A medical information system to manage a cancer database

Cancer is the second main cause of death in Brazil, and according to statistics disclosed by INCA - National Cancer Institute 466,730 new cases of the disease are forecast for 2008. The storage and analysis of tumour tissues of various types and patients' clinical data, genetic profiles, characteristics of diseases and epidemiological data may provide more precise diagnoses, providing more effective treatments with higher chances for the cure of cancer. In this paper we present a Web system with a client-server architecture, which manages a relational database containing all information relating to the tumour tissue and their location in freezers, patients, medical forms, physicians, users, and others. Furthermore, it is also discussed the software engineering used to developing the system.

Desigualdade de indicadores de mortalidade no Sudeste do Brasil

INTRODUÇÃO: Há indícios de que a deterioração das condições de trabalho ocorrida em anos recentes influencie a mortalidade. O objetivo do estudo é estimar indicadores de mortalidade para a população de Botucatu, classificada de acordo com as ocupações exercidas. MÉTODO: Foram calculados os indicadores coeficiente de mortalidade padronizado (CMP), razão de risco padronizada e anos potenciais de vida perdidos (APVP) para a população de Botucatu, em 1997, segundo ocupações e causas básicas do óbito. RESULTADOS: Os indicadores CMP e APVP variaram entre 0,6 e 39,9 óbitos/1000 trabalhadores e entre 33 e 334 anos/1000 trabalhadores, respectivamente, de acordo com a ocupação principal exercida. Observou-se que a ordenação quantitativa das causas de óbito depende da ocupação e do indicador utilizado. CONCLUSÕES: Os indicadores de mortalidade verificados apresentam uma grande heterogeneidade quando analisados de acordo com ocupação e causas básicas de óbito, refletindo a enorme desigualdade social existente na população estudada.

Uso do óxido nítrico em pediatria

Objective: To review the literature on inhaled nitric oxide and to describe its main clinical applications in pediatrics. Sources of data: A 10 year literature review with selection of the most important publications on inhaled nitric oxide, using the Medline and Cochrane Systematic Review databases. Summary of the findings: This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning; precautions and side-effects. Inhaled nitric oxide use was described in persistent pulmonary hypertension and hypoxia of the newborn, acute respiratory distress syndrome, primary pulmonary hypertension, heart surgery, chronic obstructive pulmonary disease, sickle cell anemia, and bronchospastic disease. Conclusions: Inhaled nitric oxide is a therapeutic approach with wide clinical applications in pediatrics. Its use is safe when administered in pediatric intensive care units under strict monitoring. As a pulmonary vasodilator, nitric oxide has beneficial effects on gas exchange and ventilation. Controlled trials, focusing on early gas administration should be performed under many clinical conditions, especially acute respiratory distress syndrome.

An environment for knowledge discovery in biology

This paper describes a data mining environment for knowledge discovery in bioinformatics applications. The system has a generic kernel that implements the mining functions to be applied to input primary databases, with a warehouse architecture, of biomedical information. Both supervised and unsupervised classification can be implemented within the kernel and applied to data extracted from the primary database, with the results being suitably stored in a complex object database for knowledge discovery. The kernel also includes a specific high-performance library that allows designing and applying the mining functions in parallel machines. The experimental results obtained by the application of the kernel functions are reported. © 2003 Elsevier Ltd. All rights reserved.

Subnotificação de acidentes do trabalho não fatais em Botucatu, SP, 2002

Objective: The implementation of work-related injury prevention policies has been hindered by underreporting of incidents among formal workers, and substantial underreporting among informal workforce. This study aimed at estimating the underreporting of work-related injury in a median-sized city. Methods: A random survey was carried out among residences in the urban area of Brazil. Residents were interviewed about the occurrence of work-related injury to people aged more than nine years in the last 90 days. All incidents reported were double checked in the National Social Security Institute (INSS) records. Results: There were 9,626 residences visited. It was estimated 79.5% (CI 95%: 78.8%-80.3%) of underreporting of work-related injury. Conclusions: Work-related injury reporting is poor in the study location and this may be occurring in other cities. Data suggest the need to build up information systems on Brazilian workers' health. It should incorporate methods, materials and human recourses necessary to recognize, store, analyze, and spread information support injury prevention policies and promote workers' health programs.

