Neurodevelopmental outcome of neonates treated with nitric oxide for persistent pulmonary hypertension

Persistent pulmonary hypertension of the newborn (PPHN) is a life threatening condition associated with an increased risk of neurodevelopmental impairment. The recommended treatment for this condition is inhaled nitric oxide (iNO) and has been used in our Neonatal Intensive Care Unit since 1998. We prospectively offered neurodevelopmental follow-up to children treated with iNO for PPHN, including extensive neurological evaluation, developmental/cognitive evaluation at 18 months and 3.5-5 years old, and evaluated the rate of severe and moderate handicap and normal neurodevelopmental outcome, compared to a control group and the literature. Population consisted of 29 patients treated only with iNO, born between 01.01.1999 and 31.12.2005 (study group), and 32 healthy term infants born in 1998 in our maternity (control group). During those seven years, 65 infants were admitted in our Unit with PPHN, of whom 40 were treated with iNO alone. 34 children survived (85%) and were offered neurodevelopmental follow-up, 7 children were lost to follow-up due to various reasons. 22 children were examined at the age of 18 months (76%) with a rate of moderate handicap of 22% (2 with expressive language delay, 2 with difficult behavior, and 1 child with moderate hearing loss), and a rate of major handicap of 4.5% (1 child with cerebral palsy due to perinatal stroke, and moderate hearing loss). At preschool age, 17 (50%) were examined, the rate of moderate handicap was 22% (4 borderline intelligence, 1 hearing loss), and the rate of major handicap was 4.5% (one child with cerebral palsy and hearing loss), compared to 26.9% and 0% in the control group. Mean developmental quotient at 18 months was 100.3 ± 8.7 (control group 118.3), and at preschool age mean cognitive indices were within normal limits for the 2 tests performed at 3.5 or 5 years (108 ± 21, 94.4 ± 17). Most of the children with a less favorable neurodevelopmental outcome suffered from birth asphyxia (ruptured uterus, placental abruption, maternal hypotension, diabetic cardiomyopathy), and notably, the 2 children with sensorineural hearing loss both suffered from severe hypoxic-ischemic enkelopathy. Treatment with iNO was not the direct cause of the neurodevelopmental impairments observed in children treated for PPHN.

Impact du genre et du modèle sur les mécanismes d’épileptogénèse dans le cerveau immature

Les modèles kainate et pentylènetétrazole représentent deux modèles d’épilepsie du lobe temporal dont les conséquences à long terme sont différentes. Le premier est un modèle classique d’épileptogénèse avec crises récurrentes spontanées tandis que le second se limite aux crises aigües. Nous avons d’abord caractérisé les différents changements survenant dans les circuits excitateurs et inhibiteurs de l’hippocampe adulte de rats ayant subi des crises à l’âge immature. Ensuite, ayant observé dans le modèle fébrile une différence du pronostic lié au genre, nous avons voulu savoir si cette différence était aussi présente dans des modèles utilisant des neurotoxines. L’étude électrophysiologique a démontré que les rats KA et PTZ, mâles comme femelles, présentaient une hyperactivité des récepteurs NMDA au niveau des cellules pyramidales du CA1, CA3 et DG. Les modifications anatomiques sous-tendant cette hyperexcitabilité ont été étudiées et les résultats ont montré une perte sélective des interneurones GABAergiques contenant la parvalbumine dans les couches O/A du CA1 des mâles KA et PTZ. Chez les femelles, seul le DG était légèrement affecté pour les PTZ tandis que les KA présentaient, en plus du DG, des pertes importantes au niveau de la couche O/A. Les évaluations cognitives ont démontré que seuls les rats PTZ accusaient un déficit spatial puisque les rats KA présentaient un apprentissage comparable aux rats normaux. Cependant, encore une fois, cette différence n’était présente que chez les mâles. Ainsi, nos résultats confirment qu’il y a des différences liées au genre dans les conséquences des convulsions lorsqu’elles surviennent chez l’animal immature.

