Post-traumatic amnesia: Consistency-of-recovery and duration-to-recovery following traumatic brain impairment

The aim of this research was to examine the nature and order of recovery of orientation and memory functioning during Post-Traumatic Amnesia (PTA) in relation to injury severity and PTA duration. The Westmead PTA Scale was used across consecutive testing days to assess the recovery of orientation and memory during PTA in 113 patients. Two new indices were examined: a Consistency-of-Recovery and a Duration-to-Recovery index. a predictable order of recovery was observed during PTA: orientation-to-person recovered sooner and more consistently than the following cluster; orientation-to-time, orientation-to-place, and the ability to remember a face and name. However, the type of memory functioning required for the recall face and name task recovered more consistently than that required for memorizing three pictures. An important overall finding was that the order-of-recovery'' of orientation and memory functioning was dependent upon both the elapsed days since injury, and the consistency of recovery. The newly developed indices were shown to be a valuable means of accounting for differences between groups in the elapsed days to recovery of orientation and memory. These indices also clearly increase the clinical utility of the Westmead PTA Scale and supply an objective means of charting (and potentially predicting) patients' recovery on the different components of orientation and memory throughout their period of hospitalization.

High prevalence of asthma in five remote indigenous communities in Australia

Data on the prevalence of asthma in children residing in remote indigenous communities in Australia are sparse, despite the many reports of high prevalence in nonindigenous children of this country. Two previous Australian studies have had poor participation rates, limiting interpretation of their results. A study of children in the Torres Strait and Northern Peninsula Area of Australia was conducted to document the prevalence of asthma symptoms. Five indigenous communities were randomly selected and trained interviewers, who were local indigenous health workers, recruited participants using a house-by-house approach. Information was collected by a structured face-to-face interview based on standardized questionnaire constructed from the protocol International Study of Asthma and Allergy in Childhood; 1,650 children were included in the study with a 98% response rate. Overall, the prevalence of self-reported ever wheezing was 21%,; 12% reported wheezing in the previous year; and 16%, reported ever having asthma, There was significant variation in the prevalence of asthma symptoms between communities. It is concluded that there are significant intercommunity variations in the prevalence of asthma symptoms in remote communities and that the prevalence in these communities is as high as in nonindigenous groups.

Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer

Objective. To examine the feasibility and safety of a low anterior resection of the rectosigmoid plus adjacent pelvic tumour as part of primary cytoreduction for ovarian cancer. Methods. This study included 65 consecutive patients with primary ovarian cancer who had debulking surgery from 1996 through 2000. All patients underwent an en bloc resection of ovarian cancer and a rectosigmoid resection followed by an end-to-end anastomosis. Parameters for safety and efficacy were considered as primary statistical endpoints for the aim of this analysis. Results. Postoperative residual tumour was nil, 1 cm in 14, 34, and 14 patients, respectively. The median postoperative hospital stay was 11 days (range, 6 to 50 days). Intraoperative complications included an injury to the urinary bladder in one patient. Postoperative complications included wound complications (n=14, 21.5%), septicemia (n=9, 13.8%), cardiac complications (n=7, 10.8%), thromboembolic complications (n=5, 7.7%) ileus (n=2, 3.1%) anastomotic leak (n=2, 3.1%) and fistula (n=1, 1.5%). Reasons for a reoperation during the same admission included repair of an anastomotic leak (n=1), postoperative hemorrhage (n=1), and wound debridement (n=1). Wound complications, septicemia, and anastomotic leak formation were more frequent in patients who had a serum albumin level of less than or equal to 30 g/L preoperatively. There was one surgically related mortality in a patient who died from a cerebral vascular accident 2 days postoperatively. Conclusions. An en bloc resection as part of primary cytoreductive surgery for ovarian cancer is effective and its morbidity is acceptably low. (C) 2001 Academic Press.

