Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions

The aim of the study was to assess risk factors for vascular dementia (VaD) in elderly psychiatric outpatients without dementia, and to determine to what extent clinical interventions targeted such risk factors. Out of 250 clinical charts, 78 were selected of patients over 60 years old, who showed no signs of dementia. Information was obtained regarding demographics, clinical conditions (diagnosis according to ICD-10), complementary investigation, cognitive functions (via CAMCOG), neuroimaging, and the presence of risk factors for VaD. Depression was the most prevalent psychiatric disorder (74%). A great majority of the patients (86%) had at least one risk factor for VaD. One-third of the sample showed three or more risk factors for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), tryglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (19.2%), alcohol abuse (16.7%), and sedentarism (14.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD. © 2007 Elsevier B.V. All rights reserved.

Situação vacinal infantil e características individuais e familiares do interior de São Paulo

The aim of this study was to describe and analyze individual and family characteristics of children and those of health services, as well as their relationship with the immunization status for different kinds of vaccines and doses. Three sources of information were used: records from the Municipal Health Information System, immunization charts, and interviews using closed-ended questions. The families interviewed still had one or two growing children; caretakers were usually young unemployed mothers with easy access to health services. Around 30% of them were not instructed on the vaccine being given, its reactions or when to return for the next shot. The greatest levels of tardiness occurred with the vaccines against measles (6.3%) and Haemophilus influenzae B (4.2%). It was possible to observe that tardiness or absence of vaccinations seem to have a stronger relationship with service characteristics than with population characteristics.

Modelagem numérica da superfície na geração da planialtimetra segundo dados de quatro equipamentos topogríficos

The aim of this present work was to compare planialtimetric charts obtained from different risings using two different theodolite types, a total station, and a precision level, used as control. Using a total station, an area was marked with clear variations of relief, following a grid, with a distance of 20 meters among stakes. After that, the stakes were read by the total station and two theodolites of different precisions. The geometric leveling was done by a precision level. The data were input in the DataGeosis software and the numerical modelling of the land was made with mesh of maximum rigidity, generating planialtimetric representation for each rising. It was verified, through comparison of the four representations that little variations occur in relation to the control. The closest representation of the control was the planialtimetry based on the data from the total station, in which the representations obtained from the theodolites were identical among themselves. It was concluded that in the process of obtaining detailed planialtimetry of small areas, submitted to the grid, it was not necessary to use composed geometric leveling, reducing work to the exclusive use of a total station or conventional theodolite.

Avaliação da assistência pré-natal e puerperal desenvolvidas em região do interior do Estado de São Paulo em 2005

Objectives: to evaluate the structure and process of the prenatal and puerperal care given by Direção Regional de Saúde (DIR) XI, at the city of Botucatu, State of São Paulo, Brazil. Methods: an evaluation of resources and activities developed during prenatal and puerperal care in twenty municipalities comprising DIR XI which had adhered the Prenatal and Birth Humanization Program until 2003. Interviews with city managers and analysis of 385 sampled patient charts taking into account recommendations by the Health Department. Results: structure analysis showed that caregiving was centered on medical work; basic equipment and instruments were available; 85.2% of patients began prenatal care with up to 120 days of pregnancy, and 75.9% had at least six prenatal consultations. The active search for absentees and strategies for early prenatal care initiation were observed in 30% and 50% of the municipalities, respectively. Process indicators showed that 3.6% of women had six prenatal consultations, one puerperal consultation, all basic exams and tetanus immunization. Recording of gestational age, arterial blood pressure and weight was of approximately 90%; 58.7% of the women underwent childbirth review and 31.5% were vaccinated. Conclusions: the performance of the set of activities is a challenge to prenatal care at DIR XI.

