Effect of oscillatory breathing on the variability of the RR Intervals and its prognostic importance in individuals with left ventricular global systolic dysfunction

OBJECTIVE: To assess the effect of the oscillatory breathing on the variability of RR intervals (VRR) and on prognostic significance after one year follow-up in subjects with left ventricular global systolic dysfunction. METHODS: We studied 76 subjects, whose age ranged from 40 to 80 years, paired for age and gender, divided into two groups: group I - 34 healthy subjects; group II - 42 subjects with left ventricular global systolic dysfunction (ejection fraction < 0.40). The ECG signals were acquired during 600s in supine position, and analyzed the variation of the thoracic amplitude and the VRR. Clinical and V-RR variables were applied into a logistic multivariate model to foretell survival after one year follow-up. RESULTS: Oscillatory breathing was detected in 35.7% of subjects in vigil state of group II, with a concentration of the spectral power in the very low frequency band, and was independent of the presence of diabetes, functional class, ejection fraction, cause of ventricular dysfunction and survival after one year follow-up. In the logistic regression model, ejection fraction was the only independent variable to predict survival. CONCLUSION: 1) Oscillatory breathing pattern is frequent during wakefulness in the left ventricular global systolic dysfunction and concentrates spectral power in the very low band of V-RR; 2) it does not relate to severity and cause of left ventricular dysfunction; 3) ejection fraction is the only independent predictive variable for survival in this group of subjects.

Acute Schistosomiasis: Report on Five Singular Cases

The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus

Lutzomyia derelicta (Diptera: Psychodidae) a singular new phlebotomine sand fly from an inselberg in northeastern amazonia

Lutzomyia derelicta n. sp. is described from specimens collected in an isolated xeric habitat in the rainforest in the north of the State of Pará, Brazil. The new species lacks the posterior bulge in the dorsal wall of the cibarium characteristic of the New World genus Lutzomyia, and the armature of the male genitalia is of the pattern found elsewhere only in the Old World species of Sergentomyia. L. derelicta is phenetically intermediate between the known species of Lutzomyia and Sergentomyia, and cannot readily be placed in any existing subgenus or species group of either genus.

Delineando as propriedades que conferem ao cuidar em enfermagem seu estatuto singular: o quadro e o fato

O ensaio reconsidera o processo de institucionalização do cuidar evidenciando a ordem própria desse fato mobilizado por essa interdição. Evidencia os efeitos desse processo na conformação do pacto identificatório profissional instituição, o arcabouço estrutural que lhe dá sustentação, identificando suas propriedades, assim como as possibilidades de criar um dispositivo de trabalho apto a promover o reencontro com a tarefa primária resignificada.

Projeto terapêutico singular no âmbito da saúde mental: uma experiência no curso de graduação em medicina

O Jardim Campo Belo, localizado no município de Campinas (SP), é um bairro de alta vulnerabilidade social e grande demanda por serviços de saúde, sendo a única oferta em saúde mental o matriciamento com outra unidade de saúde. Neste contexto, durante as disciplinas do segundo ano de Medicina, foi realizado um projeto de intervenção no Centro de Saúde, mediante acompanhamento em domicilio de pacientes usuários de psicotrópicos. Realizaram-se visitas quinzenais às casas de dez pacientes. Nestas visitas, trabalhou-se um roteiro semidirigido, em que se buscou conhecer as demandas de cada paciente. Alguns destes aumentaram os cuidados com a própria saúde, e num caso houve até suspensão do uso dos medicamentos psicotrópicos, em parceria com a equipe; em outros casos, as visitas serviram como válvula de escape social, tornando-se um espaço onde se ofertava atenção aos que estavam acostumados ao abandono social. Os alunos envolvidos relatam grande aprendizado graças às vivências e ao envolvimento com o tema, que se tornou um grande suplemento pedagógico.

Singular Reference Without Singular Thought

Abstract In this paper I challenge the widespread assumption that the conditions for singular reference are more or less the same as the conditions for singular thought. I claim that we refer singularly to things without thinking singularly about them more often than it is usually believed. I first argue that we should take the idea that singular thought is non-descriptive thought very seriously. If we do that, it seems that we cannot be so liberal about what counts as acquaintance; only perception (and memory) will do. I also briefly discuss and reject semantic instrumentalism. Finally, I argue that while singular reference is cheap, singular thought comes only at a price.

