Qualidade da água para consumo humano e concentração de fluoreto

O artigo visa analisar a concentração de fluoreto na água para consumo humano, considerando o balanço entre benefícios e riscos à saúde, e produzir subsídios para atualização da legislação brasileira. Estudos de revisão sistemática, documentos oficiais e dados meteorológicos foram examinados. As temperaturas nas capitais brasileiras indicam que o fluoreto deveria variar de 0,6 a 0,9 mg/L para prevenir cárie dentária. Concentração de fluoreto natural de 1,5 mg/L é tolerável para consumo no Brasil se não houver tecnologia de custo-benefício aceitável para ajuste/remoção do seu excesso. A ingestão diária de água com fluoreto em concentração > 0,9 mg/L representa risco à dentição em menores de oito anos de idade e os consumidores deveriam ser expressamente informados desse risco. Considerando a expansão do programa nacional de fluoretação da água para regiões de clima tipicamente tropical, deve-se revisar a Portaria 635/75, relacionada ao fluoreto adicionado às águas de abastecimento público.

Epidemiological modelling (including economic modelling) and its role in preventive drug therapy

In contrast to curative therapies, preventive therapies are administered to largely healthy individuals over long periods. The risk-benefit and cost-benefit ratios are more likely to be unfavourable, making treatment decisions difficult. Drug trials provide insufficient information for treatment decisions, as they are conducted on highly selected populations over short durations, estimate only relative benefits of treatment and offer little information on risks and costs. Epidemiological modelling is a method of combining evidence from observational epidemiology and clinical trials to assist in clinical and health policy decision-making. It can estimate absolute benefits, risks and costs of long-term preventive strategies, and thus allow their precise targeting to individuals for whom they are safest and most cost-effective. Epidemiological modelling also allows explicit information about risks and benefits of therapy to be presented to patients, facilitating informed decision-making.

A NEUROECONOMIC MODELING OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)

In this paper we present a new neuroeconomics model for decision-making applied to the Attention-Deficit/Hyperactivity Disorder (ADHD). The model is based on the hypothesis that decision-making is dependent on the evaluation of expected rewards and risks assessed simultaneously in two decision spaces: the personal (PDS) and the interpersonal emotional spaces (IDS). Motivation to act is triggered by necessities identified in PDS or IDS. The adequacy of an action in fulfilling a given necessity is assumed to be dependent on the expected reward and risk evaluated in the decision spaces. Conflict generated by expected reward and risk influences the easiness (cognitive effort) and the future perspective of the decision-making. Finally, the willingness (not) to act is proposed to be a function of the expected reward (or risk), adequacy, easiness and future perspective. The two most frequent clinical forms are ADHD hyperactive (AD/HDhyp) and ADHD inattentive (AD/HDdin). AD/HDhyp behavior is hypothesized to be a consequence of experiencing high rewarding expectancies for short periods of time, low risk evaluation, and short future perspective for decision-making. AD/HDin is hypothesized to be a consequence of experiencing high rewarding expectancies for long periods of time, low risk evaluation, and long future perspective for decision-making.

Management of Common Bile Duct Stones in Cirrhotic Patients with Coagulopathy: A Comparison of Supra-Papillary Puncture and Standard Cannulation Technique

Bleeding is not uncommon following endoscopic sphincterotomy. Supra-papillary puncture (SPP) might be safer than standard cannulation (SC) techniques in patients with coagulopathy. The aim of the study was to compare the safety and effectiveness of SPP and SC. This was a prospective case control intervention study. Decompensated cirrhotic patients with coagulopathy and choledocolithiasis underwent SC and SPP methods for biliary access. One hundred five patients (56 [53.3%] men, mean [SD] age 56 [15.8]) underwent ERCP. SC and SPP were performed in 63 and 42 patients, respectively. Biliary access was achieved in 56/63 (89%) and 40/42 (95%) of patients undergoing SC and SPP, respectively (P = 0.13; 95% CI [-0.16; 0.03]). Complications occurred in 10/63 (15.8%) patients undergoing SC and 5/42 (11.9%) SPP (P = 0.28; 95% CI [-0.17, 0.16]). Five (7.9%) and two (3.2%) episodes of post-sphincterotomy bleeding was seen in the SC and SPP groups, respectively (P = 0.36; 95% CI [-0.16, 0.05]). In contrast, three (4.8%) episodes of pancreatitis were seen in the SC and none in the SPP group (P = 0.05; 95% CI [0.001; 0.004]). A cost-effectiveness analysis demonstrated that SPP is an acceptable alternative at an ICER of US$ 5,974.92 per additional successful procedure. SPP is a safe and effective technique for the management of common bile duct stones in decompensated cirrhotic patients. Conditional to the willingness-to-pay and to the local ERCP-related costs, SPP is also a cost-effective alternative to the SC methods. SPP is associated with a lower rate of complications but larger studies to validate these findings are necessary.