Laparoscopic repair of vesicovaginal fistula

Purpose: Vesicovaginal fistula (VVF) is one of the most devastating surgical complications that can occur in women. The primary cause remains an abdominal hysterectomy. Approach to this condition can be transvaginal or transabdominal. Laparoscopic repair of VVF may be an alternative approach to this treating rare condition. We present seven cases of VVF treated with transperitoneal laparoscopic technique and our results. Methods: We retrospectively reviewed the charts of 7 women ranging from 37 to 74 years in age (mean age 52.8 years) at our institution who underwent laparoscopic transperitoneal repair of VVF between February 2004 and March 2006. Etiology of the VVF, surgical technique, operative time, length of hospital stay, and complications were reviewed. Results: Six of the seven VVFs we repaired laparoscopically resulted from gynecologic procedures, and one patient presented with a VVF after a ureterolithotripsy. Mean operative time ranged from 130 to 420 minutes (mean 280 minutes), and mean hospital stay was 7 days. In one patient conversion to open surgery was necessary due to prolonged operative time. Two complications occurred a urinary tract infection in one patient and an inferior limb compartment syndrome in another. Conclusion: Transvaginal laparoscopic repair of VVF is feasible and safe and provides excellent results. It is a good alternative to the abdominal approach. However, advanced laparoscopic skills are mandatory. © 2008 Mary Ann Liebert, Inc.

Double sampling X̄ control chart for a first order autoregressive process

In this paper we propose the Double Sampling X̄ control chart for monitoring processes in which the observations follow a first order autoregressive model. We consider sampling intervals that are sufficiently long to meet the rational subgroup concept. The Double Sampling X̄ chart is substantially more efficient than the Shewhart chart and the Variable Sample Size chart. To study the properties of these charts we derived closed-form expressions for the average run length (ARL) taking into account the within-subgroup correlation. Numerical results show that this correlation has a significant impact on the chart properties.

Recurrent urinary tract infections: Evaluation of the prophylactic efficacy of urinary antiseptics methenamine and methylthioninium chloride

Introduction: Urinary tract infection (UTI) is a very common condition in clinical practice, affecting an estimated 50% of all adult women during a lifetime. The most common causative agent is E. coli; UTI may also be caused by S. saprophyticus, Enterobacteria (Klebsiella sp and Serratia sp.), Enterococcus sp., and P aeruginosa. Recurrent UTIs occur at least twice per semester or three times a year. Prophylactic measures to prevent recurrent UTIs include changes in contraception methods, cranberry products, increased fluid intake, urination after intercourse, vaginal estrogen therapy for post-menopausal women, antibiotics, and urinary tract antiseptic agents. Objectives: To evaluate the use of a combination of methenamine and methyl-thioninium chloride in the prophylaxis of recurrent uncomplicated lower UTIs, with respect to: • Signs and symptoms of UTI • Etiologic agent(s) • Recurrence rates • Need for antibiotic therapy in case of recurrence • Incidence of adverse events associated with the treatment, including any reported alterations of laboratory tests Materials & methods: A descriptive, analytic, restrospective study was performed at Hospital Universitário Constantino Otaviano - UNIFESO. Medical charts from patients presenting recurrent uncomplicated lower UTI attended from 2001-present were analyzed, including the following information: Demographic data (age, gender, weight, ethnicity, living conditions): medical history/signs and symptoms of UTI; identification of treatment and dosing regimens; treatment duration; recurrence rates and need for antibiotic therapy in case of recurrence; other medications prescribed; and records of adverse events. Results: E. coli was identified as etiologic agent in 80% of the patients. Following antibiotic therapy, all patients received prophylactic treatment with the combination of methenamine and methylthioninium chloride. Treatment duration ranged from three to six months. Adverse events were observed in 13/60 patients (21.7%). At the end of the respective treatment periods, a statistically significant (p<0.0001) number of patients showed no UTI recurrence. Conclusion: Based on the results from the collected data, we conclude that an orally administered combination of methenamine and methylthioninium chloride is safe and effective in the prophylactic treatment of recurrent uncomplicated lower urinary tract infection. © Copyright Morelra Jr. Editora.

