Adaptação e validação de conteúdo da versão brasileira do Posttraumatic Cognitions Inventory

OBJETIVO: Realizar a tradução, adaptação e validação de conteúdo da versão brasileira do Posttraumatic Cognitions Inventory . MÉTODOS: O processo de tradução e adaptação das instruções iniciais e dos itens do PTCI envolveu cinco etapas: (1) tradução; (2) retradução; (3) correção e adaptação semântica; (4) validação do conteúdo por profissionais da área (juízes); e (5) teste da versão final, por meio de uma escala verbal-numérica. Como indicadores de desempenho para a compreensão, foram computados os escores de tendência central (média) e dispersão (desvio padrão) para cada item na etapa 5. Definiu-se escore médio ≥ 3 para compreensão satisfatória. RESULTADOS: As 36 questões e as instruções iniciais foram traduzidas e adaptadas para compor a versão brasileira do Posttraumatic Cognitions Inventory . Quarenta e cinco adultos responderam aos itens do Posttraumatic Cognitions Inventory na etapa teste da versão final, mostrando compreensão adequada do instrumento na escala verbal-numérica (M = 4,13; dp = 0,11). CONCLUSÕES: O Posttraumatic Cognitions Inventory é um instrumento de fácil compreensão e semanticamente válido. Estudos posteriores são necessários para a verificação e adequação da avaliação de suas propriedades psicométricas na população brasileira.

Socioeconomic inequality in catastrophic health expenditure in Brazil

OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families.METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index.RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated.CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

Global warming in Amazonia: impacts and Mitigation

Global warming has potentially catastrophic impacts in Amazonia, while at the same time maintenance of the Amazon forest offers one of the most valuable and cost-effective options for mitigating climate change. We know that the El Niño phenomenon, caused by temperature oscillations of surface water in the Pacific, has serious impacts in Amazonia, causing droughts and forest fires (as in 1997-1998). Temperature oscillations in the Atlantic also provoke severe droughts (as in 2005). We also know that Amazonian trees die both from fires and from water stress under hot, dry conditions. In addition, water recycled through the forest provides rainfall that maintains climatic conditions appropriate for tropical forest, especially in the dry season. What we need to know quickly, through intensified research, includes progress in representing El Niño and the Atlantic oscillations in climatic models, representation of biotic feedbacks in models used for decision-making about global warming, and narrowing the range of estimating climate sensitivity to reduce uncertainty about the probability of very severe impacts. Items that need to be negotiated include the definition of "dangerous" climate change, with the corresponding maximum levels of greenhouse gases in the atmosphere. Mitigation of global warming must include maintaining the Amazon forest, which has benefits for combating global warming from two separate roles: cutting the flow the emissions of carbon each year from the rapid pace of deforestation, and avoiding emission of the stock of carbon in the remaining forest that can be released by various ways, including climate change itself. Barriers to rewarding forest maintenance include the need for financial rewards for both of these roles. Other needs are for continued reduction of uncertainty regarding emissions and deforestation processes, as well as agreement on the basis of carbon accounting. As one of the countries most subject to impacts of climate change, Brazil must assume the leadership in fighting global warming.

Treatment of delayed rupture of the left ventricle after mitral valve replacement

Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

Tree population and community dynamics in a Brazilian tropical semideciduous forest

The dynamics of the tree community and 30 tree populations were examined in an area of tropical semideciduous forest located on the margin of the Rio Grande, SE Brazil, based on surveys done in 1990 and 1997 in three 0.18 ha plots. The main purpose was to assess whether variations in dynamics were related to topography and the effects of a catastrophic flood in 1992. Rates of mortality and recruitment of trees and gain and loss of basal area in two topographic sites, lower (flooded) and upper (non-flooded), were obtained. Projected trajectories of mean and accelerated growth in diameter were obtained for each species. In both topographic sites, mortality rates surpassed recruitment rates, gain rates of basal area surpassed loss rates, and size distributions changed, with declining proportions of smaller trees. These overall changes were possibly related to increased underground water supply after the 1992 flood as well as to a c. 250-year-old process of primary succession on abandoned gold mines. Possible effects of the 1992 flood showed up in the higher proportions of dead trees in the flooded sites and faster growth rates in the flood-free sites. Species of different regeneration guilds showed particular trends with respect to their demographic changes and diameter growth patterns. Nevertheless, patterns of population dynamics differed between topographic sites for only two species.