Advances in neurotrauma in Australia 1970-2000

The management of neurotrauma in Australia has been one of the significant public health triumphs during the last 30 years of the 20th century. State and national government agencies act in a coordinated fashion to collect data and to promote research on how to manage neurotrauma patients. Between 1970 and 1995, fatalities from road accidents decreased by 47%. Hospital admissions have decreased by 40% despite a 40% increase in the population and a 120% increase in registered vehicles. Fatalities per 10,000 registered vehicles were 8.05% in 1970 and they fell to 1.84% per vehicles in 1995, while fatalities per 10;000 population were 3 in 1970 falling to 1.11 in 1995. Hospitalization from road crashes decreased 23% between March 1988 and March 1997. Public education has steadily improved, backed by the state public health sources. A uniform code of road safety laws has been adopted, backed by legislation and legal penalties and increasing police enforcement. Clinical care of patients has improved as a result of faster communications, tele-medicine, trauma systems, the CT scanner; intensive care units, and improved monitoring. Patient rehabilitation and counseling are now carried out at units accredited by the Australian Council on Health Care Standards.

Brain natriuretic peptide: Disease marker or more in cardiovascular medicine?

Brain natriuretic peptide (BNP) is predominantly a cardiac ventricular hormone that promotes natriuresis and diuresis, inhibits the renin-anglotensin-aldosterone axis, and is a vasodilator. Plasma BNP levels are raised in essential hypertension, and more so in left ventricular (LV) hypertrophy and heart failure. Plasma BNP levels are also elevated in ischemic heart disease. Attempts have been made to use plasma BNP levels as a marker of LV dysfunction, but these have shown that plasma BNP levels are probably not sensitive enough to replace echocardiography in the diagnosis of LV dysfunction. Pericardial BNP or N-BNP may be more suitable markers of LV dysfunction. Plasma BNP levels are also elevated in right ventricular dysfunction, pregnancy-induced hypertension, aortic stenosis, age, subarachnoid hemorrhage, cardiac allograft rejection and cavopulmonary connection, and BNP may have an important pathophysiological role in some or all of these conditions. Clinical trials have demonstrated the natriuretic, diuretic and vasodilator effects, as well as inhibitory effects on renin and aldosterone of infused synthetic human BNP (nesiritide) in healthy humans. BNP infusion improves LV function in patients with congestive heart failure via a vasodilating and a prominent natriuretic effect. BNP infusion is useful for the treatment of decompensated congestive heart failure requiring hospitalization. The clinical potential of BNP is limited as it is a peptide and requires infusion. Drugs that modify the effects of BNP are furthering our understanding of the pathophysiological role and clinical potential of BNP. Increasing the effects of BNP may be a useful therapeutic approach in heart failure involving LV dysfunction. The levels of plasma BNP are increased by blockers, cardiac glycosides and vasopeptidase inhibitors, and this may contribute to the usefulness of these agents in heart failure. (C) 2001 Prous Science. All rights reserved.

High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue hemorrhagic fever

Infection with any 1 of 4 dengue viruses produces a spectrum of clinical illness ranging from a mild undifferentiated febrile illness to dengue fever (DF) to dengue hemorrhagic fever (DHF), a potentially life-threatening disease. The morbidity and mortality of DHF can be reduced by early hospitalization and careful supportive care. To determine its usefulness as a predictor of DHF, plasma levels of the secreted dengue virus nonstructural protein NS1 (sNS1) were measured daily in 32 children with dengue-2 virus infections participating in a prospective, hospital-based study. Free sNS1 levels in plasma correlated with viremia levels and were higher in patients with DHF than in those with DF. An elevated free sNS1 level (greater than or equal to600 ng/mL) within 72 h of illness onset identified patients at risk for developing DHF.

O isolamento no Hospital Col��nia Pedro Fontes, Itanhenga/ES e a caracteriza����o da popula����o do Educand��rio Alzira Bley no per��odo de 1937 a 1979