Monitoring bivariate processes

The T2 chart and the generalized variance |S| chart are the usual tools for monitoring the mean vector and the covariance matrix of multivariate processes. The main drawback of these charts is the difficulty to obtain and to interpret the values of their monitoring statistics. In this paper, we study control charts for monitoring bivariate processes that only requires the computation of sample means (the ZMAX chart) for monitoring the mean vector, sample variances (the VMAX chart) for monitoring the covariance matrix, or both sample means and sample variances (the MCMAX chart) in the case of the joint control of the mean vector and the covariance matrix.

Perfil de usuários de AASI com fissura labiopalatina

Cleft palates cause alterations in palate and lip structures, and it may also cause hearing loss because of recurrent otitis media. The appropriate treatment is controversial. It may include the prescription of antibiotics and insertion of a ventilation tube, or even otorhinolaryngological and audiological assistance, and hearing rehabilitation, with the use of an individual sound amplifier aid (ISAA). Aim: To characterize the profile of individuals with cleft palate and hearing loss, users of ISAA are assisted by the center of otorhinolaryngology and speech therapy of a hospital specialized in craniofacial anomalies and hearing impairment. Retrospective Study. Material and Methods: Retrospective analysis of 131 charts of patients with corrected cleft palate and hearing loss, fitted with ISAA by the center abovementioned. Results: The sample (n=131) was characterized by a prevalence of females (53%), unilateral incisive transforaminal cleft (27%), presence of associated anomalies (51%), history of alterations of the middle ear (56%) and surgery intervention (56%). Conclusion: The general profile of the individuals with cleft palate and hearing loss, fitted with ISAA, was characterized by the predominance of cleft lip and palate, positive history of middle ear alterations, surgery intervention and bilateral sensorineural hearing loss. © Revista Brasileira de Otorrinolaringologia. All Rights reserved.

Preliminary results concerning the VSS X- chart with unknow in-control parameters

The VSS X- chart is known to perform better than the traditional X- control chart in detecting small to moderate mean shifts in the process. Many researchers have used this chart in order to detect a process mean shift under the assumption of known parameters. However, in practice, the process parameters are rarely known and are usually estimated from an in-control Phase I data set. In this paper, we evaluate the (run length) performances of the VSS X- control chart when the process parameters are estimated and we compare them in the case where the process parameters are assumed known. We draw the conclusion that these performances are quite different when the shift and the number of samples used during the phase I are small. ©2010 IEEE.

Análise da dieta e condição de saúde bucal em pacientes gestantes

Objectve: To perform a critical analysis of the diet record model adopted, to evaluate the cariogenicity of the maternal diet, and the incidence of dental caries in pregnant women treated at a prevent on clinic in an undergraduate dental course. Method: A cross-sectional study was performed with consultations to the database of the clinic and review of patients' charts and diet records. The sample was calculated and 205 patents were randomly selected. Bivariate statistical analysis was done at a significance level of 5% (α=0.05), using the statistical soft wares Epi Info versão 3.2, GraphPad Instat 3.6 and BioEstat. Results: The analysis of the diet records showed that 68.8% of the pregnant women presented a cariogenic diet, with high frequency of ingest on of fermentable carbon hydrates, mainly sucrose, with liquid consistency, and preferably consumed between the main meals. There was higher trend of the pregnant women mentioning a low frequency of carbon hydrate ingestion during the interview, while registering a diet rich of these components in their diet records (p<0.0001). The mean DMFT of the patients was 13.9 ± 5.4. There was no statistically significant association between diet and oral health variables (p>0.05). Conclusion: The diet record was proven an effective and valid method, if correctly employed. The prevalence of dental caries in the group of pregnant women was high and, although more than half of the sample presented a cariogenic diet, a significant association between diet and co-factors was not found.

