The pterional craniotomy: tips and tricks

This review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.

O processo de construção do perfil de competências gerenciais para enfermeiros coordenadores de área hospitalar

Este estudo objetivou construir o perfil de competências gerenciais, consensuado por enfermeiros coordenadores de área. Desenvolvido em um hospital filantrópico de São Paulo, na modalidade de pesquisa-ação, participaram da pesquisa 13 enfermeiros coordenadores de área. A coleta de dados ocorreu por meio da técnica de grupo focal. Para a análise dos dados utilizaram-se os referenciais teóricos relacionados a processo de trabalho e competências gerenciais. Os resultados identificaram maior ênfase atribuída às competências relacionadas aos papéis de mentor, coordenador e diretor. Foi possível, então, construir um plano de desenvolvimento profissional, pautado em competências que atendam as dimensões técnica, ético-política, comunicativa e de desenvolvimento da cidadania. A análise do processo de trabalho gerencial e o estudo das competências no âmbito gerencial mostraram-se importantes, pois problematizaram necessidades de aprimoramento desses profissionais, assim, respondendo às demandas pessoais, profissionais e organizacionais.

Adversidades e resiliência no contexto da depressão materna: estudos de casos comparativos

A depressão materna, associada a outros estressores, configura cenários contextuais familiares que podem influenciar o desenvolvimento infantil. Neste trabalho, objetivou-se caracterizar e comparar, por meio do método de estudo de caso, condições favorecedoras de resiliência ou de adversidade para crianças em idade escolar que convivem com a depressão materna recorrente, focalizando os processos-chave da resiliência, analisados em cenários familiares diversos. Foram avaliadas seis duplas mãe-criança, sendo mães com depressão recorrente e episódios moderados ou graves, três crianças com dificuldades escolares e comportamentais e três crianças sem tais dificuldades. Foram aplicados entrevistas, questionário e testes psicológicos, integrando-se os dados em três cenários familiares associados à depressão materna. Para crianças sem dificuldades, foram identificadas como condições favorecedoras dos processos-chave da resiliência a organização da rotina familiar com a efetiva participação paterna, bem como a postura próativa materna no enfrentamento cotidiano de adversidades.

Agente Comunitário de Saúde no controle da tuberculose na Atenção Primária à Saúde

OBJETIVO: Avaliar o desempenho do Agente Comunitário de Saúde (ACS) no controle da tuberculose (TB) em áreas assistidas pela Estratégia Saúde da Família (ESF), sendo estabelecida uma análise comparativa com os ACSs inscritos nas Unidades Básicas de Saúde (UBS) tradicionais. MÉTODOS: Estudo transversal, realizado em um município prioritário para o controle da TB no Estado de São Paulo, com uma amostra mínima de 108 ACSs das ESFs e das UBSs. Para a coleta de dados, utilizou-se um instrumento elaborado para a Atenção Primária à Saúde (APS), adaptado para atenção à TB. RESULTADOS: No que concerne às ações de controle da TB, observou-se que não houve diferenças com significância estatística entre o desempenho dos ACSs das unidades da ESF e os inscritos nas UBSs. CONCLUSÃO: O estudo evidenciou a fragilidade dos ACSs em incorporar na sua prática as ações de controle da TB nas distintas modalidades de APS, apesar do destaque dado à ESF.

Incidence of lower limb bone fractures in female individuals of Aracaju (Sergipe), Brazil

Studies indicate that the number of hip bone fractures caused by osteoporosis may rise from 1.66 to 6.26 million until 2050, worldwide. For this reason, implementation of preventive measures becomes a necessity. Female individuals are usually more affected due to a variety of factors including old age, early menopause, chronicle disease in the family history, calcium deficit, as well as the lack of physical exercise (sedentary individual). The aim of this study was to estimate the incidence of hip and lower limb fracture in female individuals’ resident in Aracaju city. From the period of January 2008-2009, around of 300 fracture cases were of lower limb analyzed from females. The incidence of femur fractures in women increased according to age group, 66.17 individuals per 10,000 inhabitants (over 60 years-old). These findings allow us to conclude that the incidence of hip and lower limb bone fractures among women over 60 years were more significant in the femur.

Canine heartworm disease in Porto Velho: first record, distribution map and occurrence of positive mosquitoes

The aim of this study was to make the first report on canine heartworm disease in the state of Rondônia and confirm its transmission in this state. Blood samples were randomly collected from 727 dogs in the city of Porto Velho. The samples were analyzed to search for microfilariae and circulating antigens, using three different techniques: optical microscopy on thick blood smears stained with Giemsa; immunochromatography; and PCR. Mosquitoes were collected inside and outside the homes of all the cases of positive dogs and were tested using PCR to search for DNA of Dirofilaria immitis. Ninety-three blood samples out of 727 (12.8%) were positive according to the immunoassay technique and none according to the thick smear method. Among the 93 positive dogs, 89 (95.7%) were born in Porto Velho. No difference in the frequency of infection was observed between dogs raised indoors and in the yard. PCR on the mosquitoes resulted in only one positive pool. This result shows that the transmission of canine heartworm disease is occurring in the city of Porto Velho and that there is moderate prevalence among the dogs. The techniques of immunochromatography and PCR were more effective for detecting canine heartworm than thick blood smears. The confirmation of canine heartworm disease transmission in Porto Velho places this disease in the ranking for differential diagnosis of pulmonary nodules in humans in Rondônia.