A key role for Na+/K+-ATPase in the endothelium-dependent oscillatory activity of mouse small mesenteric arteries

Oscillatory contractile activity is an inherent property of blood vessels. Various cellular mechanisms have been proposed to contribute to oscillatory activity. Mouse small mesenteric arteries display a unique low frequency contractile oscillatory activity (1 cycle every 10-12 min) upon phenylephrine stimulation. Our objective was to identify mechanisms involved in this peculiar oscillatory activity. First-order mesenteric arteries were mounted in tissue baths for isometric force measurement. The oscillatory activity was observed only in vessels with endothelium, but it was not blocked by L-NAME (100 µM) or indomethacin (10 µM), ruling out the participation of nitric oxide and prostacyclin, respectively, in this phenomenon. Oscillatory activity was not observed in vessels contracted with K+ (90 mM) or after stimulation with phenylephrine plus 10 mM K+. Ouabain (1 to 10 µM, an Na+/K+-ATPase inhibitor), but not K+ channel antagonists [tetraethylammonium (100 µM, a nonselective K+ channel blocker), Tram-34 (10 µM, blocker of intermediate conductance K+ channels) or UCL-1684 (0.1 µM, a small conductance K+ channel blocker)], inhibited the oscillatory activity. The contractile activity was also abolished when experiments were performed at 20°C or in K+-free medium. Taken together, these results demonstrate that Na+/K+-ATPase is a potential source of these oscillations. The presence of α-1 and α-2 Na+/K+-ATPase isoforms was confirmed in murine mesenteric arteries by Western blot. Chronic infusion of mice with ouabain did not abolish oscillatory contraction, but up-regulated vascular Na+/K+-ATPase expression and increased blood pressure. Together, these observations suggest that the Na+/K+ pump plays a major role in the oscillatory activity of murine small mesenteric arteries.

ARS Antiqua: mosteiro de são bento, o eterno no tempo

Este artigo investiga a condição de instituição total da Ordem Beneditina, a partir da experiência do Mosteiro de São Bento da Bahia. Tem como ponto de partida a questão de quanto da tradição beneditina - normas monásticas, ética teológica, instituição total - define o Mosteiro contemporâneo. Trata-se de pesquisa longitudinal que mapeou as mudanças ocorridas na gestão do Mosteiro, no período entre 1994 e 2004. A pesquisa delimitou algumas das ações da atual Abadia no sentido de articular instâncias institucionais, de explicitar laços sociais que compõem suas afiliações de elite e imprimir novos modelos de gestão interna e atuação na cidade. A Ordem pré-moderna, fundamentada na Regra Beneditina do século VI d.C., é apreendida como uma forma singular e paradoxal de “instituição total”.

Inovação na cooperação intermunicipal no Brasil: a experiência da Federação Catarinense de Municípios (Fecam) na construção de consórcios públicos

Este artigo analisa uma experiência inovadora de cooperação intermunicipal no Brasil, por meio da observação da atuação da Federação Catarinense de Municípios (Fecam) no fomento e na organização de consórcios públicos intermunicipais. Investiga o uso de uma estratégia singular para enfrentar determinados limites à montagem de formas de consórcio no Brasil, entre os quais a dificuldade dos municípios, sem algum estímulo externo, para construir parcerias estáveis entre si. O ponto central da análise realça a possibilidade de associações municipalistas induzirem a cooperação de forma mais duradoura e com maior sustentação técnica. Com base no estudo de caso qualitativo, observou-se a atuação da Fecam como advocacy e como estrutura institucional profissionalizada que fomenta a cooperação entre municípios.