Cardiovascular Risk and Clinical Factors in Athletes: 10 Years of Evaluation

DE MATOS, L. D. N. J., N. D. A. O. CALDEIRA, P. D. S. PERLINGEIRO, I. L. G. DOS SANTOS, C. E. NEGRAO and L. F. AZEVEDO. Cardiovascular Risk and Clinical Factors in Athletes: 10 Years of Evaluation. Med. Sci. Sports Exerc., Vol. 43, No. 6, pp. 943-950, 2011. Purpose: Preparticipation screening in athletes is a very current but controversial theme. Part of this controversy is due to the cost benefit, especially when the screening is merely used as a prevention of sudden cardiac death caused by rare and hereditary diseases. The purpose of this study was to describe the prevalence of preexisting diseases, cardiovascular risk factor for cardiovascular diseases development, and hematological profile in a population of amateur and professional athletes. Methods: Data of 623 athletes (529 men and 94 women), aged 13-77 yr, were analyzed to detect preexisting diseases. The variables total cholesterol, LDL, HDL, triglycerides, fasting glucose, body mass index, hemoglobin, hematocrit, and ferritin were analyzed in two groups according to age, that is, younger and older 35 yr old, and their prevalence (%) and distribution in quartiles were presented. chi(2) test and Pearson product-moment correlation coefficients between variables were applied, and P < 0.05 was adopted for significance. Results: Hypertension was the most prevalent preexisting diseases, although the data showed low prevalence of cardiomyopathy. Cardiovascular risk factors were prevalent in both genders. There were positive correlations between cardiovascular risk factors and age and between body mass index and lipid levels in male athletes. Also, there was a high prevalence of low ferritin levels for women, with positive correlation between the levels of hemoglobin and ferritin. Conclusions: In the present study, hypertension was the most prevalent diagnosed disease, and cardiovascular risk factors showed important prevalence, especially in athletes older than 35 yr. Although physical training represents a cardioprotective factor to the onset of cardiovascular disease, it does not exclude the prevalence of risk factors and diseases in athletes.

Juvenile helping behaviour in the Dusky Moorhen, Gallinula tenebrosa

In Dusky Moorhens, Gallinula tenebrosa, helping behaviour maybe displayed by juveniles when groups contain offspring of different age classes. We investigated the frequency and amount of parental care provided by juvenile moorhens to younger siblings from subsequent same-year broods. In some social groups, juveniles provided up to 33% of the total number of feeds provided to chicks. Juveniles were observed to feed chicks when as young as six weeks of age, often while still receiving food from adults themselves. Low within-group relatedness and low reproductive costs associated with juvenile helping have important consequences for the cost-benefit ratio of helping behaviour in this species.

Realtime fetal ultrasound by telemedicine in Queensland. A successful venture?

We have established a realtime fetal tele-ultrasound consultation service in Queensland, which has been integrated into our routine clinical practice, The service, which uses ISDN transmission at 384 kbit/s, allows patients in Townsville to be examined by subspecialists in Brisbane, 1500 km away. For the 90 tele-ultrasound consultations performed for the first 71 patients, 90% of the babies have been delivered, and outcome data have been received on all the pregnancies. All significant anomalies and diagnoses have been confirmed. The referring clinicians would have physically referred 24 of the 71 patients to Brisbane in the absence of telemedicine. A crude cost-benefit calculation suggests that the tele-ultrasound service resulted in a net saving of A$6340, and at the same time enabled almost four times the number of consultations to be carried out.

