Geographical Distribution and Demographic Characteristics of Gestational Trophoblastic Disease

OBJECTIVE: To outline the geographical distribution pattern of gestational trophoblastic disease (GTD) in a referral center in Bahia, Brazil, and determine the demographics of the disease.STUDY DESIGN: We conducted a study of data retrieved from medical records of 140 GTD patients referred to our Trophoblastic Diseases Center in 2002-2007, assessing geographical distribution across health care districts, demographics, referral sources, and previous pregnancy status.RESULTS: The most common GTD types were hydatidiform mole (106, 75.7%), invasive mole (32, 22.9%), choriocarcinoma (1, 0.7%), and placental site trophoblastic tumor (1, 0.7%). GTD incidence was 8.5 in 1,000 deliveries. Most patients originated from the coastal region (East district), which includes the state capital (77.9%). The 20-34 age group predominated (65%). Education level (67.9% attended elementary school only) and employment rate (42.9%) were low. Secondary hospitals were the principal source of referral (84.3%), followed by self-referrals (15.7%). Regarding previous pregnancy status, 42.1% (n = 59) had had term pregnancy, 39.3% (n = 55) no pregnancy, 15% (n = 21) miscarriage, and 0.7% (n = 1) ectopic pregnancy; 4 patients (2.9%) had previous hydatidiform mole.CONCLUSION: GTD predominated in the peak fertility age group and among patients of unfavorable sociodemographic status. (J Reprod Med 2010;55:305-310)

Referral letters in oral medicine: an approach for the general dental practitioner

The aim of this study was to analyze the contents of referral letters related to clinical history and reason for consultation. A total of 236 consecutive referral letters were evaluated. Analysis of the referral letters was based on key items concerning patient identification. chief complaint, previous consultation. laboratory investigation and use of drugs for the chief complaint. A database was organized (Epinfo 6.04) and the chi (2) test (a = 0.05) was applied to the results. of the 800 files examined. only 30%, (236) had a referral letter. of the 236 referral letters. 67% were from dentists, 22% from physicians and 11% from unidentified professionals. Patient age did not appear in 70%, of the letters and the chief complaint was mentioned only in 55%. The letters had no details such as description of the oral lesion (80%), anatomical site (34%), size (99%), symptoms (83%), or period of evolution (92%). Clinical diagnosis was not included in 84% of the letters. Less than 5% of the referral letters contained information about previous consultation and laboratory investigation. The chi (2) test showed significant differences for ail items of the referral letter. Referral letters did not satisfy minimal requirements about clinical history or reason for consultation. leading to failed communication among professionals. Based on this study, we suggest that standard letters are important to improve the quality of the letters, reducing the rate of omission of relevant items.

Case study of children of referrals to health services: an individualizing design?

Nowadays education for all is recommended as an international action. However in Brazil one can observe homogeneous practices for a heterogeneous public. When the student has learning difficulties, there seems to be an attempt to normalization and pathologization by the means of referral, many times being indiscriminate, to health services. This case study aimed to analyze records of pedagogical strategies to meet the students educational needs before sending them to health services. Two records sent to a multidisciplinary team of a Regional Specialty Clinic (ARE) in a city of the state of São Paulo/Brazil, were used. The results reflect that the records of the educators do not show the pedagogical strategies used with the students and that the education system still seeks homogeneous classes, devaluating the diversity present in its context.

What Role Should Government Regulation Play in Ecological Restoration? Ongoing Debate in São Paulo State, Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Normas jurídicas para a restauração ecológica: uma barreira a mais a dificultar o êxito das iniciativas?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação do desempenho diagnóstico e do valor de corte para o índice de respiração rápida e superficial na predição do insucesso da extubação

OBJETIVO: Avaliar o desempenho diagnóstico do índice de respiração rápida e superficial (IRRS) na predição do insucesso da extubação de pacientes adultos em terapia intensiva e verificar a adequação do valor de corte clássico para esse índice. MÉTODOS: Estudo prospectivo realizado na unidade de terapia intensiva de adultos do Hospital das Clínicas da Faculdade de Medicina de Botucatu, através da avaliação do IRRS em 73 pacientes consecutivos considerados clinicamente prontos para extubação. RESULTADOS: O IRRS com valor de corte clássico (105 ciclos/min/L) apresentou sensibilidade de 20% e especificidade de 95% (soma = 115%). A análise da curva receiver operator characteristic (ROC) demonstrou melhor valor de corte (76,5 ciclos/min/L), o qual forneceu sensibilidade de 66% e especificidade de 74% (soma = 140%), e a área sob a curva ROC para o IRRS foi de 0,78. CONCLUSÕES: O valor de corte clássico do IRRS se mostrou inadequado nesta casuística, prevendo apenas 20% dos pacientes com falha na extubação. A obtenção do novo valor de corte permitiu um acréscimo substancial de sensibilidade, com aceitável redução da especificidade. O valor da área sob a curva ROC indicou satisfatório poder discriminativo do índice, justificando a validação de sua aplicação.

Emprego do cell block de agarose como método complementar no diagnóstico citológico de tumores mamários caninos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fuzzy distributed artificial intelligence systems

In this paper, we introduce a DAI approach called hereinafter Fuzzy Distributed Artificial Intelligence (FDAI). Through the use of fuzzy logic, we have been able to develop mechanisms that we feel may effectively improve current DAI systems, giving much more flexibility and providing the subsidies which a formal theory can bring. The appropriateness of the FDAI approach is explored in an important application, a fuzzy distributed traffic-light control system, where we have been able to aggregate and study several issues concerned with fuzzy and distributed artificial intelligence. We also present a number of current research directions necessary to develop the FDAI approach more fully.

