Anticoagulant treatment for subsegmental pulmonary embolism

BackgroundAcute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.ObjectivesTo assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.Search methodsThe Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched (October 2013).Selection criteriaRandomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.Data collection and analysisTwo review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.Main resultsNo studies were identified that met the inclusion criteria.Authors' conclusionsThere is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.

Sintomas e condutas vocais na perspectiva de educadores atuantes no ensino fundamental

The objective of the present study was to identify previous and current vocal symptoms and to verify the behaviors ahead of the symptoms. Moreover, the gotten relations between the professional profile and data had been searched. 78 teachers had participated of the research, being two men and 76 women. Questionnaire was applied. In this questionnaire was elaborated on the basis of previous research and it contained questions on vocal health. The results to indicate that were evidenced one high (48%) frequency of the teachers had makes intense use of the voice at least has ten years. This study it allowed to conclude that it is necessary to modify the focus of interventions directed toward these professionals therefore has some factors in the work routine that intervene with its general and vocal health. Therefore interventions in the individual field are only insufficient to decide the problem.

Variabilidade da frequência cardíaca como recurso em fisioterapia: análise de periódicos nacionais

INTRODUCTION: The autonomic nervous system (ANS) could be investigated in a noninvasive way by the heart rate variability analysis (HRV) which has contributed to several health areas such as physiotherapy. OBJECTIVE: To gather information regarding the use of HRV on physiotherapy aims at providing an update of the findings for the area on journals of national circulation. MATERIALS AND METHODS: The journals of national circulation classified as greater than B2 or B2 and with free access and complete texts in some internet sites were searched on 21 area WebQualis resulting on selection of Revista Brasileira de Fisioterapia, Fisioterapia e Pesquisa and Fisioterapia em Movimento using the keywords: autonomic nervous system, sympathetic nervous system, physiotherapy and heart rate variability. RESULTS: The search resulted in 19 articles being 17 clinical trials and two case reports. CONCLUSION: The HRV has been used as a resource of interventions evaluation, as pathological conditions common to clinical practice investigation and to physiological conditions interpretation in physiotherapy. The HRV is principally used to the cardiorespiratory specialty of physiotherapy.

Comparação da aptidão física em idosos submetidos a diferentes intervenções de exercício físico

Introduction: The elderly population has increased, and the aging process is responsible for physical and metabolic changes in the body. For the elderly remain independent, with a better quality of life, preventing and treating diseases responsible for this increased of mortality should remain physically active. Objective: To investigate the influence of two types of exercise intervention on physical fitness and physical activity levels in older practitioners of Rio Claro-SP. Method: The study included 18 older adults with mean age 65.8 years (± 2.88) divided into two groups, Program in Physical Exercises Health Unit (PEFUS, n = 9) and Adapted Volleyball (n = 9). Classes of PEFUS were held twice a week lasting 60 min with strength, aerobic endurance, agility, coordination and balance exercises. Classes of Volleyball Adapted were performed 2 times per week lasting 120 minutes, divided into volleyball fundamental exercises and game. For evaluation of physical skills (strength, agility, coordination and flexibility), was performed the AAHPERD test battery. All participants were assessed at the baseline and after 3 months of interventions. The statistical analysis used was the repeated measures ANOVA, through the SPSS version 17.0 and significance level p <0.05. Result: After the interventions there was an increase of leisure time from 362.2 ± 214.9 min / week and 16.7 ± 28.3 min / week to 541.7 ± 137.2 and 44.4 ± 44.8 min / week to Adapted Volleyball and PEFUS, respectively. The variable coordination showed significant improvements after the interventions, decreasing from 12.1 ± 0.7 to 10.8 ± 0.5 sec for Volleyball Adapted and from 14.8 ± 0.9 to 12.1 ± 0, 9 sec for PEFUS (p <0.05). For the variable strength it was observed a group-moment interaction (p <0.05). Conclusion: The interventions showed positive results... (Complete abstract click electronic access below)

Desenvolvimento da malha urbana de Guaratinguetá e propostas de intervenção

The work consists of the historical city of Guaratinguetá, as well as data on their quality of life, economic development and population, transportation in Brazil and the transportation system of the city serving as a basis to support the development of the urban network. The urban fabric of the city was raised with plants of the city in different years, documents obtained by the Museum and Hall of Frei Galvão Guaratinguetá well to check the form of land use and growth drivers of the city over time. We studied also the main access roads to the city by focusing on an approach that has been the subject of a proposed urban intervention. A direct interview was performed and recorded with one of those responsible for planning the urban fabric of the city in order to gather information on the historical development, the future possibilities of interventions in the urban as well as problems encountered and other curiosities. Through the study it was observed that the urban grid Guaratinguetá developing a planned since 1970 and that the highlights of most cities in the Paraíba Valley. The work is grounded in concepts of sustainable city and also in quantitative and qualitative data from sectors responsible

Exercício físico e funções cognitivas em pacientes com doença de Alzheimer: associação com BDNF e APOE

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Oficinas sobre sexualidade com adolescentes: um estudo de caso

Adolescents are commonly seen in a “sexless” way so that when the first sexual expressions appear in our young people they are permeated by worry and fear. In this context, the school spread the vision of sex and sexuality, as hazardous due to risks of sexually transmitted diseases and unwanted pregnancy. Thus, seeking to encourage reflection on the part of adolescents with regard to sexual life, workshops were developed with 15 students in a seventh grade student at a state school in the city of Jaboticabal, São Paulo. The findings of this research indicate that adolescents have conceptions of sexuality marked by repression, including the maintenance of sex roles traditionally established. The implementation of interventions in the form of workshops revealed that the group has become an area that favors the reconstruction and rebuilding of meanings through the questions and judgment of values and attitudes socially imposed.

