928 resultados para health state classification system


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This work presents a bibliometric profile of Bioethics Journal according to the following journal databases: MEDLINE, LILACS, The Philosopher' s Index, Ulrich's, SciELO and Qualis classification system (Brazil). We found that: from 38 titles indexed in MEDLINE, 25 (66%) still exist; the country with the highest number is the U. S. A (36%); most Bioethics journals appeared in the 1990's (47%), and 36% have less than 10 years of existence. From those that disappeared (34%), the average survival time was about 4 years. There are only 12 countries with indexed journals. In Brazil, from 3 Bioethics journals, only one is (partially) indexed. English is the preponderant language (45%). Only 3% of journals are monthly. LILACS has two additional publications (Acta Bioethica, Chile, and Revista Latino Americana, Colombia). SciELO has only Acta Bioethica. In Ulrich's database, there are eight additional publications. In "Qualis" classification system there are four journals.

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Objective: To evaluate changes in mammographic density and Tc-99m-sestamibi scintimammographic uptake in postmenopausal women on hormone replacement therapy (HRT).Methods: Seventy-five postmenopausal women were prospectively studied and allocated into three groups: 50 women were randomized to either Group 1 (G1, n = 25), which received 2 mg of 17 beta-oestradiol continuously combined with 1 mg of norethisterone acetate (E-2/NETA, Kliogest (R), Medley) or Group 2 (G2), which received 2.5 mg/day of tibolone (Livial (R), Organon). The remaining 25 women, who were asymptomatic and had no desire to undergo HRT, constituted the control group (G3). Each patient was submitted to both mammography and scintimammography at baseline and after six months. Mammographic density was evaluated by using the BI-RADS classification system. The classification system of Barros et al. was used in the interpretation of scintimammography. For statistical analysis, the Chi-square test, ANOVA and Pearson's correlation were used.Results: At six months, increased mammographic density was observed in 48% of G1, 12% of G2 and 16% of G3 patients (p < 0.001). The increase in sestamibi uptake was 56% in G1, 28% in G2 and 24% in G3 (p < 0.001). Increases in both density and uptake were significantly higher in the group on E-2/NETA than among tibolone users and the controls.Conclusion: In postmenopausal women, HRT with E-2/NETA was associated with increased mammographic density and increased Tc-99m-sestamibi scintimammographic uptakes, suggesting greater mithochondrial activity in the cells of the mammary duct. This was not observed in users of 2.5 mg of tibolone, demonstrating that the effects on the breast were reduced. The same was observed in the control group. (c) 2005 Elsevier B.V.. All rights reserved.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Este trabalho propõe-se a refletir sobre o conteúdo e as implicações, para a oferta da educação básica, de duas das principais medidas que sustentaram a reforma da educação paulista implantada pelo primeiro governo de Mario Covas (1995-1998). São elas: a reorganização das escolas da rede estadual e a política de municipalização do ensino fundamental mediante a adoção de convênios.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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We proposed a simple feedback control method to suppress chaotic behavior in oscillators with limited power supply. The small-amplitude controlling signal is applied directly to the power supply system, so as to alter the characteristic curve of the driving motor. Numerical results are presented showing the method efficiency for a wide range of control parameters. Moreover, we have found that, for some parameters, this kind of control may introduce coexisting periodic attractors with complex basins of attraction and, therefore, serious problems with predictability of the final state the system will asymptote to. (c) 2006 Elsevier Ltd. All rights reserved.

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Este artigo apresenta os principais resultados de uma pesquisa concluída que teve como objeto de estudo a função de coordenação pedagógica na rede estadual paulista, com destaque para o trabalho do professor coordenador pedagógico (PCP). A partir de um estudo bibliográfico-documental, analisamos as principais resoluções publicadas pela Secretaria de Estado da Educação de São Paulo no período de 1996 a 2010. Para a definição do período de análise, foram consideradas as sucessivas medidas educacionais de natureza neoliberal ocorridas na referida rede de ensino. A partir das resoluções selecionadas, foram estabelecidas algumas categorias de análise relacionadas à função: denominação, justificativa e atribuições legais; requisitos necessários para os professores coordenadores e critérios de escolha; avaliação do trabalho realizado e bibliografia básica solicitada nos processos seletivos. A análise dos documentos legais permite identificar a apropriação da função pelas reformas educacionais recentes, reconhecendo as implicações para o trabalho docente e para a organização da escola. Influenciadas por princípios gerencialistas e performáticos, as reformas educacionais promoveram profundas alterações na natureza do trabalho do professor coordenador pedagógico, o qual, de articulador no âmbito da escola, passou a ser legalmente o sujeito responsável pela disseminação das medidas oficiais e pelo controle das atividades docentes.

