Miíase Mamária: relato de 2 casos

RESUMO Miíase é definida por uma parasitose causada por larvas em desenvolvimento de algumas espécies de moscas que infestam humanos ou animais. Os autores apresentam dois casos de miíase mamária. Chamam atenção para as características observadas nesta patologia e para o diagnóstico diferencial dos processos inflamatórios localizados na mama.

The demand for global student talent: Capitalizing on the value of university-industry collaboration

The university sector in Europe has invested money and effort into the internationalization of higher education. The benefits of internationalizing higher education are fuelled by changing global values, choices and practices. However, arguments that serve the internationalization of higher education tend to stress either local organizational or individual interests; seldom do they emphasize the societal benefits. This dissertation investigates how collaboration between university and industry facilitates a shift in thinking about attracting and retaining global student talent, in terms of co-creating solutions to benefit the development of our knowledge society. The macro-structures of the higher education sector have the tendency to overemphasize quantitative goals to improve performance verifiability. Recruitment of international student talent is thereby turned into a mere supply issue. A mind shift is needed to rethink the efficacy of the higher education sector with regard to retaining foreign student talent as a means of contributing to society’s stock of knowledge and through that to economic growth. This thesis argues that academic as well as industrial understanding of the value of university-industry collaboration might then move beyond the current narrow expectations and perceptions of the university’s contribution to society’s innovation systems. This mind shift is needed to encourage and generate creative opportunities for university-industry partnerships to develop sustainable solutions for successful recruitment of foreign student talent, and thereby to maximize the wealth-creating potential of global student talent recruitment. This thesis demonstrates through the use of interpretive and participatory methods, how it is possible to reveal new and important insights into university-industry partnering for enhancing attraction and retention of global student talent. It accomplishes this by expressly pointing out the central role of human collaborative experiencing and learning. The narratives presented take the reader into a Finnish and Dutch universityindustry partnering environment to reflect on the relationship between the local universities of technology and their operational surroundings, a relationship that is set in a context of local and global entanglements and challenges.

Berättelse öfver Sylviaföreningens värksamhet under arbetsåret 1900—1901 afgifven till årsmötet den 17 febr. 1902

19 x 29 cm

Sylviaföreningen

14 x 22 cm

Kertomus Sylviayhdistyksen toiminnasta vuonna 1900—1901 annettu vuosikokoukseen 17 p. Helmik. 1902

19 x 29 cm

Uma proposta de classificação ecográfica mamária

OBJETIVOS: as melhorias tecnológicas na qualidade da imagem têm aumentado a importância da ultra-sonografia no estudo das patologias mamárias. A necessidade de padronização para caracterizar, descrever e emitir laudos na análise das imagens motivaram o desenvolvimento de um sistema de classificação de laudos ecográficos mamários. MÉTODOS: o sistema de classificação proposto agrupou as imagens ecográficas mamárias em cinco classes: I - normal, II - benigna, III -indeterminada, IV - suspeita, V - altamente suspeita. As características morfológicas ecográficas utilizadas para a descrição das imagens foram: forma, limites, contorno, ecogenicidade, ecotextura, ecotransmissão, orientação e sinais secundários. O teste padrão, numa casuística de 450 lesões, foi considerado o seguimento ecográfico das lesões por período de 6 a 24 meses e a histopatologia da peça cirúrgica nos casos operados. RESULTADOS: a classificação ecográfica mamária para o diagnóstico de câncer de mama apresentou sensibilidade de 90,2% (IC: 82,8-94,9%) e especificidade de 96,2% (IC: 94,0-97,6%) O valor preditivo positivo foi de 84,1% (IC: 76,0-89,9%) e o valor preditivo negativo foi de 97,8% (IC: 95,9-98,9%), alcançando acurácia de 95,1%. CONCLUSÕES: a adoção do sistema de classificação ecográfica resulta na uniformidade e otimização dos laudos. Facilita ainda a comparação com a clínica, com os exames histopatológicos e de imagem mamária, evitando procedimentos desnecessários, conduzindo a condutas terapêuticas mais adequadas

Yritysten rooli kehitysmaiden alueellisessa kehityksessä: yritystoiminnasta vaihtoehtoisia ratkaisuja virallisen kehitysavun ongelmiin?