Caracteriza e analisa a popula����o do Educand��rio, com as informa����es provenientes de uma fonte de dados documental e hist��rica contida nos dois livros de registros do Educand��rio e seus arquivos fotogr��ficos. As informa����es sobre as 3.432 pessoas comp��em um banco de dados que foi constru��do durante a realiza����o desta pesquisa e as fotografias foram digitalizadas. O Educand��rio Alzira Bley, localiza-se na BR 101 - km 9, bairro de Itanhenga - Cariacica/ES. No estudo foram realizadas entrevistas semiestruturadas com funcion��rios e ex-internos do Educand��rio, que deram vida e movimento ��s an��lises dos gr��ficos e tabelas elaborados a partir do banco de dados. Para o embasamento te��rico do estudo da popula����o s��o empregados conceitos pertinentes �� transi����o demogr��fica e �� transi����o epidemiol��gica, ��s migra����es for��adas, ��s redes migrat��rias e ��s caracter��sticas da popula����o (sexo, idade, cor, origem e suas varia����es) que forneceram os elementos para a an��lise do estado da popula����o em diferentes momentos hist��ricos. A Geografia Hist��rica completa os referenciais te��ricos desta investiga����o, pois muitas caracter��sticas geogr��ficas requerem estudos hist��ricos para uma explica����o satisfat��ria de como chegaram ao que s��o hoje. As fotografias, os depoimentos e livros de registros do Educand��rio propiciaram a caracteriza����o da popula����o que passou e/ou viveu no Educand��rio Alzira Bley ao longo do per��odo das interna����es compuls��rias no Hospital Col��nia Pedro Fontes (1937-1979). Com a realiza����o desta investiga����o chegamos ��s seguintes conclus��es: a) cada gera����o �� v��tima do conhecimento cient��fico do seu tempo; b) a transi����o demogr��fica encontrava-se em sua primeira fase nos meados do s��culo XX, e os ��ndices elevados de mortalidade e de fecundidade eram observados na popula����o estudada; c) a transi����o epidemiol��gica, tamb��m em curso no Esp��rito Santo era caracterizada por elevada incid��ncia das doen��as infectocontagiosas, dentre as quais a hansen��ase era ainda uma doen��a sem cura. d) o isolamento dos hansenianos em hospitais col��nias, bem como seus filhos em prevent��rios foram movimentos de migra����o for��ada; e) a interna����o compuls��ria dos hansenianos em hospitais col��nias desencadeava uma migra����o em rede de familiares e demais parentes e amigos que pudessem estar com a doen��a.

O patrim��nio arquitet��nico da sa��de : discuss��es sobre a hist��ria da arquitetura hospitalar do s��culo XIX

O Patrim��nio Cultural da Sa��de consiste nos bens materiais e imateriais que expressam o processo da sa��de individual e coletiva nas suas dimens��es cient��fica, hist��rica e cultural. Com a inser����o do Brasil, atrav��s da COC-Fiocruz e do Minist��rio da Sa��de, na Rede Latino-americana de Patrim��nio Cultural da Sa��de, iniciou-se o incentivo ao estudo da hist��ria da medicina e da arquitetura hospitalar, buscando tamb��m a prote����o e a salvaguarda da mem��ria das edifica����es hospitalares hist��ricas. O s��culo XIX foi marcado pela constru����o de v��rias edifica����es voltadas para o controle e reclus��o dos pobres, essas institui����es eram: a Casa de Corre����o, a Santa Casa da Miseric��rdia, o Hosp��cio de Pedro II, o Asilo da Mendicidade e as Institui����es de acolhimento de Menores. Dessas edifica����es destacam-se a Santa Casa da Miseric��rdia, o Hosp��cio de Pedro II e o Asilo da Mendicidade que formam o Patrim��nio Arquitet��nico da Sa��de tombado em n��vel federal. O Hospital da Santa Casa da Miseric��rdia foi constru��do em 1840-1852 sob os modernos preceitos da medicina do s��culo XIX. A edifica����o at�� hoje mant��m o uso hospitalar e apresenta um estado de conserva����o bom em seu exterior. Por��m as condi����es internas foram consideradas ruins devido �� falta de salubridade e higiene nos ambientes. O Hospital da Santa Casa �� um Hospital de Refer��ncia, realiza atendimentos ambulatoriais, cir��rgicos e de interna����o. O Hosp��cio de Pedro II foi criado para atender exclusivamente os alienados do Imp��rio. O estilo neocl��ssico e a monumentalidade da edifica����o o fizeram ser reconhecido como Pal��cio dos Loucos. O hosp��cio funcionou at�� 1944 e quatro anos depois a edifica����o foi cedida �� Universidade do Brasil, que adaptou sua arquitetura ao uso educacional. A edifica����o apresenta estado de conserva����o regular, com exce����o da ��rea central composta pela Capela que est�� ruim, devido ao inc��ndio de 2011. O Pal��cio dos Loucos tornou-se Pal��cio Universit��rio, modificando sua identidade atrav��s das mudan��as que foram feitas em sua arquitetura. O Asilo da Mendicidade foi criado em 1876 para fechar o pent��gono asilar. A edifica����o pan��ptica buscava a efetiva observa����o e controle dos internos. A edifica����o funcionou como Asilo para mendigos at�� 1920, quando transformou-se em Hospital de S��o Francisco de Assis. Posteriormente o hospital seria transferido para a Universidade do Brasil, que funcionou como hospital escola at�� 1978. O Hospital foi desativado e ficou sem uso por dez anos, quando enfim voltou a funcionar como um estabelecimento destinado aos mais pobres. O conjunto da edifica����o �� o que apresenta o pior estado de conserva����o, considerado de ruim a p��ssimo. Comprovou-se com essa pesquisa que o mais importante para a preserva����o das caracter��sticas arquitet��nicas e art��sticas do bem �� a manuten����o do uso, seja ele qual for. Os novos usos devem ser adequados tamb��m ��s caracter��sticas e �� capacidade da arquitetura em quest��o. Atrav��s de reformas e planos adequados, os hospitais oitocentistas, que hoje se apresentam como Patrim��nio Arquitet��nico da Sa��de, podem manter um uso similar para o qual foi constru��do, como uma edifica����o voltada �� promo����o da sa��de da popula����o.

