Evaluating the quality of life in patients with refractory chronic heart failure undergoing cardiac resynchronization regarding the type of therapeutic response

The benefits of cardiac resynchronization therapy (CRT) in the quality of life have been largely demonstrated in selected patients with severe congestive heart failure (CHF). However, the differences between responders and non-responders, with regard to the effect of CRT in the various dimensions of quality of life is still a matter of discussion. Objective: to evaluate the impact of CRT on the quality of life of patients with CHF refractory to optimal pharmacological therapy, within 6 months after CRT.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

Reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil

OBJECTIVE: To evaluate possible adverse reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil. METHODS: A review of 17,113 birth records of the main hospital of the municipality of Montenegro, southern Brazil, from 1983 to 1998 was carried out. Three groups of cases were selected: (1) newborns with major congenital malformations; (2) newborns with low birth weight (<2,500 g); and (3) stillborns (>500 g). A control was assigned to each case. Controls were the first newborns weighing > or = 2,500 g without malformations and of case-matching sex. Mother's residence during pregnancy was used as an exposure parameter. Statistical analyses were performed using Chi-square test or Fisher test, odds ratio, 0.05 significance level, and 95% confidence interval. RESULTS: For unadjusted analysis, it was found a correlation between low birth weight and geographical proximity of mother's residence to the petrochemical plant (OR = 1.66; 95% CI = 1.01--2.72) or residence on the way of preferential wind direction (OR = 1.62; 95% CI = 1.03--2.56). When other covariates were added in the conditional logistic regression (maternal smoking habits, chronic disease and age), there was no association. CONCLUSIONS: Despite final results were negative, low birth weight could be a good parameter of environmental contamination and should be closely monitored in the studied area.

Radiographic outcomes and evaluation of developmental dysplasia of the hip in children

The Developmental Dysplasia of the Hip (DDH), also know as Congenital Dislocation of the Hip, is common in infants and children and may persist into adulthood. The radiographic interpretation is highly conditioned by appropriate patient positioning and image quality criteria. The main goal of this study is to demonstrate the value of radiographic evaluation of DDH. Through the retrospective analysis of 65 radiographs of the hips, only 2 (3.1%) female patients with 1-2 years of age presented radiographic findings of DDH. The inappropriate field size and the improper placement and size of the gonadal shields, were the most common errors observed.

Treatment outcomes in pulmonary tuberculosis and associated factors worldwide: a systematic review and meta-analysis

Introduction - The increasing of TB burden is usually related to inadequate case detection, diagnosis and cure. Global targets for TB control, adopted by the World Health Organization (WHO), are to detect 70% of the estimated incidence of sputum smear-positive TB and to cure 85% of newly detected cases of sputum smear-positive TB. Factors associated with unsuccessful treatment outcomes are closely related to TB risk factors. Objectives - To describe treatment success rates in pulmonary TB cases and to identify factors associated with unsuccessful treatment outcomes, according to ad-hoc studies.

Physical activity during pregnancy and fetal outcomes: a case-control study

OBJECTIVE: To investigate the relationship between physical activity during the second trimester pregnancy and low birth weight, preterm birth, and intrauterine growth restriction. METHODS: Case-control study including 273 low birth weight newborns and 546 controls carried out in the city of São Paulo, Southeastern Brazil, in 2005. Low birth weight cases were grouped into two subsamples: preterm birth (n=117) and intrauterine growth restriction (n=134), with their related controls. Information was collected by means of interviews with mothers shortly after birth and transcription of medical records. Data were analyzed using conditional multiple and hierarchical logistic regression. RESULTS: Light physical activity for over 7 hours per day was shown to be protective against low birth weight (adjusted OR=0.61; 95% CI 0.39-0.94) with a dose-response relationship (p-value for trend=0.026). A similar trend was found for intrauterine growth restriction (adjusted OR=0.51; 95% CI 0.26-0.97). Homemaking activities were associated as a protective factor for both low birth weight and preterm birth (p-value for trend=0.013 and 0.035, respectively). Leisure-time walking was found to be protective against preterm birth. CONCLUSIONS: Mild physical activity during the second trimester of pregnancy such as walking has an independent protective effect on low birth weight, preterm birth, and intrauterine growth restriction.

Defining and Classifying Learning Outcomes: A case study

Bologne came to globalize education in higher education, creating a unified architecture that potentiates higher education and enhances the continued interconnection of the spaces of education policy in higher education in the world, in particular in Europe. The aim of this work consists in the presentation of an identification model and skills’ classification and learning outcomes, based on the official documents of the course units (syllabus and assessment components) of a course of Higher Education. We are aware that the adoption of this model by different institutions, will contribute to interoperability learning outcomes, thus enhancing the mobility of teachers and students in the EHEA (European Higher Education Area) and third countries.