Kehitysmaiden alueellisen kehityksen edistäminen, köyhyys ja kehitysavun toimivuus ovat saaneet paljon huomiota osakseen kansainvälisessä keskustelussa. Sekä alueellinen kehitys että kehitysavun kenttä ovat hyvin monimutkaisia kokonaisuuksia, eivätkä kehitysmaiden kehitykseen liittyvät kysymykset täten ole helppoja. Virallinen kehitysapu ei ole yltänyt toivottuihin tuloksiin ja se onkin saanut paljon kritiikkiä osakseen. Yritykset ovat merkittävä tekijä etenkin alueellisen taloudellisen kasvun ja kehityksen, ja sitä kautta kokonaisvaltaisemman kehityksen, edistämisessä. Tästä huolimatta yritystoiminta ei ole saanut osakseen merkittävää huomiota kansainvälisessä kehityskeskustelussa. Tutkielmassa tarkastellaankin yritysten roolia kehitysmaiden alueellisessa kehityksessä. Erityisesti halutaan selvittää, millaisia ratkaisuvaihtoehtoja yritystoiminta voi tarjota niillä alueellisen kehityksen alueilla, joilla virallisen kehitysavun voidaan nähdä epäonnistuneen. Kyseessä on syntetisoiva tutkielma. Tutkimusta on täten tehty tutustumalla laajasti alueellista kehitystä, virallista kehitysapua ja yritystoimintaa käsittelevään kirjallisuuteen. Tämän pohjalta havaittiin, että virallisessa kehitysavussa tulisi keskittyä nykyistä enemmän ihmisoikeuksiin tarpeiden sijaan, vastaanotettujen apurahamäärien vakauteen, kunnollisen palautteen saamiseen, politiikkaan ja pitkän aikavälin tavoitteiden saavuttamiseen. Näiden viiden osa-alueen takana nähtiin puutteita seuraavissa kehitystekijöissä: inhimillisen pääoman vahvistamisessa, vakaan kasvun tavoittelemisessa, palautteen saamisen tärkeyden ymmärtämisessä, poliittisen vallan hajauttamisessa ja pitkän aikavälin kasvun ja kehityksen lähteisiin panostamisessa. Yritykset voivat vahvistaa inhimillistä pääomaa työllisyyden kautta suoraan ylläpitämällä kyvykkyyksiä tai välillisesti kannustamalla kouluttautumista. Yritystoiminnan nähtiin myös tarjoavan paremmat mahdollisuudet vakaan kasvun saavuttamiselle kuin virallisen kehitysavun. Markkinat antavat yrityksille palautetta ihmisten tarpeista ja toisaalta menestyminen markkinoilla edellyttää paikallisen toimintaympäristön tuntemista ja yritysvastuun kantamista. Yritysten työllistävä vaikutus auttaa hajauttamaan poliittista valtaa suoraan voimauttamalla ihmisiä tai välillisesti vähentämällä tiedon ja osaamisen kasautumista hallitsevalle eliitille. Teknologisella edistymisellä, innovoinnilla ja yrittäjyydellä on tärkeä sija yritysmaailmassa, ja ne puolestaan ovat keskeisiä pitkän aikavälin alueellisen kasvun ja kehityksen lähteitä. Yritystoimintaa voisi siis hyödyntää nykyistä enemmän kehitysmaiden alueellisen kehityksen edistämisessä niillä osa-alueilla, joilla yritykset voivat tuottaa tuloksia tehokkaasti.

Reação anafilática ao corante azul patente durante a biópsia do linfonodo sentinela em câncer de mama inicial: relato de caso

A biópsia do linfonodo sentinela no tratamento do câncer de mama vem substituindo a linfadenectomia em casos iniciais. Este tratamento pode ser realizado com o corante azul vital e/ou radiofármaco. Há relatos de reações alérgicas ao corante com diferentes graus de severidade. Relata-se um caso de reação anafilática severa após injeção intradérmica do corante azul patente, em paciente com diagnóstico de carcinoma ductal in situ. O corante azul patente, apesar de facilitar a detecção do linfonodo, apresenta risco de desencadear reações anafilactóides. É necessário que a equipe envolvida tenha preparo para diagnosticar e tratar esta complicação.

Septo uterino, duplicação cervical e septo vaginal: relato de rara malformação mülleriana com gestação a termo

Apresentamos um caso de gestação espontânea em uma paciente com útero septado completo e duplicação cervical. Paciente com 34 anos, branca, nuligesta, ciclos regulares, com suspeita de septo uterino em exame ecográfico. Ao exame, apresentava septo vaginal longitudinal até a região himenal e dois colos uterinos. Solicitada ecografia pélvica tridimensional que evidenciou duplicação cervical, septo uterino do istmo à cavidade endometrial e ausência de divisão do corpo uterino, compatível com útero septado completo e duplicação cervical verdadeira. Um mês após, relatou relação sexual desprotegida e atraso menstrual. Ao exame ecográfico foi visualizado saco gestacional único na cavidade uterina direita. Apresentou gestação sem intercorrências. A cesariana ocorreu com 37 semanas, com recém-nascido do sexo feminino saudável e puerpério normal. Esse caso ilustra uma gestação espontânea, sem intercorrências, em uma rara anomalia, cujo impacto reprodutivo ainda não está totalmente elucidado.

