Predictors of physiotherapy and occupational therapy use two years after a vocational rehabilitation for orthopaedic trauma

Introduction.- Health care utilization is an important field of our economy. Nevertheless a minority of cases induce the majority of costs. For instance, in the setting of accident insurance, the most expensive 5% of all injured cases involve 80% of the health care costs. Although physiotherapy and occupational therapy consist of only a small proportion of these costs, it is nevertheless important to evaluate the factors that predict its use in order to improve services (i.e. allocation of resources to those who need them and benefit most).Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 consecutively included patients with orthopaedic problems attending the clinique Romande de réadaptation (CRR) at Sion for inpatient rehabilitation after a work, traffic or leisure related injury. Two years after discharge, a questionnaire regarding the use of different health cares was send to the patients (1502 patients returned their questionnaires). The aim of this study was to calculate, with a logistic multivariate model, in-patient hospitalized for orthopaedic problems, the variables that mostly predict physiotherapy use 2 years after discharge.Results.- The full multivariate model contains 46 predictors. The use of physiotherapy and occupational therapy was significantly predicted in this multivariate model by the following predictors: Patients with a spinal problem (OR 1.51 versus lower-extremity problem, 95% CI 1.01 to 2.27), a disability pension (OR 1.69, 95% CI 1.09 to 2.60), patients with sports activities (OR 1.56, 95% CI 1.26 to 1.94), patients with longer stay at the rehabilitation clinic (OR 1.22 per week, 95% CI 1.05 to 1.41), women (OR 1.64, 95% CI 1.09 to 2.48) and those consulting a psychiatrist (OR 1.66, 95% CI 1.06 to 2.60).Discussion.- In this prospective study with a 2-year follow-up, different factors predicted the use of physiotherapy and occupational therapy after an injury. Further studies are needed to clarify the impact of these factors for the health care utilization and the strategies, which would allow to improve allocation of available resources.

Caracterização molecular de populações do nematóide-de-cisto-da-soja com diferentes índices de parasitismo na cultivar Hartwig

Recentemente, foi descoberta uma raça do nematóide-de-cisto-da-soja (NCS; Heterodera glycines) que apresentou a capacidade de quebrar a resistência da cultivar Hartwig, até então considerada resistente a todas as raças conhecidas do nematóide. Essa população foi coletada no Município de Sorriso, Estado do Mato Grosso, e foi caracterizada como raça 4. Para verificar a diversidade genética entre esta e outras populações pertencentes às raças 4 e 9, foi feita uma caracterização molecular pela técnica de marcadores moleculares RAPD. Foram utilizadas nove populações do NCS, das quais quatro apresentavam a capacidade de parasitar 'Hartwig'. Foi verificado que as populações capazes de parasitar 'Hartwig' foram bastante diferentes das demais. Por meio de análise de agrupamento, com base nas distâncias genéticas encontradas, foram obtidos três grupos: o primeiro, constituído por indivíduos classificados como raça 4, mas que não parasitam 'Hartwig'; o segundo, constituído por quatro populações capazes de parasitar 'Hartwig', e o terceiro, por apenas uma população, classificado como raça 9, e que também não parasita 'Hartwig'. Este estudo confirmou que a população de NCS, encontrada em Sorriso, é geneticamente distinta das demais populações da raça 4 encontradas e constitui uma nova raça, denominada 4+.

Cerebral perfusion CT in the evaluation of children with severe head trauma : 12.06

Purpose: To assess the value of cerebral perfusion CT (PCT) in children with traumatic brain injury in prediciting their consecutive clinical outcome. Materials and methods: Twelve paediatric patients with acute traumatic brain injury underwent cerebral CT coupled with PCT during their admission at the emergency room (ER). PCT maps were reviewed for mean transit time (MTT), regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) abnormalities. PCT results were compared to short- and mid-term clinical outcome. Results: 3 patients with low Glasgow Coma Scale (GCS) (98) and bad clinical outcome showed an increased MTT and decreased rCBV and rCBF. 5 patients with low GCS and good clinical outcome showed an increased MTT without abnormalities of rCBV and rCBF. In patients with GCS 08 and good outcome, PCT maps were normal in 2 cases; transient PCT abnormalities were identified in one case with an embedded fracture of the skull and in one case with an epileptic seizure. Conclusion: Cerebral PCT can identify diffuse abnormalities of cerebral perfusion in children with traumatic brain injury showing a low initial GCS and a bad outcome. PCT can be a valuable tool to predict the severity of the prognosis of these patients as soon as they are evaluated by CT-scan during their admission at the ER.