Mortality from asthma in the state of S. Paulo, Brazil (1970-1992)

Mortality from asthma has shown important variations over time in several countries. In Brazil, a mortality study performed in the 60s, covering the cities of S.Paulo and Ribeirão Preto, and other ten cities showed that S.Paulo presented the lowest death rate from asthma among of them all. It was decided to study the time trends of deaths from asthma and from the whole set of respiratory diseases from 1970 to 1992, in the population aged 15-34 yrs. old in the State of S.Paulo, as well as to compare them with those of other countries. Asthma mortality rates during the 23 years of observation since 1975, showed an oscillatory declining pattern with a peak of deaths in the initial years. The linearization of the curve allows the calculation of Pearson's correlation coefficient that was significantly negative, suggesting a decline in the mortality over this period, mainly in the 5-9 yrs. old and 30-34 yrs. old strata. The segmentation of data between the period of ICD-9, 1970 to 1978, and of ICD-9, 1979 and subsequent years, shows that there is stability within each period, in all age-groups, except for that of 5-9 yr. olds between 1970-1978. Comparing the rates of the population aged 15-34 yrs. old for the State of S. Paulo, Brazil, with trends observed in 14 other countries, an intermediate pattern for the first triennial period (1970-1972) as well as for the subsequent triennial periods, emerges. A prevalence study of asthma, a follow up program meant for using emergency rooms and a surveillance of deaths due to all respiratory diseases and specifically to asthma are strongly recommended.

Antinomias e "suturas" epistemológicas entre biológico-social e individual-coletivo no âmbito da epidemiologia social

A complexidade do objeto epidemiológico tem suscitado, ao longo do tempo, discussão sobre alguns elementos que o compõem, assumindo, muitas vezes, a forma de antinomias. Utilizando-se como substrato textos fundamentais, analisaram-se, no âmbito da epidemiologia social, a formulação e a proposta de solução para as antinomias biológico-social e individual-coletivo. Criticou-se a validade teórica das saídas apontadas pelo discurso epidemiológico-social para resolver o "conflito de leis" que permeia o referido objeto. Destacou-se o conceito marxista-helleriano de indivíduo para contribuir com a "sutura" dos três planos da realidade: o universal, o particular e o singular.

Trabalho coletivo: um desafio para a gestão em saúde

Com base na teorização da ergologia e do processo de trabalho, este ensaio objetiva contribuir para a reflexão acerca do trabalho coletivo em saúde, destacando sua especificidade e as dificuldades de construção e gestão de coletivos de trabalho. Aborda o trabalho como atividade humana que compreende, dialeticamente, a aplicação de um protocolo prescrito e uma perspectiva singular e histórica. O trabalho em saúde envolve uma relação entre sujeitos que agem nas dramáticas do uso de si e que fazem a gestão do seu próprio trabalho; é influenciado pela história das profissões de saúde e pelas determinações macro-políticas. Conclui-se que essa complexidade do trabalho em saúde precisa ser considerada no processo de gestão de equipes/coletivos profissionais de modo a articular ações que possibilitem implementar um novo projeto de atenção à saúde na perspectiva da integralidade.

Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

Decision-making on childhood vaccination by highly educated parents

OBJECTIVE To analyze the sociocultural aspects involved in the decision-making process of vaccination in upper-class and highly educated families.METHODS A qualitative approach based on in-depth interviews with 15 couples from the city of Sao Paulo, Southeastern Brazil, falling into three categories: vaccinators, late or selective vaccinators, and nonvaccinators. The interpretation of produced empirical material was performed through content analysis.RESULTS The study showed diverse and particular aspects surrounding the three groups’ decisions whether to vaccinate their children. The vaccinators’ decision to vaccinate their children was spontaneous and raised no questions. Most late or selective vaccinators experienced a wide range of situations that were instrumental in the decision to delay or not apply certain vaccines. The nonvaccinator’s decision-making process expressed a broader context of both criticism of hegemonic obstetric practices in Brazil and access to information transmitted via social networks and the internet. The data showed that the problematization of vaccines (culminating in the decision to not vaccinate their children) occurred in the context of humanized birth, was protagonized by women and was greatly influenced by health information from the internet.CONCLUSIONS Sociocultural aspects of the singular Brazilian context and the contemporary society were involved in the decision-making on children’s vaccination. Understanding this process can provide a real basis for a deeper reflection on health and immunization practices in Brazil in light of the new contexts and challenges of the world today.