Influência da idade, do sexo e da hora do dia no desempenho em teste de labirinto

The increase of elderly population in the world and in Brazil has indicated the necessity of health systems capable to evaluate, to diagnose and to intervene in the conditions of health and disease of that segment. During that stage of human development, physical and cognitive changes happen and they are capable to influence the functional acting. It s important to distinguish the limit between the normal and the pathological. Besides the common changes during the aging, biological rhithmicity changes happen, as alterations in the cycle vigil-sleep that can influence in certain tasks performance. This study aimed to verify the influence of the age, of the sex and of the hour in a maze test performance. Eighty individuals were evaluated, 40 youths (20 men and 20 women) and 40 senior (20 men and 20 women). They were separated in 2 different groups that were tested at 9:00 o clock and at 15:00 o clock. Initially they were submitted to health evaluation, cognitive evaluation and of sleep quality and chronotype. They were instructed to accomplish the maze test whose time of execution was timed and registered. Significant differences were observed according to age for the masculine group between elderly in the morning and in the afternoon and in the feminine group between youth and elderly in the test accomplished in the morning and in the afternoon. Significant differences were not observed according to sex and hour of the day and also between attempts. In compare between the 30th and the31st, accomplished in a 15minutes of interval, significant difference was observed just for the elderly group in the morning and in the afternoon. We observed significant correlations in the maze test performance with the cronotype, with the age, with the education and with the cognitive acting. The maze test was capable to detect differences between age in the acting profile and in the evaluation of the information maintenance after 15 minutes, however it was not possible to verify difference between sex and hour of the day. Finally the correlations of the maze test with another varied may indicate your importance as coadjutant instrument in those functions evaluation

Síndrome de crouzon: fatores envolvidos no desenvolvimento neuropsicologico e na qualidade de vida

A síndrome de Crouzon é caracterizada por deformidade craniana, alterações faciais e exoftalmia. O retardo no desenvolvimento neuropsicomotor é observado em alguns casos. Este estudo tem como objetivo analisar a influência do momento da cirurgia, da classe sócio-econômica associada ao nível educacional dos pais e da ocorrência de malformações do sistema nervoso central no desenvolvimento cognitivo destes pacientes correlacionando estes achados à qualidade de vida deles e de suas famílias. Foram estudados 11 pacientes com diagnóstico de síndrome de Crouzon com idade entre um ano e quatro meses e treze anos. A avaliação multidisciplinar dos pacientes incluiu, avaliação social, avaliação cognitiva, estudo do encéfalo por ressonância magnética e avaliação da qualidade de vida. O quociente de inteligência variou de 46 a 102 (m=84,2) e foi correlacionado de forma inversa com o Fator 4 do Questionário de Recursos e Estresse Simplificado (incapacidade da criança); não se correlacionou com as alterações encefálicas, com a condição sócio-econômica dos pais e nem com o momento do tratamento neurocirúrgico.

Contribuições da educação permanente para avaliação docente da prática profissional do estudante de medicina

Pós-graduação em Educação - FFC

Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage

BACKGROUND Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies. METHODS A MEDLINE analysis was performed using the search term "subarachnoid haemorrhage outcome". The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed. RESULTS A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used. CONCLUSION Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.

Leader-member exchange and attitudes:a theoretical and empirical integration

The central proposition of this thesis is that there are key benefits to examining leadership perceptions as an attitude towards the leader. In particular, it is argued that doing so can provide an enhanced understanding of leadership perceptions and therefore advance theory in this area. To provide empirical support for this theoretcial integration, the current research focused on one of the most popular leadership theories, leader-member exchange (LMX), and demonstrated how the concept of attitude strength could advance understanding of how and when LMX influenced employee job performance. Although the measurement of LMX requires employees to provide a cognitive evaluation of their relationship with their leader, previous research has, to date, not considered this evaluation to be an attitude. This thesis provides a justification for doing so and develops two novel constructs: LMX importance and LMX ambivalence. Both of these variables are argued to represent previously unconsidered facets of the LMX relationship, which, according to attitude theory, provide a more multifaceted understanding of leadership perceptions than previously envisaged. Such an understanding can provide a more detailed understanding of how such perceptions influence outcomes. Two studies provided an empirical test of the above reasoning. Study 1, a longitudinal field study, demonstrated initial support for many of the hypotheses. LMX amivalence was shown to lead to poorer task performance and organisational citizenship behaviour, mediated by the experience of negative affect. Evidence was also found for the moderating effect of LMX importance, although felt obligations was not found to mediate this moderated effect. While Study 1 used project groups as its participants, Study 2 provided a first test of the construct in an organisational setting; with three companies proving data. Again, strong support was found for the negative effects of LMX ambivalence on employee outcomes, with evidence also found for the role of perceived organisational support in mitigating these negative effects. Support was also found for the moderated mediation hypothesis related to LMX importance, although this was only found in the largest organisation sample. Some of the main theoretical and methodological implications of viewing leadership perceptions as attitudes to the wider leadership area were discussed. The cross-fertilisation of research from the attitudes literature to understanding leadership perceptions provides new insights into leadership processes and potential avenues for further research.