Aderência autorreferida a medicamentos prescritos durante a gestação

OBJETIVO: Avaliar a adesão terapêutica autorreferida durante a gestação em amostra de mulheres brasileiras. MÉTODOS: Foi realizado um estudo transversal com puérperas internadas no serviço de obstetrícia de um hospital universitário, entre agosto e novembro de 2010. Foram incluídas puérperas com 18 anos ou mais, idade gestacional superior a 22 semanas e peso do feto igual ou maior que 500 g. Foram excluídas puérperas em uso de sedativos e/ou outros medicamentos capazes de alterar o estado de consciência. Os dados foram coletados por meio de entrevista face a face, com uso de questionário estruturado contendo perguntas sobre características sociodemográficas, uso de medicamentos, número de gestações anteriores, métodos contraceptivos utilizados, atendimento pré-natal e adesão terapêutica. Para a determinação da adesão, foi utilizada a escala de adesão terapêutica de Morisky - MMAS-4 de quatro itens. Foram utilizados o Teste H de Kruskal-Wallis e o Teste de Χ2 de Pearson e exato de Fisher para análise estatística. RESULTADOS: A média de idade das gestantes foi de 22,5 anos (DP=6,5), das quais 53,8% iniciaram acompanhamento pré-natal no primeiro trimestre da gravidez. Das 130 pacientes entrevistadas, 96,9% fizeram uso de algum medicamento durante o período gestacional, com média de 2,8 medicamentos por paciente. As principais classes prescritas foram: antianêmicos (55,1%); analgésicos, anti-inflamatórios e antipiréticos (19,0%); e anti-infecciosos (7,2%). Fizeram uso de dois a quatro medicamentos 71,6% das pacientes. Apenas 19,2% das pacientes foram consideradas aderentes. As pacientes com menores taxas de adesão foram aquelas com maior escolaridade, renda própria, início do acompanhamento pré-natal no primeiro trimestre de gravidez e aborto prévio. CONCLUSÃO: Apesar de a maioria das gestantes fazer uso de medicamentos prescritos durante a gestação, a taxa de adesão ao tratamento foi baixa, indicando uma necessidade de investigações adicionais sobre o impacto da não adesão durante a gestação e suas causas.

Frequência e fatores associados à síndrome da mama fantasma em mulheres submetidas à mastectomia por câncer de mama

OBJETIVO: Avaliar a frequência e os fatores de risco para o desenvolvimento da síndrome da mama fantasma em pacientes submetidas à mastectomia para o tratamento do câncer de mama.MÉTODOS: Estudo de coorte com mulheres atendidas em um hospital especializado da região sudeste do Brasil no período de setembro de 2008 a junho de 2009. Foram consideradas como tendo síndrome da mama fantasma pacientes com relato da presença de dor na mama fantasma e/ou sensação na mama fantasma. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) (015/08). Foi realizada análise descritiva por meio da frequência absoluta e relativa. Para avaliar a associação entre a SMF e os potenciais fatores de risco, foi realizada análise univariada, por meio de odds ratios(OR) com os respectivos intervalos com 95% de confiança (IC95%).RESULTADOS: Foram incluídas 88 pacientes. A frequência da SMF observada aos 45 dias (primeiro seguimento) foi de 44,3 e 18,2% aos 2 anos (último seguimento). A maioria das mulheres apresentou relato de sensação na mama fantasma em todos os seguimentos (37,1; 30,1 e 22%). No seguimento de 6 meses, mulheres com idade inferior a 60 anos apresentaram um risco 3,9 vezes maior de apresentar síndrome da mama fantasma (OR=3,9; IC95% 1,4-10,5) e aquelas com maior escolaridade (8 anos ou mais de estudo) apresentaram maior risco de desenvolver SMF (OR=2,6; I 95% 1,01-6,8).CONCLUSÃO: A população estudada apresentou alta frequência de SMF, com diminuição ao longo do seguimento pós-operatório. Sua ocorrência no seguimento de seis meses foi maior entre as mulheres mais jovens e com maior escolaridade.