INTERMED predicts non-return to work in an occupational rehabilitation setting for individuals with orthopaedic trauma-part 2

Introduction.- The model presented in part I (19 predictors) had good predictive values for non-return to work 2 years after vocational rehabilitation for orthopaedic trauma. However, the number of predictors is high for the detection of patients at risk in a clinic. For example, the INTERMED for itself consists of 20 questions and needs 20 minutes to be filled in. For this reason, the aim of this study was to compare the predictive value of different models for the prediction of non-return to work.Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 included inpatients with orthopaedic trauma attending a rehabilitation hospital after a work, traffic, sport or leisure related injury. Two years after discharge, 1502 patients returned a questionnaire regarding return to work. We compared the area under the receiver-operator-characteristics curve (ROC) between different models: INTERMED total score, the 4 partial INTERMED scores, the items of the most predictive partial score; with or without confounders.Results.- The ROC for the total score of the INTERMED plus the five confounders of the of the part one (qualified work, speaking French, lesion of upper extremity, education and age) was 0.72. The sole partial INTERMED score to predict return to work was the social sub score. The ROC for the five items of the latter sub score of the INTERMED was 0.69. The ROC for the five items of the social subscale of the INTERMED combined with five predictors was 0.73. This was significantly better than the use of only the five items from INTERMED alone (delta 0.034; 95% CI 0.017 to .050). The model presented in part I (INTERMED total score plus 18 predictors) was not significantly better than the five items INTERMED social score plus five confounders.Discussion.- The use of a model with ten variables (INTERMED social five items plus five confounders) has good predictive value to detect patients not returning to work after vocational rehabilitation after orthopaedic trauma. The parsimony of this model facilitates its use in a clinic for the detection of patients at risk.

Smart suction device for less blood trauma: a comparison with Cell Saver.

OBJECTIVE: The major source of hemolysis during cardiopulmonary bypass remains the cardiotomy suction and is primarily due to the interaction between air and blood. The Smart suction system involves an automatically controlled aspiration designed to avoid the mixture of blood with air. This study was set-up to compare this recently designed suction system to a Cell Saver system in order to investigate their effects on blood elements during prolonged intrathoracic aspiration. METHODS: In a calf model (n=10; mean weight, 69.3+/-4.5 kg), a standardized hole was created in the right atrium allowing a blood loss of 100 ml/min, with a suction cannula placed into the chest cavity into a fixed position during 6 h. The blood was continuously aspirated either with the Smart suction system (five animals) or the Cell Saver system (five animals). Blood samples were taken hourly for blood cell counts and biochemistry. RESULTS: In the Smart suction group, red cell count, plasma protein and free hemoglobin levels remained stable, while platelet count exhibited a significant drop from the fifth hour onwards (prebypass: 683+/-201*10(9)/l, 5 h: 280+/-142*10(9)/l, P=0.046). In the Cell Saver group, there was a significant drop of the red cell count from the third hour onwards (prebypass: 8.6+/-0.9*10(12)/l, 6 h: 6.3+/-0.4*10(12)/l, P=0.02), of the platelet count from the first hour onwards (prebypass: 630+/-97*10(9)/l, 1 h: 224+/-75*10(9)/l, P<0.01), and of the plasma protein level from the first hour onwards (prebypass: 61.7+/-0.6 g/l, 1 h: 29.3+/-9.1 g/l, P<0.01). CONCLUSIONS: In this experimental set-up, the Smart suction system avoids damage to red cells and affects platelet count less than the Cell Saver system which induces important blood cell destruction, as any suction device mixing air and blood, as well as severe hypoproteinemia with its metabolic, clotting and hemodynamic consequences.

Predição de ganho genético com diferentes índices de seleção no milho pipoca CMS-43

O melhoramento simultâneo da capacidade de expansão e da produtividade no milho pipoca são dificultados por causa da correlação negativa entre as duas características, mas o uso de índices de seleção permite contornar essa dificuldade. Em 1997/1998 foram avaliadas 166 famílias de meios-irmãos do composto de milho pipoca (Zea mays L.) CMS-43, na Embrapa-Centro Nacional de Pesquisa de Milho e Sorgo, em Sete Lagoas, MG, no delineamento em blocos casualizados. Os índices de seleção empregados para predizer os ganhos por seleção foram os de Smith e Hazel, Pesek & Baker, Elston e de Williams. O índice de seleção de Smith e Hazel permitiu a predição de ganhos superiores em maior número de caracteres; com o índice de seleção de Williams não se verificou nenhum dado significativo. O uso de índices de seleção é adequado porque permite a predição de ganhos simultâneos nas duas principais características.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

valiação de métodos geoestatísticos na espacialização de índices agrometeorológicos para definir riscos climáticos