Multiple sclerosis and herpesvirus interaction

Multiple sclerosis is the most common autoimmune inflammatory demyelinating disease of the central nervous system, and its etiology is believed to have both genetic and environmental components. Several viruses have already been implicated as triggers and there are several studies that implicate members of the Herpesviridae family in the pathogenesis of MS. The most important characteristic of these viruses is that they have periods of latency and exacerbations within their biological sanctuary, the central nervous system. The Epstein-Barr, cytomegalovirus, human herpesvirus 6 and human herpesvirus 7 viruses are the members that are most studied as being possible triggers of multiple sclerosis. According to evidence in the literature, the herpesvirus family is strongly involved in the pathogenesis of this disease, but it is unlikely that they are the only component responsible for its development. There are probably multiple triggers and more studies are necessary to investigate and define these interactions.

La gestione violenta dei conflitti in ambito di coppia

La famiglia rappresenta un micro sistema all’interno del macro sistema società, che vive, si riproduce, rimane in equilibrio o cade in situazioni di squilibrio, implode e si rigenera, attraverso gli infiniti feedback comunicativi con l’ambiente esterno. I suoi componenti sono i medium di tale processo interattivo. Quindi: tutti gli eventi all’interno del nucleo familiare, compreso il conflitto, non possono considerarsi slegati dalla società circostante. La famiglia possiede una dimensione politica che si esplicita nella distribuzione di potere fra i suoi componenti. Tale distribuzione può assumere sia forme democratiche, che dispotiche. A forme di distribuzione del potere non democratiche si associano livelli elevati di conflitto. Quest’ultimo, tuttavia, è una dimensione inevitabile delle associazioni umane. Ciò che distingue le relazioni – familiari e non – non è tanto la presenza o assenza del conflitto, quanto piuttosto la modalità di espressione e di gestione di tale conflittualità. In tal senso, infatti, l’antagonismo relazionale si può tradurre in aggressione e violenza, prevaricazione, lesione della integrità e della libertà, oppure divenire occasione di crescita, di confronto, di mediazione e di negoziazione. La ricerca svolta all’interno del Dottorato in Criminologia dell’ Università di Bologna è finalizzata, attraverso un’integrazione teorica, ad individuare le variabili intervenienti nel contesto e nell’esperienza dei conflitti violenti in ambito di coppia, per accertare il loro eventuale ruolo predittivo del fenomeno. In particolare, s’indagano le modalità attraverso le quali la condizione socio-strutturale dei partner di coppia e la costruzione sociale dei ruoli di genere - con la relativa attribuzione di potere – e le condizioni lavorative, interagiscono nell’ espressione violenta della conflittualità. Il collettivo di riferimento - individuato grazie alla collaborazione di associazioni del privato sociale e di istituzioni pubbliche presenti e operanti nel territorio della Provincia di Trento eroganti prestazioni eterogenee alle famiglie - è composto da coppie sposate/conviventi alle quali è stato somministrato un questionario strutturato.

La protezione dei diritti sociali nell'ordinamento dell'Unione Europea

This study deals with the protection of social rights in Europe and aims to outline the position currently held by these rights in the EU law. The first two chapters provide an overview of the regulatory framework in which the social rights lie, through the reorganisation of international sources. In particular the international instruments of protection of social rights are taken into account, both at the universal level, due to the activity of the United Nations Organisation and of its specialized agency, the International Labour Organization, and at a regional level, related to the activity of the Council of Europe. Finally an analysis of sources concludes with the reconstruction of the stages of the recognition of social rights in the EU. The second chapter describes the path followed by social rights in the EU: it examines the founding Treaties and subsequent amendments, the Charter of Fundamental Social Rights of Workers of 1989 and, in particularly, the Charter of Fundamental Rights of the European Union, the legal status of which was recently treated as the primary law by the Treaty of Lisbon signed in December 2007. The third chapter is, then, focused on the analysis of the substantive aspects of the recognition of the rights made by the EU: it provides a framework of the content and scope of the rights accepted in the Community law by the Charter of Fundamental Rights, which is an important contribution to the location of the social rights among the fundamental and indivisible rights of the person. In the last section of the work, attention is focused on the two profiles of effectiveness and justiciability of social rights, in order to understand the practical implications of the gradual creation of a system of protection of these rights at Community level. Under the first profile, the discussion is focused on the effectiveness in the general context of the mechanisms of implementation of the “second generation” rights, with particular attention to the new instruments and actors of social Europe and the effect of the procedures of soft law. Second part of chapter four, finally, deals with the judicial protection of rights in question. The limits of the jurisprudence of the European Union Court of Justice are more obvious exactly in the field of social rights, due to the gap between social rights and other fundamental rights. While, in fact, the Community Court ensures the maximum level of protection to human rights and fundamental freedoms, social rights are often degraded into mere aspirations of EU institutions and its Member States. That is, the sources in the social field (European Social Charter and Community Charter) represent only the base for interpretation and application of social provisions of secondary legislation, unlike the ECHR, which is considered by the Court part of Community law. Moreover, the Court of Justice is in the middle of the difficult comparison between social values and market rules, of which it considers the need to make a balance: despite hesitancy to recognise the juridical character of social rights, the need of protection of social interests has justified, indeed, certain restrictions to the free movement of goods, freedom to provide services or to Community competition law. The road towards the recognition and the full protection of social rights in the European Union law appears, however, still long and hard, as shown by the recent judgments Laval and Viking, in which the Community court, while enhancing the Nice Charter, has not given priority to fundamental social rights, giving them the role of limits (proportionate and justified) of economic freedoms.