Research into telehealth applications in speech-language pathology

A literature review was conducted to investigate the extent to which telehealth has been researched within the domain of speech-language pathology and the outcomes of this research. A total of 13 studies were identified. Three early studies demonstrated that telehealth was feasible, although there was no discussion of the cost-effectiveness of this process in terms of patient outcomes. The majority of the subsequent studies indicated positive or encouraging outcomes resulting from telehealth. However, there were a number of shortcomings in the research, including a lack of cost-benefit information, failure to evaluate the technology itself, an absence of studies of the educational and informational aspects of telehealth in relation to speech-language pathology, and the use of telehealth in a limited range of communication disorders. Future research into the application of telehealth to speech-language pathology services must adopt a scientific approach, and have a well defined development and evaluation framework that addresses the effectiveness of the technique, patient outcomes and satisfaction, and the cost-benefit relationship.

Nitrate leaching through climatologic water balance in a fertigated coffee plantation

Nitrate losses from soil profiles by leaching should preferentially be monitored during high rainfall events and during irrigation when fertilizer nitrogen applications are elevated. Using a climatologic water balance, based on the models of Thornthwaite and Penman Monteith for potential evapotranspiration, drainage soil water fluxes below the root zone were estimated in a fertigated coffee crop. Soil solution extraction at the depth of 1 m allowed the calculation of nitrate leaching. The average nitrate concentration in soil solution for plots that received nitrogen by fertigation at a rate of 400 kg ha-1, was 5.42 mg L-1, surpassing the limit of the Brazilian legislation of 10.0 mg L-1, only during one month. For plots receiving 800 kg ha-1 of nitrogen, the average was 25.01 mg L-1, 2.5 times higher than the above-mentioned limit. This information indicates that nitrogen rates higher than 400 kg ha-1 are potentially polluting the ground water. Yearly nitrate amounts of leaching were 24.2 and 153.0 kg ha-1 for the nitrogen rates of 400 and 800 kg ha-1, respectively. The six times higher loss indicates a cost/benefit problem for coffee fertigations above 400 kg ha-1.

Reabilitação térmica e energética de edifício antigo: aplicação ao antigo edifício dos CTT em Coruche

O estudo desenvolvido no presente documento teve como alvo um edifício antigo construído entre 1930 e 1940 no concelho de Coruche, com construção característica da sua época. Numa fase inicial analisou-se de que forma se comporta o edifício em termos térmicos e energéticos, com base nas metodologias de cálculo apresentadas pelo regulamento térmico em vigor (RCCTE, 2006), e de seguida foram analisadas várias soluções existentes para a reabilitação térmica e energética do edifício que poderá ser concretizada, essencialmente devido às soluções para isolamento térmico das paredes, pavimentos e cobertura, assim como devido às soluções para vidros e caixilharia dos vãos envidraçados. Numa fase posterior, foi estudada a aplicação isolada das várias soluções de reabilitação consideradas, tendo sido simulada a aplicação de várias espessuras de isolante para as soluções da envolvente opaca e vários tipos de vidro duplo e caixilharia para as soluções da envolvente envidraçada, de forma a perceber-se a implicação que cada uma tem quanto à variação das necessidades energéticas do edifício. Por fim, foram calculados os custos de aplicação das várias soluções estudadas, com auxílio de um software de orçamentação, de forma que estas possam ser comparadas em termos da relação custo/benefício, em que, o benefício de cada solução será a variação provocada nas necessidades energéticas do edifício com aplicação da mesma. Assim, procurará encontrar-se para o edifício em estudo não só as soluções mais vantajosas em termos energéticos mas também as mais rentáveis, e procurará perceber-se se um investimento numa intervenção de reabilitação deste género conduzirá a um período de retorno do investimento reduzido, que possa ser considerado aceitável.

Norma contabilística e de relato financeiro 10 – custos de empréstimos obtidos

Dissertação de Mestrado submetida ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria Trabalho efetuado sob a orientação do Mestre Carlos Martins

A actividade de observação turística de cetáceos no arquipélago dos Açores : contribuição para o seu desenvolvimento sustentável

Dissertação de Mestrado em Gestão e Conservação da Natureza.

Construção de um parque eólico industrial

Dissertação de Natureza Científica para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Edificações

Comparação técnica da conceção/solução de projetos de climatização para um hotel rural

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia com a Especialidade em Energia, Climatização e Refrigeração

Mecanismos de gestão de recursos humanos no setor público: as implicações da austeridade

Dissertação de Mestrado apresentada ao Instituto Politécnico do Porto para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gestão das Organizações – Ramo de Gestão de Empresas Orientador: Professor Doutor Pedro Nunes Orientador: Professor Henrique Curado