A review of Parkinson’s disease cardinal and dyskinetic motor symptoms assessment methods using sensor systems

This paper is reviewing objective assessments of Parkinson’s disease(PD) motor symptoms, cardinal, and dyskinesia, using sensor systems. It surveys the manifestation of PD symptoms, sensors that were used for their detection, types of signals (measures) as well as their signal processing (data analysis) methods. A summary of this review’s finding is represented in a table including devices (sensors), measures and methods that were used in each reviewed motor symptom assessment study. In the gathered studies among sensors, accelerometers and touch screen devices are the most widely used to detect PD symptoms and among symptoms, bradykinesia and tremor were found to be mostly evaluated. In general, machine learning methods are potentially promising for this. PD is a complex disease that requires continuous monitoring and multidimensional symptom analysis. Combining existing technologies to develop new sensor platforms may assist in assessing the overall symptom profile more accurately to develop useful tools towards supporting better treatment process.

Conteúdos de biologia em vestibulares seriados

A adoção de novos processos seletivos para o acesso de alunos às universidades só foi possível com a promulgação da Lei de Diretrizes e Bases da Educação Nacional n. 9.394/96. O vestibular seriado é uma dessas propostas alternativas, que prevê uma avaliação sistemática dos alunos ao término de cada ano do ensino médio. O propósito deste estudo foi caracterizar o vestibular seriado, hoje presente em 22 instituições públicas, quanto ao seu objetivo, estilos de avaliação e conteúdos da disciplina de Biologia distribuídos nos módulos referentes às três séries do ensino médio. Averiguamos que os diferentes programas analisados não apresentam uniformidade em diversos aspectos, tais como número de vagas, estrutura de avaliação e conteúdo programático. Verificamos, ainda, a ausência de consenso sobre a sequência a ser adotada para o ensino de Biologia e a resultante restrição para que o aluno possa preparar-se para as provas seriadas em mais de uma instituição.

Examining the influence of biological and psychological factors on cognitive performance in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, crossover study

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as chemical. No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS.

Estudo de caso

História Clínica: Um paciente com história de diversas lesões nos membros inferiores foi intervencionado em ambos os pés, onde realizou uma tenossinovectomia dos peroneais com reparação de ruptura desses tendões (ao pé direito em 2006 sendo actualmente ao esquerdo). Avaliação Objectiva: Apresentava dor, edema, limitação articular de todos os movimentos da tibio-társica, fraqueza muscular, pés cavos e alterações do padrão de marcha e do equilíbrio. Objectivo: foi verificar se a mobilização com movimento (MWM) do astrágalo e da articulação tibio-peroneal inferior levava a uma diminuição da dor e aumentava a amplitude de dorsiflexão e inversão neste doente com pé cavo. Intervenção: foi realizada MWM do astrágalo e do perónio na articulação tibioperoneal inferior em descarga e em semi-carga, sendo mantida essa nova posição com uma ligadura de tape. Resultados: o paciente aumentou as amplitudes articulares em descarga e em carga, diminuiu o edema da perna e pé, aumentou a funcionalidade, mas em termos de força muscular não foram quantificadas alterações. Conclusão: mesmo o paciente tendo pé cavo e sequelas de uma tenossinovectomia dos peroneais, as manobras de mobilização com movimento do astrágalo e da articulação tíbio-peroneal inferior levaram a uma eliminação da dor e a um aumento da amplitude articular.

Visualização e manipulação de informação em ambientes 3D imersivos

Ainda antes da invenção da escrita, o desenho foi utilizado para descrever a realidade, tendo evoluído ao longo dos tempos, ganhando mais qualidade e pormenor e recorrendo a suportes cada vez mais evoluídos que permitissem a perpetuação dessa imagem: dessa informação. Desde as pinturas rupestres, nas paredes de grutas paleolíticas, passando pelos hieróglifos, nos templos egípcios, nas gravuras das escrituras antigas e nos quadros sobre tela, a intenção sempre foi a de transmitir a informação da forma mais directa e perceptível por qualquer indivíduo. Nos dias de hoje as novas tecnologias permitem aceder à informação com uma facilidade nunca antes vista ou imaginada, estando certamente ainda por descobrir outras formas de registar e perpetuar a informação para as gerações vindouras. A fotografia está na origem das grandes evoluções da imagem, permitindo capturar o momento, tornando-o “eterno”. Hoje em dia, na era da imagem digital, além de se mostrar a realidade, é possível incorporar na imagem informação adicional, de modo a enriquecer a experiência de visualização e a maximizar a aquisição do conhecimento. As possibilidades da visualização em três dimensões (3D) vieram dar o realismo que faltava ao formato de fotografia original. O 3D permite a imersão do espectador no ambiente que, a própria imagem retrata, à qual se pode ainda adicionar informação escrita ou até sensorial como, por exemplo, o som. Esta imersão num ambiente tridimensional permite ao utilizador interagir com a própria imagem através da navegação e exploração de detalhes, usando ferramentas como o zoom ou ligações incorporados na imagem. A internet é o local onde, hoje em dia, já se disponibilizam estes ambientes imersivos, tornando esta experiência muita mais acessível a qualquer pessoa. Há poucos anos ainda, esta prática só era possível mediante o recurso a dispositivos especificamente construídos para o efeito e que, por isso, apenas estavam disponíveis a grupos restritos de utilizadores. Esta dissertação visa identificar as características de um ambiente 3D imersivo e as técnicas existentes e possíveis de serem usadas para maximizar a experiência de visualização. Apresentar-se-ão algumas aplicações destes ambientes e sua utilidade no nosso dia-a-dia, antevendo as tendências futuras de evolução nesta área. Serão apresentados exemplos de ferramentas para a composição e produção destes ambientes e serão construídos alguns modelos ilustrativos destas técnicas, como forma de avaliar o esforço de desenvolvimento e o resultado obtido, comparativamente com formas mais convencionais de transmitir e armazenar a informação. Para uma avaliação mais objectiva, submeteram-se os modelos produzidos à apreciação de diversos utilizadores, a partir da qual foram elaboradas as conclusões finais deste trabalho relativamente às potencialidades de utilização de ambientes 3D imersivos e suas mais diversas aplicações.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Enteroscopia por cápsula e doença de Crohn: Caminhos para a otimização