Avaliação da viabilidade miocárdica pós-enfarte: Gated-SPECT versus Gated-PET

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

Master's in autonomous systems: an overview of the robotics curriculum and outcomes at ISEP, Portugal

Robotics research in Portugal is increasing every year, but few students embrace it as one of their first choices for study. Until recently, job offers for engineers were plentiful, and those looking for a degree in science and technology would avoid areas considered to be demanding, like robotics. At the undergraduate level, robotics programs are still competing for a place in the classical engineering graduate curricula. Innovative and dynamic Master’s programs may offer the solution to this gap. The Master’s degree in autonomous systems at the Instituto Superior de Engenharia do Porto (ISEP), Porto, Portugal, was designed to provide a solid training in robotics and has been showing interesting results, mainly due to differences in course structure and the context in which students are welcomed to study and work

Effects of team task structure on team climate for innovation and team outcomes

In this cross-sectional study we analyzed, whether team climate for innovation mediates the relationship between team task structure and innovative behavior, job satisfaction, affective organizational commitment, and work stress. 310 employees in 20 work teams of an automotive company participated in this study. 10 teams had been changed from a restrictive to a more self-regulating team model by providing task variety, autonomy, team-specific goals, and feedback in order to increase team effectiveness. Data support the supposed causal chain, although only with respect to team innovative behavior all required effects were statistically significant. Longitudinal designs and larger samples are needed to prove the assumed causal relationships, but results indicate that implementing self-regulating teams might be an effective strategy for improving innovative behavior and thus team and company effectiveness.

Spatial distribution of specialized cardiac care units in the state of Santa Catarina

OBJECTIVE To analyze the methodology used for assessing the spatial distribution of specialized cardiac care units. METHODS A modeling and simulation method was adopted for the practical application of cardiac care service in the state of Santa Catarina, Southern Brazil, using the p-median model. As the state is divided into 21 health care regions, a methodology which suggests an arrangement of eight intermediate cardiac care units was analyzed, comparing the results obtained using data from 1996 and 2012. RESULTS Results obtained using data from 2012 indicated significant changes in the state, particularly in relation to the increased population density in the coastal regions. The current study provided a satisfactory response, indicated by the homogeneity of the results regarding the location of the intermediate cardiac care units and their respective regional administrations, thereby decreasing the average distance traveled by users to health care units, located in higher population density areas. The validity of the model was corroborated through the analysis of the allocation of the median vertices proposed in 1996 and 2012. CONCLUSIONS The current spatial distribution of specialized cardiac care units is more homogeneous and reflects the demographic changes that have occurred in the state over the last 17 years. The comparison between the two simulations and the current configuration showed the validity of the proposed model as an aid in decision making for system expansion.

Drilling delamination outcomes on glass and sisal reinforced plastics

Nowadays, fibre reinforced plastics are used in a wide variety of applications. Apart from the most known reinforcement fibres, like glass or carbon, natural fibres can be seen as an economical alternative. However, some mistrust is yet limiting the use of such materials, being one of the main reasons the inconsistency normally found in their mechanical properties. It should be noticed that these materials are more used for their low density than for their high stiffness. In this work, two different types of reinforced plates were compared: glass reinforced epoxy plate and sisal reinforced epoxy plate. For material characterization purposes, tensile and flexural tests were carried out. Main properties of both materials, like elastic modulus, tensile strength or flexural modulus, are presented and compared with reference values. Afterwards, plates were drilled under two different feed rates: low and high, with two diverse tools: twist and brad type drill, while cutting speed was kept constant. Thrust forces during drilling were monitored. Then, delamination area around the hole was assessed by using digital images that were processed using a computational platform previously developed. Finally, drilled plates were mechanically tested for bearing and open-hole resistance. Results were compared and correlated with the measured delamination. Conclusions contribute to the understanding of natural fibres reinforced plastics as a substitute to glass fibres reinforced plastics, helping on cost reductions without compromising reliability, as well as the consequence of delamination on mechanical resistance of this type of composites.

TRAILER – e-Portfolio for collecting and recognizing informal learning process and outcomes

Informal learning is becoming more and more important: Nowadays people learn more this way, through the Internet, than in schools or normal trainings. But they don’t get any certificateswhich attest this fact. So they can't show the employer or teacher etc. that they have learned something. TRAILER project aim is to solve this problem by developing a special tool for managing of all competences and skills acquired through informal learning experiences. Both from the perspective of the user and the perspective of an institution or a company. We’ll present the IT tool to show how people can make their informal learning outcomes visible. TRAILER helps users to gather all information about process and outcomes of their informal learning. Users can share this with friends, colleagues or their employees, teachers and so on. They can create an interactive e-portfolio which can be attached to their CV, cover letter or Knowledge Management system etc. After the presentation of the tool we will discuss possible areas and fields to use this tool. Also we would like to discuss all possible use of the tool by the participants and another needs in this area. Moreover we want to discuss other problems in informal learning process, ways to solve the problems and discuss other ideas of different IT tools which could help in informal learning process. During the discussion we’ll use an interactive respond system which can be used on mobile devices: it makes possible for participants to share their opinions individually before knowing another persons' opinion.

Cardiac involvement in human rabies: case report

A case of human rabies with cardiac involvement and viral inclusion bodies in the heart is presented. The Negri bodies were found in the Schwann cells of the right epicardial atrium, with secondary mononuclear cells inflammation. In the myocardium, an interstitial edema, proliferation of Anitschkov and rare mononuclear inflammatory cells were seen. There was no relevant cardiovascular signs or symptoms. The rarity of histological descriptions of Negri bodies in the heart is stressed, as well as the importance of cardiac involvement as a potential complication for cases with life prolonged by intensive care units, or in the end-stages of the disease.