Relation of happiness, hope and affection with quality of life in patients with heart failure

Introduction: Meeting the actual role of positive psychology, begins to be recognized the relation of positive variables with health. Objective: To know the relation of happiness, hope and affection with quality of life in individuals with heart failure. Population and Methodology: 128 individuals with heart failure, 98 men and 30 women, 61.9��12,1 years of age, 6,6��3,9 years in school and 74,2% retired because of this disease. 56,3% were in Class III of New York Heart Association, with poor left ventricular ejection fraction (25,3��6,2%). The clinical history was of 9,4��8,5 years for this heart disease and had at least one hospitalization due to heart failure with 51,6% having ischemic heart disease.

Happiness, hope and affection as predictors of quality of life and functionality of individuals with heart failure at 3 month follow up

Introduction: Meeting the actual role of positive psychology, begins to be recognized the contribution of positive variables in health outcomes. Objective: To know the contribution of happiness, hope and affection individually and as a whole in the quality of life and functionality of individuals with heart failure. Population and Methodology: 128 individuals with heart failure, 98 men and 30 women, 61.9��12,1 years of age, 6,6��3,9 years of school and 74,2% retired because of this disease. 56,3% were in Class III of New York Heart Association, with poor left ventricular ejection fraction (25,3��6,2%). The clinical history was of 9,4��8,5 years for this heart disease and had at least one hospitalization due to heart failure with 51,6% having ischemic heart disease.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.

Monitoriza����o da insufici��ncia card��aca por par��metros fisiol��gicos em portadores de cardioversor-desfibrilhador implant��vel e/ou sistema de ressincroniza����o card��aca: HF-PREDICT

Mestrado em Tecnologia de Diagn��stico e Interven����o Cardiovascular. ��rea de especializa����o: Interven����o Cardiovascular.

Reabilita����o no internamento hospitalar: prospectiva na din��mica de actores - Implementa����o da governa����o cl��nica num hospital E.P.E.

Mestrado em Interven����o S��cio-Organizacional na Sa��de - ��rea de especializa����o: Pol��ticas de Administra����o e Gest��o de Servi��os de Sa��de.

Probabilistic linkage in household survey on hospital care usage

OBJECTIVE: To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. METHODS: A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. RESULTS: Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. CONCLUSIONS: The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.

Necessidades dos idosos do concelho da Praia da Vit��ria em cuidados continuados domicili��rios

Disserta����o de Mestrado em Gerontologia Social