Tese de Doutoramento em Medicina

Mediastinitis after cardiac transplantation

OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6%) of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years) and 10 (83.3%) patients were males. Seven (58.3%) patients showed sternal stability on palpation, 4 (33.3%) patients had pleural empyema, and 2 (16.7%) patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7%) patients. Staphylococcus epidermidis was identified in 2 (16.7%) patients, Enterococcus faecalis in 1 (8.3%) patient, and the cause of mediastinitis could not be determined in 1 (8.3%) patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7%) patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3%) patient. Out of this series, 5 (41.7%) patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3%) patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

Neuropathies périphériques d'origine médicamenteuse [Drug-induced peripheral neuropathy].

Drug-induced peripheral neuropathies are common, secondary to multiple drug classes, in particular chemotherapeutic agents. They have an important impact on patients' quality of life. In recent years, significant progress has been made in the understanding of some pathophysiological mechanisms. The use of more objective assessment tools should allow the development of individualized and more effective therapeutic strategies.

Free-breathing 3D coronary MRA: the impact of "isotropic" image resolution.

During conventional x-ray coronary angiography, multiple projections of the coronary arteries are acquired to define coronary anatomy precisely. Due to time constraints, coronary magnetic resonance angiography (MRA) usually provides only one or two views of the major coronary vessels. A coronary MRA approach that allowed for reconstruction of arbitrary isotropic orientations might therefore be desirable. The purpose of the study was to develop a three-dimensional (3D) coronary MRA technique with isotropic image resolution in a relatively short scanning time that allows for reconstruction of arbitrary views of the coronary arteries without constraints given by anisotropic voxel size. Eight healthy adult subjects were examined using a real-time navigator-gated and corrected free-breathing interleaved echoplanar (TFE-EPI) 3D-MRA sequence. Two 3D datasets were acquired for the left and right coronary systems in each subject, one with anisotropic (1.0 x 1.5 x 3.0 mm, 10 slices) and one with "near" isotropic (1.0 x 1.5 x 1.0 mm, 30 slices) image resolution. All other imaging parameters were maintained. In all cases, the entire left main (LM) and extensive portions of the left anterior descending (LAD) and the right coronary artery (RCA) were visualized. Objective assessment of coronary vessel sharpness was similar (41% +/- 5% vs. 42% +/- 5%; P = NS) between in-plane and through-plane views with "isotropic" voxel size but differed (32% +/- 7% vs. 23% +/- 4%; P < 0.001) with nonisotropic voxel size. In reconstructed views oriented in the through-plane direction, the vessel border was 86% more defined (P < 0.01) for isotropic compared with anisotropic images. A smaller (30%; P < 0.001) improvement was seen for in-plane reconstructions. Vessel diameter measurements were view independent (2.81 +/- 0.45 mm vs. 2.66 +/- 0.52 mm; P = NS) for isotropic, but differed (2.71 +/- 0.51 mm vs. 3.30 +/- 0.38 mm; P < 0.001) between anisotropic views. Average scanning time was 2:31 +/- 0:57 minutes for anisotropic and 7:11 +/- 3:02 minutes for isotropic image resolution (P < 0.001). We present a new approach for "near" isotropic 3D coronary artery imaging, which allows for reconstruction of arbitrary views of the coronary arteries. The good delineation of the coronary arteries in all views suggests that isotropic 3D coronary MRA might be a preferred technique for the assessment of coronary disease, although at the expense of prolonged scan times. Comparative studies with conventional x-ray angiography are needed to investigate the clinical utility of the isotropic strategy.

Nonlinear analysis of human physical activity patterns in health and disease.