Untersuchungen zur Verfestigungskinetik in Suspensionen kolloidaler Partikel

Kolloidale Suspensionen, bei denen man die kolloidalen Teilchen als "Makroatome" in einem Kontinuum aus Lösungsmittelmolekülen auffaßt, stellen ein geeignetes Modellsystem zur Untersuchung von Verfestigungsvorgängen dar. Auf Grund der typischen beteiligten Längen- und Zeitskalen können Phasenübergänge bequem mit optischen Verfahren studiert werden. In der vorliegenden Arbeit wurde die Kinetik der Kristallisation in drei kolloidalen Systemen unterschiedlicher Teilchen-Teilchen-Wechselwirkung mit Lichtstreu- und mikroskopischen Methoden untersucht. Zur Untersuchung von Suspensionen aus sterisch stabilisierten PMMA-Teilchen, die in guter Näherung wie harte Kugeln wechselwirken, wurde ein neuartiges Laserlichtstreuexperiment aufgebaut, das die gleichzeitige Detektion von Bragg- und Kleinwinkelstreuung an einer Probe erlaubt. Damit konnte der zeitliche Verlauf der Kristallisation verfolgt sowie u.a. Nukleationsraten und erstmals auch Wachstumsgeschwindigkeiten bestimmt werden; diese wurden mit klassischer Nukleationstheorie sowie Wilson-Frenkel-Wachstum verglichen. In beiden Fällen konnte sehr gute Übereinstimmung mit der Theorie festgestellt werden. In Systemen geladener Partikel wurden mit Bragg-Mikroskopie die Wachstumsgeschwindigkeiten heterogener, an der Wand der Probenzelle aufwachsender Kristalle untersucht. Die Anpassung eines Wilson-Frenkel-Wachstumsgesetzes gelingt auch hier, wenn man die dazu eingeführte reskalierte Energiedichte auf den Schmelzpunkt bezieht. Geeignete Reskalierung der Daten erlaubt den Vergleich mit den Hartkugelsystemen. Zum ersten Mal wurde die Kristallisationskinetik in zwei verschiedenen kolloidalen binären Mischungen bestimmt und ausgewertet: In Beimischungen einer nichtkristallisierenden Teilchensorte zu einer kristallisierenden Suspension konnten die Daten mit einem modifizierten Wilson-Frenkel-Gesetz beschrieben werden, während in Mischungen aus zwei kristallisierenden Partikelsystemen eine unerwartet hohe Abnahme der Wachstumsgeschwindigkeiten beobachtet wurde. Kolloidale Suspensionen hartkugelähnlicher Mikrogel-Partikel konnten mit Hilfe des Lichtstreuaufbaues ebenfalls zum ersten Mal untersucht werden. Es wurde eine ähnliche Kristallisationskinetik wie in den PMMA-Systemen gefunden, jedoch auch einige wichtige Unterschiede, die insbesondere den Streumechanismus im Kleinwinkelbereich betrafen. Hier wurden verschiedene Interpretationsvorschläge diskutiert.

MRI of hip osteoarthritis and implications for surgery

Osteoarthritis of the hip joint is caused by a combination of intrinsic factors and extrinsic factors. Different surgical techniques are being performed to delay or halt osteoarthritis. Success of salvage procedures of the hip depends on the existing cartilage and joint damage before surgery; the likelihood of therapy failure rises with advanced osteoarthritis. For imaging of intra-articular hip pathology, MR imaging represents the best technique because of its ability to directly visualize cartilage, superior soft tissue contrast, and the prospect of multidimensional imaging. This article gives an overview on the standard MR imaging techniques used for diagnosis of hip osteoarthritis and their implications for surgery.

Access to specialized pediatric cancer care in Switzerland

Specialized pediatric cancer centers (PCCs) are thought to be essential to obtain state-of-the-art care for children and adolescents. We determined the proportion of childhood cancer patients not treated in a PCC, and described their characteristics and place of treatment.