773 resultados para Disclosure of Interventions


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Objective: Early mother-infant interactions are impaired in the context of infant cleft lip, and are associated with adverse child psychological outcomes, but the nature of these interaction difficulties is not yet fully understood. The aim of this study was to explore adult gaze behaviour and cuteness perception, which are particularly important during early social exchanges, in response to infants with cleft lip, in order to investigate potential foundations for the interaction difficulties seen in this population. Methods: Using an eye-tracker, eye movements were recorded as adult participants viewed images of infant faces with and without cleft lip. Participants also rated each infant on a scale of cuteness. Results: Participants fixated significantly longer on the mouths of infants with cleft lip, which occurred at the expense of fixation on eyes. Severity of cleft lip was associated with the strength of fixation bias, with participants looking even longer at the mouths of infants with the most severe clefts. Infants with cleft lip were rated as significantly less cute than unaffected infants. Men rated infants as less cute than women overall, but gave particularly low ratings to infants with cleft lip Conclusions: Results demonstrate that the limited disturbance in infant facial configuration of cleft lip can significantly alter adult gaze patterns and cuteness perception. Our findings could have important implications for early interactions, and may help in the development of interventions to foster healthy development in infants with cleft lip.

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A pesquisa avaliou o grau de disclosure da utilização de derivativos, por companhias abertas não-financeiras brasileiras. Dez "dimensões" dessa utilização foram analisadas, à luz principalmente do que dispõe a regulamentação americana sobre a matéria. Os resultados mostram que, em comparação com o que esta exige, o grau de disclosure da utilização de derivativos pelas empresas brasileiras deixa muito a desejar; nesse mister, as empresas com participação de capital estrangeiro não apresentam práticas de disclosure superiores às empresas simplesmente domésticas.

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In this paper we test whether the disclosure of test scores has direct impacts on student performance, school composition and school inputs. We take advantage of the discontinuity on the disclosure rules of The National Secondary Education Examination (ENEM) run in Brazil by the Ministry of Education: In 2006 it was established that the 2005 mean score results would be disclosed for schools with ten or more students who took the exam in the previous year. We use a regression discontinuity design to estimate the e ects of test disclosure. Our results indicate that private schools that had their average scores released in 2005 outperformed those that did not by 0.2-0.6 in 2007. We did not nd same results for public schools. Moreover, we did not nd evidence that treated schools adjusted their inputs or that there was major changes in the students composition of treated schools. These ndings allow us to interpret that the main mechanism driving the di erences in performance was the increased levels of students', teachers' and principals' e ort exerted by those in schools that had scores publicized.

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Foreign capital and institutional investors play a key role in the Brazilian capital and financial markets. Internationally promoted regulatory patterns, especially IOSCO principles, have been increasingly influencing administrative rule making by the Brazilian Securities and Exchange Commission (CVM) as well as the adoption of transnational rules in Brazil by means of self-regulatory activity. Even though there is a certain level of convergence of market regulatory standards at the transnational level, implementation and enforcement of rules remains essentially domestic. We analyze two case studies regarding the transposition of international standards into the Brazilian legal system, which illustrate this tension between the transnational and domestic dimensions of financial markets regulation. The first case concerns a CVM rule on disclosure of executive compensation and the its interpretation by local courts. The second case refers to the adoption of suitability rules.

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This paper examines whether access to information enhances political accountabil- ity. Based upon the results of Brazil's recent anti-corruption program that randomly audits municipal expenditures of federally-transferred funds, it estimates the e®ects of the disclosure of local government corruption practices upon the re-election success of incumbent mayors. Comparing municipalities audited before and after the elections, we show that the audit policy reduced the incumbent's likelihood of re-election by approximately 20 percent, and was more pronounced in municipalities with radio sta- tions. These ¯ndings highlight the value of information and the role of the media in reducing informational asymmetries in the political process.

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This paper explores the institutional change introduced by the public disclosure of an education development index (IDEB, Basic Education Development Index) in 2007 to identify the e ect of education accountability on yardstick competition in education spending for Brazilian municipalities. Our results are threefold. First, political incentives are pervasive in setting the education expenditures. The spatial strategic behavior on education spending is estimated lower for lame-ducks and for those incumbents with majority support at the city council. This suggests a strong relation between commitment and accountability which reinforces yardstick competition theory. Second, we nd a minor reduction (20%) in spatial interaction for public education spending after IDEB's disclosure | compared to the spatial correlation before the disclosure of the index. This suggests that public release of information may decrease the importance of the neighbors` counterpart information on voter`s decision. Third, exploring the discontinuity of IDEB`s disclosure rule around the cut-o of 30 students enrolled in the grade under assessment, our estimates suggest that the spatial autocorrelation | and hence yardstick competition | is reduced in 54%. Finally, an unforeseen result suggests that the disclosure of IDEB increases expenditures, more than 100% according to our estimates.