SIG - SPRING aplicado na determinação da capacidade de uso das terras da microbacia do Ribeirão Pouso Alegre - Jaú (SP)

A população mundial vem sofrendo, cada vez mais, as conseqüências das agressões efetuadas pelo homem ao meio ambiente, principalmente quanto à ocupação e uso inadequado das terras, o que ocasiona empobrecimento e depauperamento do solo, influenciando na qualidade e disponibilidade de água, levando à destruição das reservas florestais. Assim, é necessária a implantação de políticas públicas, que contemplem o desenvolvimento econômico, urbano, rural e social de uma região, preservando os recursos naturais para futuras gerações. A bacia em estudo está localizada entre as coordenadas UTM 764942; 7546214 e 741816; 7534759, com uma área de 14699,7ha. Este trabalho visou definir as classes de capacidade de uso de terra da microbacia do Ribeirão Pouso Alegre - Jaú (SP) através do Sistema de Informações Geográficas - SPRING. A carta de capacidade de uso da terra foi elaborada a partir do cruzamento das cartas clinográfica e de solo, que foram elaboradas pelo SIG Spring, e o cruzamento de dados foi feito através do LEGAL - Linguagem Espacial para Geoprocessamento Algébrico. Os resultados mostraram que a microbacia é constituída essencialmente pelas classes II e III e o SIG-SPRING permitiu através dos seus módulos discriminarem e quantificar as áreas das classes de terras, declive e capacidade de uso da terra rapidamente.

Análise dos parâmetros morfométricos da bacia do Rio Preto, Serra do Espinhaço (Minas Gerais, Brasil)

The Rio Preto Hydrographic Basin (RPHB) is located in the North-central portion of the state of Minas Gerais, Brazil, 30 km ENE of the city of Diamantina. The sources of the stream of that name are found in the Rio Preto State Park, which has an area of 10,755 hectares. The total area, perimeter, extension, and axial length of the RPHB, as well as other morphometric characteristics, with emphasis on shape indexes, were obtained with the help of the ArcGis 9.2 program. The cartographic data were taken from digitalized topographic charts in a scale of 1:100,000 of the Brazilian Geographical Institute (IBGE). The measured drainage area is of 389.3 km2 and the perimeter is 136.9 km. Due to structural influence, the shape of the RPHB is irrgular and elongated, with drainage developed in a dendritic and parallel pattern. Those characteristics were checked by means of the compaxity coefficient and the shape factor. The first one was estimated in 1.94, what implies that the basin is not subject to fast flooding in years with normal precipitation. The high degree of fluvial downcutting of the basin is confirmed by the fact that it is a 5th order basin, it presents a significant branching rate and a medium drainage density.

Risk factors for low birth weight in Botucatu city, SP state, Brazil: A study conducted in the public health system from 2004 to 2008

Background: Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil. Methods. A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≤ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW. Results: According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x 2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate. Conclusion: LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW. © 2012 Fonseca et al; licensee BioMed Central Ltd.

Long-term cardiac changes in patients with systemic lupus erythematosus

Background: The aim of this study was evaluate the late-onset repercussions of heart alterations of patients with systemic lupus erythematosus (SLE) after a 13-year follow up. Methods. A historical prospective study was carried out involving the analysis of data from the charts of patients with a confirmed diagnosis of lupus in follow up since 1998. The 13-year evolution was systematically reviewed and tabulated to facilitate the interpretation of the data. Results: Forty-eight patient charts were analyzed. Mean patient age was 34.5 ± 10.8 years at the time of diagnosis and 41.0 ± 10.3 years at the time of the study (45 women and 3 men). Eight deaths occurred in the follow-up period (two due to heart problems). Among the alterations found on the complementary exams, 46.2% of cases demonstrated worsening at reevaluation and four patients required a heart catheterization. In these cases, coronary angioplasty was performed due to the severity of the obstructions and one case required a further catheterization, culminating in the need for surgical myocardial revascularization. Conclusion: The analysis demonstrated progressive heart impairment, with high rates of alterations on conventional complementary exams, including the need for angioplasty or revascularization surgery in four patients. These findings indicate the need for rigorous cardiac follow up in patients with systemic lupus erythematosus. © 2013 de Godoy et al.; licensee BioMed Central Ltd.