A definição das melhores datas para plantio de milho, adotadas no Zoneamento de Riscos Climáticos do Estado de São Paulo, é baseada nas variações espaço-temporais do índice de satisfação das necessidades de água da planta (ISNA), sendo a média ponderada o método de interpolação utilizado na espacialização deste parâmetro. Este método não considera a propagação espacial do erro da estimativa, o que permite interpretações imprecisas sobre as melhores datas de plantio, principalmente nas situações de início e de final do ciclo. O objetivo deste trabalho foi comparar métodos de espacialização de valores numéricos dos índices agrometeorológicos e avaliar sua variação espacial. Foram utilizados os métodos da média ponderada, krigagem ordinária e krigagem por indicação. A krigagem por indicação foi o método mais apropriado para espacializar o índice ISNA e definir a melhor data de plantio do milho.

Índices para avaliar qualidade pós-colheita de goiabas em diferentes estádios de maturação

O objetivo deste trabalho foi determinar índices de maturação adequados para avaliar a influência dos estádios de maturação nas transformações físico-químicas após a colheita de goiabas (Psidium guajava cv. Pedro Sato). Frutos colhidos nos estádios de maturação, segundo a cor da casca (1: verde-escura, 2: verde-clara e 3: verde-amarela), foram armazenados a 25±1ºC e 80±5% UR e avaliados quanto às transformações físicas e químicas e percentual de podridão. No momento da colheita, a cor da casca, a firmeza da polpa e a relação sólidos solúveis totais/acidez total titulável apresentaram diferenças significativas entre os três estádios de maturação. Durante o amadurecimento, as transformações físico-químicas foram semelhantes entre os estádios de maturação. O período máximo de viabilidade do fruto para comercialização foi de dois, quatro e seis dias após a colheita, nos estádios 3, 2 e 1, respectivamente. Os teores de sólidos solúveis totais, acidez total titulável e ácido ascórbico apresentaram baixo coeficiente de correlação com as variáveis estudadas. A cor da casca, a firmeza da polpa e a relação sólidos solúveis totais/acidez total titulável foram considerados índices de maturação adequados para a goiaba 'Pedro Sato'.

Comparação de métodos de determinação da gravidade específica de ovos de poedeiras comerciais

O objetivo deste trabalho foi avaliar um aparelho desenvolvido para a determinação da gravidade específica (GE) do ovo em água, comparando-o ao método de imersão em solução salina. Foram coletados 200 ovos de duas linhagens de poedeiras comerciais, divididos ao acaso em dois grupos de 50 ovos por linhagem e submetidos a duas seqüências de determinação da GE. Não foram observadas diferenças significativas entre os métodos utilizados. A determinação da GE dos ovos utilizando o aparelho desenvolvido pode ser realizada com a mesma precisão da determinação em solução salina.

Lésions traumatiques rachidiennes et indications au traitement chirurgical [Surgical indications in spinal trauma]

Surgical indications in spinal trauma remain a controversial topic. In general, unstable cervical injuries such as displaced odontoid fractures, burst fractures or tear drop fractures require surgical intervention. Thoracolumbar compression injuries without posterior wall involvement or significant kyphosis can be treated conservatively. Surgery is indicated in fractures-dislocations and burst fractures with significant canal narrowing and/or major kyphosis. The role of emergency decompression as well as that of steroids remain uncertain since no study to date has convincingly proven their efficacy.

Índices de estacionalidad de los precios medios recibidos por los productores de manzanas chilenas

El objetivo de este trabajo fue analizar el comportamiento de los precios medios FOB (franco a bordo) de manzanas frescas chilenas. A partir de este análisis, se estimaron los precios medios recibidos por los productores. Se estimaron patrones de estacionalidad ajustada de los precios recibidos por los productores de manzanas chilenas, a través del método del promedio geométrico móvil. Para las estimaciones se consideraron los precios FOB promedio mensuales desde enero de 1990 a septiembre de 2004. Los resultados mostraron: una baja estacionalidad de precios; una estabilidad de precios para junio y desde septiembre a diciembre; un valor máximo en julio. Los precios más bajos ocurrieron en abril y mayo. La principal conclusión, desde el punto de vista económico, sugiere que la rentabilidad de los huertos de manzanos podría ser incrementada, a través de un mejoramiento en el proceso de planificación de la producción.