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Embora o escopo deste trabalho seja de origem teórica, relata um estudo exploratório que busca situar a base de conceituação em Educação Especial para alunos Dotados e Talentosos, no Brasil, captando as definições compreendidas por profissionais da educação pela sondagem de sua opinião sobre que termos e expressões são usados, com que significados e em que situações. Os sujeitos incluíam 80 educadores interessados ou envolvidos na área (Grupo A) e 107 professores da rede pública no interior de São Paulo (Grupo B). Há poucas diferenças de opinião entre os sujeitos, nos dois grupos, com algumas exceções, principalente em questões relacionadas a nível de conhecimento e familiaridade com referencial teórico. Ambos os grupos indicam conceituação confusa, notadamente para os termos oficiais, superdotação e altas-habilidades; a maior carga de rejeição e exploração na mídia é alocada a superdotação. Os conceitos alta capacidade, alto desempenho e dotação são definidos em consonância com o referencial básico, que diferencia capacidade natural de capacidade adquirida; Talento reflete a ambiguidade encontrada na área, referindo-se, ao mesmo tempo, a capacidade natural e capacidade adquirida.

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INTRODUÇÃO: O hipotireoidismo subclínico (HSC), definido por concentrações elevadas do TSH em face de níveis normais dos hormônios tireoidianos, tem elevada prevalência no Brasil, particularmente entre mulheres e idosos. Embora um número crescente de estudos venha associando o HSC com maior risco de doença arterial coronariana e de mortalidade, não há ensaio clínico randomizado sobre o benefício do tratamento com levotiroxina na redução dos riscos e o tratamento permanece controverso. OBJETIVO: Este consenso, patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia e desenvolvido por especialistas brasileiros com vasta experiência clínica em tireoide, apresenta recomendações baseadas em evidências para uma abordagem clínica do paciente com HSC no Brasil. MATERIAIS E MÉTODOS: Após estruturação das questões clínicas, a busca das evidências disponíveis na literatura foi realizada inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO - Lilacs. A força da evidência, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão e a experiência brasileira. RESULTADOS: Os temas abordados foram definição e diagnóstico, história natural, significado clínico, tratamento e gestação, que resultaram em 29 recomendações para a abordagem clínica do paciente adulto com HSC. CONCLUSÃO: O tratamento com levotiroxina foi recomendado para todos os pacientes com HSC persistente com níveis séricos do TSH > 10 mU/L e para alguns subgrupos especiais de pacientes.

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INTRODUÇÃO: O hipertireoidismo é caracterizado pelo aumento da síntese e liberação dos hormônios tireoidianos pela glândula tireoide. A tireotoxicose refere-se à síndrome clínica decorrente do excesso de hormônios tireoidianos circulantes, secundário ao hipertireoidismo ou não. Este artigo descreve diretrizes baseadas em evidências clínicas para o manejo da tireotoxicose. OBJETIVO: O presente consenso, elaborado por especialistas brasileiros e patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia, visa abordar o manejo, diagnóstico e tratamento dos pacientes com tireotoxicose, de acordo com as evidências mais recentes da literatura e adequadas para a realidade clínica do país. MATERIAIS E MÉTODOS: Após estruturação das questões clínicas, foi realizada busca das evidências disponíveis na literatura, inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO - Lilacs. A força das evidências, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão. RESULTADOS: Foram definidas 13 questões sobre a abordagem clínica inicial visando ao diagnóstico e ao tratamento que resultaram em 53 recomendações, incluindo investigação etiológica, tratamento com drogas antitireoidianas, iodo radioativo e cirurgia. Foram abordados ainda o hipertireoidismo em crianças, adolescentes ou pacientes grávidas e o manejo do hipertireoidismo em pacientes com oftalmopatia de Graves e com outras causas diversas de tireotoxicose. CONCLUSÕES: O diagnóstico clínico do hipertireoidismo, geralmente, não oferece dificuldade e a confirmação diagnóstica deverá ser feita com as dosagens das concentrações séricas de TSH e hormônios tireoidianos. O tratamento pode ser realizado com drogas antitireoidianas, administração de radioiodoterapia ou cirurgia de acordo com a etiologia da tireotoxicose, as características clínicas, disponibilidade local de métodos e preferências do médico-assistente e paciente.

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Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.