Peritoneal dialysis in acute renal failure

The definition of adequate dialysis in acute renal failure (ARF) is complex and involves the time of referral to dialysis, dose, and dialytic method. Nephrologist experience with a specific procedure and the availability of different dialysis modalities play an important role in these choices. There is no consensus in literature on the best method or ideal dialysis dose in ARF. Peritoneal dialysis (PD) is used less and less in ARF patients, and is being replaced by continuous venovenous therapies. However, it should not be discarded as a worthless therapeutic option for ARF patients. PD offers several advantages over hemodialysis, such as its technical simplicity, excellent cardiovascular tolerance, absence of an extracorporeal circuit, lack of bleeding risk, and low risk of hydro-electrolyte imbalance. PD also has some limitations, though: it needs an intact peritoneal cavity, carries risks of peritoneal infection and protein losses, and has an overall lower effectiveness. Because daily solute clearance is lower with PD than with daily HD, there have been concerns that PD cannot control uremia in ARF patients. Controversies exist concerning its use in patients with severe hypercatabolism; in these cases, daily hemodialysis or continuous venovenous therapy have been preferred. There is little literature on PD in ARF patients, and what exists does not address fundamental parameters such as adequate quantification of dialysis and patient catabolism. Given these limitations, there is a pressing need to re-evaluate the adequacy of PD in ARF using accepted standards. Therefore, new studies should be undertaken to resolve these problems. Copyright © Informa Healthcare.

Border detection in digital images: An approach by fuzzy numbers

The purpose of this paper is to introduce a new approach for edge detection in gray shaded images. The proposed approach is based on the fuzzy number theory. The idea is to deal with the uncertainties concerning the gray shades making up the image, and thus calculate the appropriateness of the pixels in relation to an homogeneous region around them. The pixels not belonging to the region are then classified as border pixels. The results have shown that the technique is simple, computationally efficient and with good results when compared with both the traditional border detectors and the fuzzy edge detectors. © 2007 IEEE.

Hindlimb unloading producing effects on bone biomechanical properties in mature male rats

Aging is associated with decline in muscle mass and strength and reduced bone density. Age-related bone loss is a primary factor in osteoporosis and all individuals are potential candidates for osteoporosis because bone loss with aging occurs in men and women, but less studied in men. To examine the appropriateness of hindlimb elevation, by tail suspension as a model for diminished mechanical loading, and to determine the influence of age on bone responsiveness to skeletal unloading, we use dual X ray absorptiometry (DXA) and digital radiographic images to analyze the response of the femur from mature rats to biomechanical loads. Femurs from male Wistar rats (9-mo-old) were scanned using DXA and DIGORA and measures obtained in ephipyseal and diaphyseal regions of interest. The mechanical testing was divided into compression load to fracture the head and a three-point bending load to fracture the femur middiaphysis. In femoral epiphysis from hindlimb unload (HU), animals presented significant differences between mineral bone content and density assessed by DXA. Detailed regions of femoral epiphysis (head, throcanteric fossa, throcanter and metaphysis) presented significant lower values from radiographic density. Only compressive load necessary to fracture the femoral head neck was also significantly diminished in HU animals. Disuse induced, as in elderly patients, deterioration of the trabecular bone architecture with critical effect on bone fragility. Rats with 21 days of hindlimb unloading can simulate disuse, suggesting that certain sub-regions of their aging bones are more susceptible to fracture, while other, i.e. diaphyses, are not.

Edge detection in digital images using fuzzy numbers

The purpose of this paper is to introduce a new approach for edge detection in grey shaded images. The proposed approach is based on the fuzzy number theory. The idea is to deal with the uncertainties concerning the grey shades making up the image and, thus, calculate the appropriateness of the pixels in relation to a homogeneous region around them. The pixels not belonging to the region are then classified as border pixels. The results have shown that the technique is simple, computationally efficient and with good results when compared with both the traditional border detectors and the fuzzy edge detectors. Copyright © 2009, Inderscience Publishers.

Técnica do grupo focal como método de avaliação do conhecimento de adolescentes sobre saúde bucal

This study aims to the understanding of adolescents regarding oral health, using the Focus Group technique. The study was conducted at three public schools in the city of Araçatuba, São Paulo State, Brazil, with ten students in each. In order to conduct the focus groups, the following words, which featured high error levels, were addressed in survey questions on oral health: oral health; plaque, permanent teeth; fluoride; gum bleeds?; dental floss; transmission of cavities. During the discussions in the focus groups, it was observed that many teenagers were surprised at the situation to which they were submitted and at the topic they were discussing. The word 'oral health' was associated with the condition of cleanliness of the oral cavity, not identifying oral health as part of general health. The term 'transmission of cavities' did not have a sufficient understanding. The term 'permanent tooth' was well understood and was associated with a type of tooth that would not be replaced. The word 'fluoride' had more association with the task of cleaning than protection of the teeth. It is concluded that the use of the focus group technique is of great importance in the interpretation of the knowledge of adolescents on oral health and the appropriateness of the terminology of questionnaires on the same subject.

Caracterização do uso do solo e das áreas de preservação permanente, visando a adequação ambiental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Entre o fazer e o ensinar antropologia: a graduação em Ciências Sociais no Estado de São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)