The reliable and objective assessment of chronic disease state has been and still is a very significant challenge in clinical medicine. An essential feature of human behavior related to the health status, the functional capacity, and the quality of life is the physical activity during daily life. A common way to assess physical activity is to measure the quantity of body movement. Since human activity is controlled by various factors both extrinsic and intrinsic to the body, quantitative parameters only provide a partial assessment and do not allow for a clear distinction between normal and abnormal activity. In this paper, we propose a methodology for the analysis of human activity pattern based on the definition of different physical activity time series with the appropriate analysis methods. The temporal pattern of postures, movements, and transitions between postures was quantified using fractal analysis and symbolic dynamics statistics. The derived nonlinear metrics were able to discriminate patterns of daily activity generated from healthy and chronic pain states.

Psychiatrie [Psychiatry].

Contemporary psychiatry uses a variety of complementary approaches which enrich one another. In this paper, we describe the development of a brief psychodynamic approach for hospitalized patients with major depression, as well as the recent commercialization of an atypical neuroleptic depot medication. In addition, we discuss electro-convulsotherapy which, despite it has been widely and understandably condemned on the basis of its abusive and non medical application in certain political contexts, deserves objective assessment on the basis of scientific data stemming from recent research suggesting it is in some contexts a valuable tool.

Kansainvälinen markkinavalinta ohjelmistoalan mikroyrityksessä

Tutkielman tutkimusongelmana on, miten kansainvälinen kohdemarkkinoiden valinta pitäisi suorittaa ohjelmistoalan mikroyrityksessä. Tutkielma on kvalitatiivinen, yksittäinen tapaustutkimus. Teoriaosassa tutkimusongelmaa lähestytään tarkastelemalla kirjallisuutta, joka käsittelee kansainväliseen kohdemarkkinavalintaan vaikuttavia tekijöitä sekä olemassa olevia markkinavalintamalleja. Vanhojen mallien pohjalta kehitetään uusi käytännönläheinen ohjelmistoalan mikroyritykselle sopiva maavalintamalli. Kehitetty maavalintamalli koostuu eri vaiheista, joita ovat 1) sisäisten tekijöiden kartoittaminen, 2) alkukarsinta, 3) yrityksen kilpailukyvyn ja markkinoiden houkuttelevuuden mittaaminen matriisin avulla. Kehitettyä mallia sovelletaan tapausyritykseen tekemällä kansainvälinen markkinavalinta perustuen työpöytätutkimukseen, jossa käytetään Internetistä saatavaa sekundääridataa ja markkinatietoa. Työn lopussa esitetään markkinavalinnan tulokset ja toimenpidesuositukset yrityksen johdolle. Tutkimus osoittaa, että resurssipulasta huolimatta systemaattinen ja loogisesti etenevä maavalintaprosessi on mahdollista toteuttaa myös mikroyrityksessä. Ennalta määrätyt numeeriset rajat valintakriteereille mahdollistavat markkinoiden tarkastelun objektiivisuuden. Suurimpana haasteena ohjelmistoalan mikroyrityksen kansainvälisessä kohdemarkkinavalinnassa on yrityksen kilpailukyvyn mittaaminen eri markkinoilla. Tämäjohtuu osin ohjelmistoalan dynaamisesta luonteesta sekä kilpailija-analyysien subjektiivisuudesta.

Gender and age differences in polysomnography findings and sleep complaints of patients referred to a sleep laboratory

Our objective was to examine the effet of gender on the sleep pattern of patients referred to a sleep laboratory. The data (questionnaires and polysomnographic recordings) were collected from a total of 2365 patients (1550 men and 815 women). The polysomnography permits an objective assessment of the sleep pattern. We included only polysomnography exams obtained with no more than one recording system in order to permit normalization of the data. Men had a significantly higher body mass index than women (28.5 ± 4.8 vs 27.7 ± 6.35 kg/m²) and had a significantly higher score on the Epworth Sleepiness Scale (10.8 ± 5.3 vs 9.5 ± 6.0), suggesting daytime sleepiness. Women had a significantly higher sleep latency than men, as well as a higher rapid eye movement (REM) latency. Men spent more time in stages 1 (4.6 ± 4.1 vs 3.9 ± 3.8) and 2 (57.0 ± 10.5 vs 55.2 ± 10.1) of non-REM sleep than women, whereas women spent significantly more time in deep sleep stages (3 and 4) than men (22.6 ± 9.0 vs 19.9 ± 9.0). The apnea/hypopnea and arousal indexes were significantly higher and more frequent in men than in women (31.0 ± 31.5 vs 17.3 ± 19.7). Also, periodic leg movement index did not differ significantly between genders, but rather differed among age groups. We did not find significant differences between genders in the percentage of REM sleep and sleep efficiency. The results of the current study suggest that there are specific gender differences in sleep pattern.

Comparación de cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo.

Existen varias causas de la insuficiencia venosa profunda, la insuficiencia venosa superficial es una de ellas; por tal motivo, una intervención activa de la insuficiencia superficial ya sea cirugía convencional, esclerosis o radiofrecuencia mejora el reflujo del sistema venoso profundo. En nuestro medio no se acostumbra a intervenir los pacientes con insuficiencia venosa mixta bajo la creencia de exacerbar la enfermedad o generar complicaciones. Se pretende documentar los cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo, médico vs quirúrgico