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Objective. Juvenile localized scleroderma (JLS) includes a number of conditions often grouped together. With the long-term goal of developing uniform classification criteria, we studied the epidemiological, clinical and immunological features of children with JLS followed by paediatric rheumatology and dermatology centres. Methods. A large, multicentre, multinational study was conducted by collecting information on the demographics, family history, triggering environmental factors, clinical and laboratory features, and treatment of patients with JLS. Results. Seven hundred and fifty patients with JLS from 70 centres were enrolled into the study. The disease duration at diagnosis was 18 months. Linear scleroderma (LS) was the most frequent subtype (65%), followed by plaque morphea (PM) (26%), generalized morphea (GM) (7%) and deep morphea (DM) (2%). As many as 15% of patients had a mixed subtype. Ninety-one patients (12%) had a positive family history for rheumatic or autoimmune diseases; 100 (13.3%) reported environmental events as possible trigger. ANA was positive in 42.3% of the patients, with a higher prevalence in the LS-DM subtype than in the PM-GM subtype. Scl70 was detected in the sera of 3% of the patients, anticentromere antibody in 2%, anti-double-stranded DNA in 4%, anti-cardiolipin antibody in 13% and rheumatoid factor in 16%. Methotrexate was the drug most frequently used, especially during the last 5 yr. Conclusion. This study represents the largest collection of patients with JLS ever reported. The insidious onset of the disease, the delay in diagnosis, the recognition of mixed subtype and the better definition of the other subtypes should influence our efforts in educating trainees and practitioners and help in developing a comprehensive classification system for this syndrome. © 2006 Oxford University Press.

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The great diversity of materials that characterizes the urban environment determines a structure of mixed classes in a classification of multiespectral images. In that sense, it is important to define an appropriate classification system using a non parametric classifier, that allows incorporating non spectral (such as texture) data to the process. They also allow analyzing the uncertainty associated to each class from the output alues of the network calculated in relation to each class. Considering these properties, an experiment was carried out. This experiment consisted in the application of an Artificial Neural Network aiming at the classification of the urban land cover of Presidente Prudente and the analysis of the uncertainty in the representation of the mapped thematic classes. The results showed that it is possible to discriminate the variations in the urban land cover through the application of an Artificial Neural Network. It was also possible to visualize the spatial variation of the uncertainty in the attribution of classes of urban land cover from the generated representations. The class characterized by a defined pattern as intermediary related to the impermeability of the urban soil presented larger ambiguity degree and, therefore, larger mixture.

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This work had as objective verifies the water quality used for irrigation by the vegetables producers of Botucatu-SP area. They were interviewed 27 producers that sell vegetables in the street markets of Botucatu. Among these producers, ten were selected, being one of each place. Three samples of water of each source were collected. The main standard to evaluate the obtained results were the CONAMA Resolution (National Environment Council) N° 357, March 17, 2005, that it establishes the standard for water classification. The Electric Conductivity was evaluated of agreement value suggested by CETESB and the color was verified according to OMS (Health World Organization), for potable water due to CONAMA Resolution not to stipulate a value for classification. For the public health, just the coliformes and nitrate are the preoccupying variables for they be related with the incidence of diseases, so, the analyzed waters, 40% of them (A, F, H and J producers) offer some risk for the health of Botucatu population, second established standard for CONAMA. We can to conclude that in a general way, those waters, are in conditions no alarming, because they don't present values very different from those established by the legislation.

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Lymphoma studies deals with morphological classification and immunophenotypic features and they have to be amplified for cellular kinetics evaluation. This evaluation can only be safely made, when the proliferative index are evaluated. In men the proliferation index have, most of the time, important influence in the neoplasia prognosis and treatment In this work it was used 40 canine lymphomas that were classified according to Kiel methods and immunophenotype was achieved with CD3 (T lymphocyte) and CD79a (B lymphocyte). Cellular proliferation was evaluated by AgNORs and Ki-67 (MIB-1) According to Kiel classification system, high grade lymphomas were more frequent and T and B lymphoma showed the same frequency.When cellular proliferation was evaluated, there was a significant difference between high grade and low grade lymphomas by AgNOR and Ki-67 (MIB-1) methods, but did not differ when comparing immunophenotype. Among high grade malignancy lymphomas the NORs medium number per cell nucleoli was 1.37± 0.32 and in low grade was 0.98± 0.36, concerning Ki-67 the positive cellular percentual was 43.19% ± 19.01, e 14.09% ± 11.74 in high and low grade, respectively.