Fatores psicológicos preditores do grau de funcionalidade em idosos

A velhice pode estar associada ao sofrimento, aumento da dependência física, declínio funcional, isolamento social, depressão e improdutividade. No envelhecimento observam-se lentificação no processamento cognitivo, redução da atenção, dificuldades na retenção das informações aprendidas (memória de trabalho) e diminuição na velocidade de pensamento e habilidades visuoespaciais. Por outro lado, as que se mantêm inalteradas são: inteligência verbal, atenção básica, habilidade de cálculo e a maioria das habilidades de linguagem (Moraes, Moraes & Lima, 2010). O objetivo deste estudo é comparar funções executivas com grau de funcionalidade para averiguar em que medida estas variáveis predizem funcionalidade. Trinta idosos de três valências diferentes constituíram a amostra deste estudo. Os instrumentos de avaliação administrados foram os seguintes: Escala de Barthel, MontrealCognitiveAssessment (MoCA), Trail Making Test (TMT), Teste de Aprendizagem Audio-Verbal de Rey (RAVLT), Figura Complexa de Rey, Teste Stroop de Cores e Palavras (TSCP), DigitSpan, Escala Geriátrica de Depressão. Dos resultados obtidos destacam-se a existência de relações estatisticamente significativas entre a saúde mental e a funcionalidade. Quanto melhor é a saúde mental, maior é o grau de funcionalidade e os participantes do “Domicílio” possuem melhor saúde mental, atenção, planeamento e construção visuo-espacial do que os do “Centro de Dia”, e estes melhor do que os do “Lar”. A Organização Mundial de Saúde (OMS) destaca a capacidade funcional e a independência como fatores preponderantes para o diagnóstico de saúde física e mental na população idosa. Alguns autores indicam que a avaliação cognitiva deve ser sempre acompanhada de uma avaliação funcional e vice-versa.

Utilização de pescado na elaboração de produto destinado à merenda escolar

O pescado é considerado um alimento de grande valor nutricional presente na dieta, devido a sua elevada qualidade proteica. O consumo desta importante fonte proteica ainda não faz parte da rotina da população brasileira. Para tanto, o governo busca alternativas para mudança desta realidade. O desenvolvimento e introdução de produtos a base de pescado na merenda escolar vem sendo indicados como uma solução estratégica para inserir este alimento na dieta da população. Nesse sentido, este trabalho teve por objetivo elaborar produto a base de anchoita (Engraulis anchoita) e verificar sua aceitação junto à rede pública de ensino, visando um futuro aumento do consumo de pescado. A matériaprima utilizada foi à espécie anchoita (Engraulis anchoita), capturada através de cruzeiros realizados pelo navio oceanográfico Atlântico Sul, da Universidade Federal do Rio Grande (FURG). O desenvolvimento do trabalho gerou três artigos. O primeiro artigo intitulou-se “Elaboração de almôndegas utilizando como matéria-prima anchoita (Engraulis anchoita)”. O objetivo do trabalho foi formular almôndegas à base de carne de pescado (Engraulis anchoita) e caracteriza-las quanto à composição proximal e aminoacídica. Foi verificado que em torno de 160 gramas do produto elaborado atende às necessidades aminoacídicas estipuladas pela FAO, para um adulto. Os resultados indicaram que o produto elaborado está de acordo com padrão de identidade estabelecido pela legislação brasileira. No segundo artigo “Capacitação de merendeiras na elaboração de produtos de pescado” o objetivo foi promover a capacitação de merendeiras na elaboração de produtos de pescado. Uma análise sobre comportamento, intenção do comportamento e atitude frente ao consumo de pescado, foi realizada. Além disso, também foi realizada uma avaliação sobre a percepção cognitiva das merendeiras em relação a segurança alimentar, antes e após o treinamento. Com relação ao comportamento, os resultados demonstraram que a população estudada apresentou a intenção de comer pescado, no entanto, não apresentou o comportamento de consumo. Os resultados de avaliação cognitiva e segurança alimentar demonstraram que o desenvolvimento do curso foi satisfatório, uma vez que novas percepções e conhecimentos sobre segurança alimentar foram adquiridos pelas merendeiras. O terceiro artigo “Respostas hedônicas e associação de palavras para melhor compreensão da aceitação de produtos de pescado na merenda escolar” teve como objetivo avaliar a aceitação de almôndega de pescado (Engraulis anchoita) junto à merenda escolar de uma escola da rede pública de ensino. Os resultados demonstraram que a idade e aceitação obedecem a uma relação inversa na aceitação de produtos de pescado. A avaliação cognitiva possibilitou identificar que as percepções que melhor explicam a aceitação das almôndegas de pescado pelos escolares estão relacionadas com os atributos hedônicos e sensoriais do produto. Em suma, o desenvolvimento dessa dissertação demonstrou que a elaboração de almôndegas de pescado (Engraulis anchoita) destinadas à merenda escolar surge como uma importante ferramenta para impulsionar a inserção do pescado na merenda escolar e contribuir para uma educação alimentar quanto ao consumo de pescado.