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TEMA: este trabalho teve como objetivo descrever o processo de intervenção fonoaudiológica em um caso de síndrome de Kabuki, com ênfase na terapia de linguagem. PROCEDIMENTOS: trata-se de relato de caso de uma criança de seis anos e seis meses de idade, gênero feminino, com diagnóstico de síndrome de Kabuki, que realizou terapia fonoaudiológica durante três anos em uma clínica-escola. Foi realizada análise documental dos dados do prontuário relativos à anamnese, avaliação e relatórios terapêuticos fonoaudiológicos, exames e avaliações multidisciplinares. Aos três anos e cinco meses, a criança passou por avaliação fonoaudiológica e apresentou, como histórico, características típicas da síndrome de Kabuki: alteração cardíaca, episódios de pneumonia, otite média secretora recorrente, alterações ortopédicas e crises convulsivas. Na avaliação fonoaudiológica, apresentou tempo de atenção auditiva e visual reduzido, dificuldade de compreensão oral, comunicação por meio de poucos gestos e vocalizações e problemas de comportamento. RESULTADOS: o processo terapêutico teve como objetivo principal promover o desenvolvimento da linguagem com ênfase na interação social por meio de atividades lúdicas, orientação familiar e escolar. Foi observada melhora na compreensão e emissão oral, no contato social e manutenção da atenção. CONCLUSÃO: este estudo permitiu divulgar o percurso de atuação fonoaudiológica na síndrome de Kabuki, do processo diagnóstico à terapia de linguagem. Verificou-se que a terapia foi eficaz no que se refere às habilidades comunicativas e de interação social. Esses dados podem contribuir para elucidar lacunas existentes na literatura acerca da terapia fonoaudiológica na síndrome em questão e subsidiar intervenções clínicas nesses casos.

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Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

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PURPOSE: Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS: We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS: As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention´s effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS: Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient´s wishes and circumstances in the absence of high-quality primary studies. It´s not a replacement for the gold standard randomized clinical trial, but an alternative analysis for clinical research.

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A low rate of physical activity (PA) participation is observed worldwide. The identification of feasible and reliable instruments able to accurately measuring PA and help in the development of interventions to promote PA are necessary. This study aimed to analyze the concordance between the Stages of Behavior Change Questionnaire (SBCQ) and the International Physical Activity Questionnaire (IPAQ long-version) in assessing adult leisure-time physical activity (LTPA). A total of 1.588 adults completed the IPAQ to assess LTPA and the participants who performed more than 10 min/week were classified in active individuals. Using the SBCQ, active individuals were those classified in the action or maintenance stage and inactive individuals were those classified in the precontemplation, contemplation or preparation stage. The concordance between SBCQ and IPAQ was found to be 0.80. Separated by gender, it was observed a concordance between the two instruments of 0.82 for women, and 0.77 for men. Regarding age group, it was found to be 0.81 for young and middle-aged adults, and 0.77 for older people. The SBCQ presented a very good concordance with IPAQ to assess LTPA.

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The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.

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Aim. The aim of this study was to evaluate the internal reliability and validity of the BrazilianPortuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. Background. Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. Design. Methodological and cross-sectional research design. Methods. The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The BrazilianPortuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbachs alpha). Results. A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r = -0.47, p < 0.01), Vitality (r = -0.44, p < 0.01) and Mental health (r = -0.42, p < 0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r = -0.375, p < 0.01) (Known groups). The Cronbachs alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)0.46 (psychological impact) among the domains, confirming the internal consistency reliability. Conclusions. The BrazilianPortuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. Relevance to clinical practice. Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

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OBJECTIVE: To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS: A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS: During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, p<0.001], systolic blood pressure [-4.6(17.9) vs. 1.8(4.3) mmHg per year, p<0.001], 2-hour plasma glucose [-1.2(2.1) vs. -0.2(0.6) mmol/L per year, p<0.001], LDL-cholesterol [-0.3(0.9) vs. -0.1(0.2) mmol/L per year, p<0.001] and Framingham coronary heart disease risk score [-0.25(3.03) vs. 0.11(0.66) per year, p=0.02] but not in triglycerides [0.2(1.6) vs. 0.1(0.42) mmol/L per year, p<0.001], and fasting insulin level [1.2(5.8) vs. -0.7(2.2) IU/mL per year, p<0.001] compared with the pre-intervention period. Significant reductions in the prevalence of impaired fasting glucose/impaired glucose tolerance and diabetes were seen during the intervention (from 58.4% to 35.4%, p<0.001; and from 30.1% to 21.7%, p= 0.004, respectively). CONCLUSIONS: A one-year community-based health promotion program brings cardiometabolic benefits in a high-risk population of Japanese-Brazilians.