments. Copyright © 2013 by the American Association of Orthodontists.

Influence of the Vertical Position of Maxillary Central Incisors on the Perception of Smile Esthetics Among Orthodontists and Laypersons

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Social aspects of dental caries in the context of mother-child pairs

The relationship between mother and child in the context of oral health has traditionally been exposed by the scientific literature in microbiology, which lacks a broad and necessary discussion of health and illness seen as processes, both biological and social. Objective: Investigate the family social determinants associated with the caries history of children and the need for dental treatment (NDT) among their mothers was the objective of this study. Material and Methods: This research employed a cross-sectional study of mother-child pairs living in southern Brazil. Data collection occurred in public institutions of early childhood education. The instruments included a structured questionnaire administered to mothers and clinical oral examinations of the mothers and children. The social variables considered were marital status, maternal education, number of children, income, employment status, and frequency of visits to a dental professional. The measured outcomes were the maternal NDT and child caries history. Data were analyzed by the chi-square test (chi 2) and by discriminant analysis. Results: The final sample consisted of 272 mother-child pairs and it was found that the greatest need for treatment was among mothers with low educational level and low family income who rarely or never visited a dentist. Tooth decay was less frequent in only child, and most frequent in children of mothers with low educational attainment, and in children in lower income households who rarely or never visited the dentist. The social determinants of caries in children and of the maternal NDT were similar. It follows that the maternal NDT and caries history among children were strongly associated with maternal education (p<0.0001), household income (p<0.0001), and frequency of visits to a dental professional (0.0018). Caries history among children was also associated with number of children in the household (p<0.0001). Conclusions: The results suggest that the caries experience in children depended less on the family social variables than on the maternal NDT.

Perception of brazilian citizens about Darwinism and the (Non) Influence of God in the evolutionary process

The current context is unique in relation to the teaching of evolution in Brazil and the population's perception of evolution. On the one hand, it is said often about Darwinism in various media, especially due to the relatively recent commemoration of the two hundred years of the birth of Charles Darwin and one hundred and fifty years of the launch of the book The Origin of Species. On the other hand, it is clear, in recent years, a timid movement, more worryingly, in favor of equitable approach of creationist and evolutionist theories in the classroom. This article is a part of a research whose goal is to raise the design that Brazilian respondents have about the Darwinian view (which disregards the divine influence in the evolution of the species). The instrument used for data collection is a questionnaire, type Likert scale, which consists of a series of statements in which respondents must express their degree of agreement or disagreement with each statement. In this study, we present the results of the statement. "The thought of Darwin, which does not consider God as a participant in the process of evolution, is...". Analysis correlated with data on religion and education of the respondents are also held. The results point to a tendency of respondents not to accept the Darwinian view that disregards God's interference in the evolutionary process. The data also show that respondents' choices are influenced by religion and education. The frequency of responses that tend to accept the Darwinian view (which disregards the divine participation in the evolution of the species) is higher among respondents with higher levels of education. Adherents to religions "evangelical" tend to deny this view more often than followers of other religions. Given the potential risks of inserting creationist approaches in school education, it is necessary a discussion of the possible impacts of this rejection of Darwin's thinking (which does not consider God as a participant in the evolutionary process), indicated here, in the teaching of evolution. This work was supported by FAPEMIG.