Narrativa transmedia y percepción cognitiva en El Ministerio del Tiempo (TVE)

Introducción: En el presente trabajo se analiza la serie de ficción de TVE El Ministerio del Tiempo con el objetivo de determinar si el mayor conocimiento de la serie de ficción, el uso de las redes sociales y los recursos multimedia modifican la percepción del espectador. Metodología: Se procedió a realizar un trabajo de campo compuesto por 124 observadores a los que se les ha aplicado la escala EDI (Escala de identificación con los personajes). Resultados: Se concluye que un mayor conocimiento de la serie y el uso de las propuestas transmedia produce una mayor identificación con los personajes de ficción, aunque solo en los ítems que definen una mayor carga emocional o sentimental. Discusión: Lo anterior evidencia sin embargo, que no es aplicable a la evaluación cognitiva de aquellos espectadores más fieles a la serie. Conclusiones: Con los resultados obtenidos es posible afirmar que los contenidos transmedia se suceden en la percepción de los observadores desde lo racional a lo emocional. El conocimiento previo de la serie y el uso de las propuestas transmedia alarga la relación con lo visionado más allá del disfrute ocasional.

METODOLOGÍA PARA LA GESTIÓN DE CUENCAS HIDROGRÁFICAS SIGUIENDO EL ENFOQUE DEL RIESGO INTEGRAL

Se presenta metodología general del enfoque de riesgo a través de la tecnología de los Sistemas de Información Geográfcos, la evolución de los conceptos del enfoque integral de riesgo como apoyo a la Gestión de las Cuencas Hidrográfcas y su evolución. Mediante ejemplos de proyectos realizados con base en una metodología integradora en la variable de riesgo, que es útil, para realizar un ordenamiento integral de los recursos ambientales (biofísicos, socioeconómico-culturales) a nivel de la Cuenca Hidrográfca.El grado de riesgo se determina, partiendo de que el riesgo se entiende como una evaluación cognoscitiva de las pérdidas que pueden ocurrirle a un elemento expuesto, de acuerdo con sus características, su situación y un contexto particular de tiempo y de espacio, el análisis, cuantifca espacialmente el grado de riesgo, utilizando la tecnología SIG.El modelo general de ordenamiento territorial con énfasis en prevención en el que se considere el riesgo como una función de la amenaza y de la vulnerabilidad, esto es, r = f(A,V) Finalmente, se  introduce  la evolución de  los conceptos con el aporte de  los escenarios de amenazas y el manejo de la vulnerabilidad socioeconómica que permite aplicar el enfoque de riesgo integral, por medio de la tecnología SIG.Palabras claves: Amenaza, vulnerabilidad, riesgo, manejo integrado de recursos naturales,ordenamiento territorial, Sistemas de Información Geográfcos.Abstract General methodology of focusing on risk is presented through the technology of the Geographic Information System (GIS), the evolution of the concepts of the integral focus of risk as a support to the management of Hydrographic Watershed and its evolution.Through  examples of  completed projects,  an  integrative methodology  is made of  the  risk variable that is useful to achieving an integral ordering of the environmental resources (biophysics, socioeconomic-cultural) at the Hydrographic Watershed level.The risk degree is determined, starting form the premise that the risk can be understood as a cognitive evaluation from the losses that can happen to an exposed element, according to their characteristics, situation and a particular context of time and space, the quantifed analysis, especially of the degree of risk, using GIS technology.The general model of territorial ordering, with emphasis on prevention and what is considered the risk as a function of the hazard and the vulnerability, that is: r = f(A, V).Finally, evolution of the concepts is introduced, with the contribution of the hazard scenarios and management of the socioeconomic vulnerability that allows application of the risk focus, by GIS technology.Key words: hazards, vulnerability, risk, integrated management of natural resources, territorial ordering, GIS, Geographic Information Systems.