Fitoterapia no sistema de saúde pública (SUS) no Estado de São Paulo, Brasil

Phytotherapy is a form of familiar treatment throughout the world and recommended by the World Health Organisation to be used in all regions, especially in the poorer countries, to improve the state of health of their people. The aim of this study was to describe the use of herbal medicine as an alternative therapy in the public health system in Sao Paulo State. The fieldwork consisted in obtaining information, from all the Regional Health Authorities in the State, about which municipal health areas use this therapy and sending them a questionnaire requesting details about the application of phitotherapy: when the therapy had been adopted, which plants were used, whether the programme had been discontinued or not and if so, for what reason. The cities that use the phytotherapy are: Campinas; Canas; Guaratingueta; Herculandia; Piquete; Pindamonhangaba; Roseira e Sao Jose do Barreiro, Ribeirao Preto, Sao Lourenço da Serra, Cruzeiro e Dobrada. And the three plant more used are: Guaco (Mikania glomerate); Calendula (Calendula officinalis) e Babosa (Aloe vera) The lack of support has led some Authorities to discontinue their active in 08 programmes. Nevertheless, it is concluded that the efficacy and low cost of herbal treatments has engendered a growing interest among health professionals in placing proposals for implanting this therapy in 13 cities in the Municipal Health. Thus, there should be growing practical support for the establishment of such programmes in the future.

Animais de laboratório: O camundongo

The animal experimentation in the scientific research has contributed excessively for the development of science and technology, promoting to long of the years the discovery of prophylactic measures and treatments for diseases that attack the humans. Animals of some species have been used in the last times, being the mouse the more intensely used and more deeply known scientifically. The objective of this work was to carry through a bibliographical survey including data of our research group, about the use of mice in the animal experimentation, approaching its general biology, reproduction physiology, creation systems, genetics, habitation, feeding, handling, pain and euthanasia, techniques of risk developed in the experimentation, blood collection, pharmacological and toxicological experiments. Although current trends praise the use of alternative methods (in vitro studies, cells cultures, etc.), the animal models, as the mouse, present as main advantage the supply of information on the organism as a whole, fact that is not obtained with other methods, what still it makes possible its utilization in scientific research.

A clinical decision support system for cancer diseases

The second main cause of death in Brazil is cancer, and according to statistics disclosed by National Cancer Institute from Brazil (INCA) 466,730 new cases of cancer are forecast for 2008. The analysis of tumour tissues of various types and patients' clinical data, genetic profiles, characteristics of diseases and epidemiological data may lead to more precise diagnoses, providing more effective treatments. In this work we present a clinical decision support system for cancer diseases, which manages a relational database containing information relating to the tumour tissue and their location in freezers, patients and medical forms. Furthermore, it is also discussed some problems encountered, as database integration and the adoption of a standard to describe topography and morphology. It is also discussed the dynamic report generation functionality, that shows data in table and graph format, according to the user's configuration. © ACM 2008.

Comparação entre hipertensão autoreferida e pressão arterial casual e presença de fatores de risco em funcionários da saúde Bauru e Jaú

Model: Prevalence study. Objectives: To evaluate the presence of self-reported hypertension to compare with blood pressure measurements. Besides, this work investigated health information level of workers and if the job position has any influence on blood pressure (BP). Methods: This study evaluated 349 health workers (44±10 years old) from Bauru and Jau cities, who answered some questions about history of health condition, use of medicines, past surgeries as well as social, scholar and physical conditions and had their blood pressure measured. Each subject selfreported as normotensive or hypertensive. Values of systolic ≥ 140 mmHg and/or diastolic PA ≥ 90 mmHg were considered elevated. Among the health workers evaluated, 198 were submitted to anthropometric and biochemical evaluations. Values are presented as means ± SD and frequency of distribution. It was used T-student test (p<0.05). Results: From all workers evaluated only 16% self-reported as hypertensive, which 56% presented high BP, however 91% used to take antihypertensive medicines. Among the 84% who self-reported as normotensive, 24% presented high BP and 8% used to take medicines. Although most of the employees of each section self-reported as normotensive, more than a half presented high BP and which was more common in the health's section (76.3%). Conclusion: These results suggest that besides the majority of the employees self-reported as normotensive, an elevated number of health workers presented high blood pressure and used to take medicines inappropriately, which indicates that they did not have enough knowledge about their health. Furthermore, it was observed that Health Section presented the higher blood pressure values.

Caracterização do tratamento medicamentoso com estatinas em unidade básica de saúde

Study Model: Retrospective study. Study Objective: To characterize statin treatment management due to lipid alterations and side effects throughout statin treatment in basic healthcare unit. Methods: Medical reports of women from a basic healthcare unit were analyzed, obtaining: disease presence, regular medication prescription, statin type and dosage, biochemical exams results, musculoskeletal complaints, and statin use cessation, going back the information until the medical consultation of first prescription. Results: Prescribed statins were Simvastatin and Atorvastatin at low doses (10-20 mg). Dose (48,4%) and/or type (25,4%) alterations occurred for lipid profile adequacy. Lipid levels were reduced without creatine kinase elevation. Treatment withdrawn (30,6%) was mainly due to their own decision (74%), which was strongly associated with records of musculoskeletal complaints (Odds Ratio: 6,40[1,53-26,78]). Conclusion: Statin treatment was effective in reducing serum lipid levels and self-reported pain was underestimated, characterizing the major limiting factor for treatment adherence.