Formação inicial docente: o estágio como espaço de aprendizagens

The study presented here aimed to understand how the traineeship supervisor can act for this moment to be a valuable learning for future teachers, with a view to her operations to expand the knowledge of students. For this, we analyzed the pedagogical actions that occurred during the supervised training of a pedagogy course at a public university situated in the state of Paraná, Brazil. Supported in qualitative research this investigation shows that the supervisory actions, in the view of interns, favored teacher education: respect for the supervisor to people; her orientation to the importance of reflecting on aspects recognized as negative, her help in the preparation of interdisciplinary lesson plan and the need for a flexible lesson plan; her presence in moments of interventions; feedback given and appreciation of the role of the educator in the teaching / learning.

Intoxicação crônica por chumbo e implicação no desenvolvimento escolar

To understand the implications of lead contamination contributes to more effective public politics to eliminate exposure to the metal and orientation of interventions that minimize their effects. In this paper we intended to evaluate the effects of lead contamination in children, with the Teste de Desempenho Escolar (TDE). In Study 1, transversal, aimed to evaluate the influence of blood lead levels in 28 participants of both sexes, of seven to fifteen years, divided into two groups according to the level of contamination. In Study 2, longitudinal study aimed to evaluate the effects of contamination on the school ,performance of 10 children at an interval of four years. Results showed significant underperformance for children with higher levels of contamination and that the level of academic performance remains significantly lower than expected for the series in which they find themselves. The data seem to indicate the deleterious effects of lead contamination in school performance.

Práticas parentais maternas e a influência de variáveis familiares e do bebê

Parenting practices can be understood as the behaviors emitted by parents to educate and socialize their children. The present study investigates the influence of the parenting practices according to the baby sex and age, family configuration and number of children. For this, 50 adult mothers were questioned according to the Parental Styles Inventory for Mothers with Babies (IEPMB). An analysis with the results indicates that mothers with baby girls normally uses a more Positive Monitoring practice when compared with mothers with boy babies. A positive correlation (r = +0.54, p <0.001) was found, between the age of the baby and the practice of negligence, meaning that there is an increase of the usage in the practical as the baby age increases. Also a significant difference (p = 0.04) in the Inconsistent Punishment practice pointed out to the fact that mothers from nuclear families seem to use this practice more than mothers from other family configurations. And multiparous mothers use more Physical Abuse practical than primiparous mothers (p = 0.02). Concerning this analysis, we support a discussion in the present work about the importance of interventions that focus on the effect of specific positive practices, the reduction of negative practices and the role of the network support on the children development.

Acesso aos níveis de atenção à saúde em um município do Estado de São Paulo: perspectivas de gestores, profissionais e usuários

Pós-graduação em Saúde Coletiva - FMB

O pós FUNDEB no oferecimento de matrículas para a educação infantil no estado de São Paulo

Pós-graduação em Educação - IBRC

Cyberhooligans: a manifestação da violência das redes sociais

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

Circuit board accident - organizational dimension hidden by prescribed safety

This study analyzes an accident in which two maintenance workers suffered severe burns while replacing a circuit breaker panel in a steel mill, following model of analysis and prevention of accidents (MAPA) developed with the objective of enlarging the perimeter of interventions and contributing to deconstruction of blame attribution practices. The study was based on materials produced by a health service team in an in-depth analysis of the accident. The analysis shows that decisions related to system modernization were taken without considering their implications in maintenance scheduling and creating conflicts of priorities and of interests between production and safety; and also reveals that the lack of a systemic perspective in safety management was its principal failure. To explain the accident as merely non-fulfillment of idealized formal safety rules feeds practices of blame attribution supported by alibi norms and inhibits possible prevention. In contrast, accident analyses undertaken in worker health surveillance services show potential to reveal origins of these events incubated in the history of the system ignored in practices guided by the traditional paradigm.

A rede básica para o metrô de São Paulo e a priorização do automóvel

De que adiantam planos e projetos para determinadas políticas públicas se as decisões do Executivo nem sempre os consideram? Este trabalho busca demonstrar que os planos e os projetos para o setor de transporte têm sofrido com a priorização dos modais individuais. Desde as políticas de incentivos às indústrias automobilísticas até isenções fiscais. A existência de planos e projetos para o metrô de São Paulo e seu conseqüente abandono por longos períodos apontam para a supremacia do automóvel sobre o coletivo, principalmente no período de 1968 até 1983. Todo o planejamento, inclusive nos períodos de supremacia dos planos e projetos para o território urbano, cai por terra se estes instrumentos não vão ao encontro dos interesses político-econômicos do momento.