Cognitive functioning in subjects with recent-onset psychosis from a low-middle-income environment: Multiple-domain deficits and longitudinal evaluation

Cognitive deficits are a key feature of recent-onset psychosis, but there is no consensus on whether such deficits are generalized or confined to specific domains. Besides, it is unclear whether cognitive deficits: a) are found in psychotic patients in samples from outside high-income countries; and b) whether they progress uniformly over time in schizophrenia and affective psychoses. We applied 12 tests organized into eight cognitive domains, comparing psychosis patients (n = 56, time from initial contact = 677.95+/-183.27 days) versus healthy controls (n = 70) recruited from the same area of Sao Paulo, Brazil. Longitudinal comparisons (digit span and verbal fluency) were conducted between a previous assessment of the subjects carried out at their psychosis onset, and the current follow-up evaluation. Psychosis patients differed significantly from controls on five domains, most prominently on verbal memory. Cognitive deficits remained detectable in separate comparisons of the schizophrenia subgroup and, to a lesser extent, the affective psychosis subjects against controls. Longitudinal comparisons indicated significant improvement in schizophrenia, affective psychoses, and control subjects, with no significant group-by-time interactions. Our results reinforce the view that there are generalized cognitive deficits in association with recent-onset psychoses, particularly of non-affective nature, which persist over time. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Evaluation of a summary score of cognitive performance for use in trials in perioperative and critical care.

Background/Aims: Cognitive dysfunction after medical treatment is increasingly being recognized. Studies on this topic require repeated cognitive testing within a short time. However, with repeated testing, practice effects must be expected. We quantified practice effects in a demographically corrected summary score of a neuropsychological test battery repeatedly administered to healthy elderly volunteers. Methods: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Assessment Battery (for which a demographically corrected summary score was developed), phonemic fluency tests, and trail-making tests were administered in healthy volunteers aged 65 years or older on days 0, 7, and 90. This battery allows calculation of a demographically adjusted continuous summary score. Results: Significant practice effects were observed in the CERAD total score and in the word list (learning and recall) subtest. Based on these volunteer data, we developed a threshold for diagnosis of postoperative cognitive dysfunction (POCD) with the CERAD total score. Conclusion: Practice effects with repeated administration of neuropsychological tests must be accounted for in the interpretation of such tests. Ignoring practice effects may lead to an underestimation of POCD. The usefulness of the proposed demographically adjusted continuous score for cognitive function will have to be tested prospectively in patients.

An evaluation of volume-based morphometry for prediction of mild cognitive impairment and Alzheimer's disease.

Voxel-based morphometry from conventional T1-weighted images has proved effective to quantify Alzheimer's disease (AD) related brain atrophy and to enable fairly accurate automated classification of AD patients, mild cognitive impaired patients (MCI) and elderly controls. Little is known, however, about the classification power of volume-based morphometry, where features of interest consist of a few brain structure volumes (e.g. hippocampi, lobes, ventricles) as opposed to hundreds of thousands of voxel-wise gray matter concentrations. In this work, we experimentally evaluate two distinct volume-based morphometry algorithms (FreeSurfer and an in-house algorithm called MorphoBox) for automatic disease classification on a standardized data set from the Alzheimer's Disease Neuroimaging Initiative. Results indicate that both algorithms achieve classification accuracy comparable to the conventional whole-brain voxel-based morphometry pipeline using SPM for AD vs elderly controls and MCI vs controls, and higher accuracy for classification of AD vs MCI and early vs late AD converters, thereby demonstrating the potential of volume-based morphometry to assist diagnosis of mild cognitive impairment and Alzheimer's disease.