O processo de comunicação médico/família/criança: a percepção de mães de crianças portadoras de doenças crônicas graves

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Protecting medical images with biometric information

Medical images are private to doctor and patient. Digital medical images should be protected against unauthorized viewers. One way to protect digital medical images is using cryptography to encrypt the images. This paper proposes a method for encrypting medical images with a traditional symmetric cryptosystem. We use biometrics to protect the cryptographic key. Both encrypted image and cryptographic key can be transmitted over public networks with security and only the person that owns the biometrics information used in key protection can decrypt the medical image. © Springer Science+Business Media B.V. 2008.

Influence of visual information on optimal obstacle crossing

Human motion seems to be guided by some optimal principles. In general, it is assumed that human walking is generated with minimal energy consumption. However, in the presence of disturbances during gait, there is a trade-off between stability (avoiding a fall) and energy-consumption. This work analyses the obstacle-crossing with the leading foot. It was hypothesized that energy-saving mechanisms during obstacle-crossing are modulated by the requirement to avoid a fall using the available sensory information, particularly, by vision. A total of fourteen subjects, seven with no visual impairment and seven blind, walked along a 5 meter flat pathway with an obstacle of 0.26 m height located at 3 m from the starting point. The seven subjects with normal vision crossed the obstacle successfully 30 times in two conditions: blindfolded and with normal vision. The seven blind subjects did the same 30 times. The motion of the leading limb was recorded by video at 60 Hz. There were markers placed on the subject's hip, knee, ankle, rear foot, and forefoot. The motion data were filtered with a fourth order Butterworth filter with a cut-off frequency of 4 Hz. The following variables were calculated: horizontal distance between the leading foot and the obstacle at toe-off prior to (DHPO) and after (DHOP) crossing, minimal vertical height from the foot to the obstacle (DVPO), average step velocity (VELOm). The segmental energies were also calculated and the work consumed by the leading limb during the crossing obstacle was computed for each trial. A statistical analysis repeated-measures ANOVA was conducted on these dependent variables revealing significant differences between the vision and non-vision conditions in healthy subjects. In addition, there were no significant differences between the blind and people with vision blindfolded. These results indicate that vision is crucial to determine the optimal trade-off between energy consumption and avoiding a trip during obstacle crossing.

Teaching the Rational Use of Medicines to medical students: a qualitative research

Background: Prescribing is a complex and challenging task that must be part of a logical deductive process based on accurate and objective information and not an automated action, without critical thinking or a response to commercial pressure. The objectives of this study were 1) develop and implement a discipline based on the WHO's Guide to Good Prescribing; 2) evaluate the course acceptance by students; 3) assess the impact that the Rational Use of Medicines (RUM) knowledge had on the students habits of prescribing medication in the University Hospital.Methods: In 2003, the RUM principal, based in the WHO's Guide to Good Prescribing, was included in the official curriculum of the Botucatu School of Medicine, Brazil, to be taught over a total of 24 hours to students in the 4th year. We analyzed the students' feedback forms about content and teaching methodology filled out immediately after the end of the discipline from 2003 to 2010. In 2010, the use of RUM by past students in their medical practice was assessed through a qualitative approach by a questionnaire with closed-ended rank scaling questions distributed at random and a single semistructured interview for content analysis.Results: The discipline teaches future prescribers to use a logical deductive process, based on accurate and objective information, to adopt strict criteria (efficacy, safety, convenience and cost) on selecting drugs and to write a complete prescription. At the end of it, most students considered the discipline very good due to the opportunity to reflect on different actions involved in the prescribing process and liked the teaching methodology. However, former students report that although they are aware of the RUM concepts they cannot regularly use this knowledge in their daily practice because they are not stimulated or even allowed to do so by neither older residents nor senior medical staff.Conclusions: This discipline is useful to teach RUM to medical students who become aware of the importance of this subject, but the assimilation of the RUM principles in the institution seems to be a long-term process which requires the involvement of a greater number of the academic members.

Abductive reasoning, information, and mechanical systems

We investigate, from a philosophical perspective, the relation between abductive reasoning and information in the context of biological systems. Emphasis is given to the organizational role played by abductive reasoning in practical activities of embodied embedded agency that involve meaningful information. From this perspective, meaningful information is provisionally characterized as a selforganizing process of pattern generation that constrains coherent action. We argue that this process can be considered as a part of evolutionarily developed learning abilities of organisms in order to help with their survival. We investigate the case of inorganic mechanical systems (like robots), which deal only with stable forms of habits, rather than with evolving learning abilities. Some difficulties are considered concerning the hypothesis that mechanical systems may operate with meaningful information, present in abductive reasoning. Finally, an example of hypotheses creation in the domain of medical sciences is presented in order to illustrate the complexity of abduction in practical reasoning concerning human activities. © 2007 Springer-Verlag Berlin Heidelberg.