Tieliikennetelematiikkalaitteiden huoltoon liittyvän verkoston toiminnan kehittäminen

Diplomityössä on tutkittu tieliikennetelematiikkalaitteiden huoltoon liittyvän verkoston toiminnan kehittämistä. Tutkittuun verkostoon kuuluvat Valtti-yksikkö (Valtakunnallinen liikennetelematiikka ja liikenteenhallinnan tietopalvelut), ELYkeskukset, tieliikennekeskukset, hallinta- ja valvontatoimija sekä huoltotoimijat. Tarkoituksena oli selvittää, kuinka verkoston toiminnan tehokkuutta voidaan parantaa. Tähän sisältyi verkoston toimijoiden tunnistaminen sekä toimijoiden roolien ja vastuiden määrittäminen. Lisäksi on tutkittu kuinka verkoston toimijoiden välistä tiedonkulkua voidaan parantaa ja kuinka ITIL-viitekehys soveltuu verkoston toimintaan. Diplomityötä varten on haastateltu verkoston toimijoiden edustajia heidän näkemyksistään verkoston toiminnasta ja sen kehittämistarpeista.

How (not) to interview children : interviews with young children in sexual abuse investigations in Finland

The present thesis had two main objectives: The first was to assess how child sexual abuse (CSA) interviews in Finland are conducted through analysing the interviewing techniques applied and the language used by the interviewers, as well as to suggest ways to improve interviews if they were found to have deficiencies. The second main aim was to contribute to the growing research corpus concerning CSA interviews, in particular, by addressing how interviewers follow up information provided by the child, by analysing whether child health care professionals would use childadapted language, and by studying the kind of modifications in the verbal behaviour of interviewers and children that were associated with a) repeated interviews, b) a support person’s presence at the interview, and c) the use of anatomically detailed dolls. Two complementary samples of CSA interviews were analysed. The first one was composed of child interviews with 3-12-year-old children (N = 27) that had been considered problematic by lawyers or other involved professionals (Studies I and IV). The second sample consisted of unselected interviews (N = 43) with children aged 3 to 8 years conducted in a number of hospitals in different parts of the country (Studies II and III). Study I: The verbal interaction between interviewer and child was analysed in a sample of interviews that had been considered to be problematic by involved professionals. Results showed that interviewers used inappropriate questioning techniques, relying on option-posing, specific suggestive and unspecific suggestive questions to a significant extent, these comprising around 50% of all interviewer utterances. The proportion of invitations, which the research community recommends interviewers to rely on, was strikingly low. Invitations and directive utterances were associated with an increase in informative responses by the child in terms of response type, number of new details reported, as well as length of response. The opposite was true for option-posing and suggestive utterances. Longer questions by the interviewer (in number of words) often rendered no reply from the child, whereas shorter questions were followed by descriptive answers. Even after the child had provided an informative answer, interviewers failed to follow up the information in an adequate way and instead continued to rely on focused and leading questions. Study II: Due to the possible bias of the sample analysed in Study I, the most important analyses were rerun with the unselected sample and reported separately. Results were quite similar between the two studies, indicating that the problems observed in Study I, with interviewers relying on option-posing and suggestive questions to a significant extent, are likely to be general and not specific for those interviews. Even if suggestive questions were slightly less and invitations slightly more common in this sample than in the previous study, almost half of the interviewer questions were still optionposing or suggestive, and also in this sample, interviewers failed to follow up information by the child in a facilitating manner. Differentiating between judicial and contextual details showed that while facilitators, invitations, and directive utterances elicited more contextual than judicial details, the opposite was true for specific suggestive utterances. These results might be explained by the reluctance of children to describe sexual details related to the abuse events. Alternatively, they may also be due to children describing incorrect sexual details as a result of suggestive interviewing techniques. Study III: This study examined features of the language used by the interviewers. Interviewer utterances included multiple questions, long statements, complicated grammar and concepts, as well as unclear references to persons and situations. More than a fifth of the interviewer utterances were coded as belonging to at least one of these categories. The results suggest that even professionals who are experienced in interacting with children may have difficulties in using a child-sensitive language, adding to the pool of studies showing similar problems to occur in legal hearings with children conducted by lawyers. As children rarely comment on, or even recognise, their lack of comprehension, the use of a language that is too complex can have detrimental consequences for the outcomes of investigative interviews. Interviewers used different approaches to introduce the topic of abuse. While 15% of the children spontaneously addressed the topic of abuse, probably indicating that they felt confident with the interviewer and the situation, in almost 50% of the cases, the interviewer introduced the topic of abuse in a way that can be considered leading. Interviews were characterised by a lack of structure, apparent in frequent rapid switches of topic by the interviewer. This manner was associated with a decrease in the number of new details provided by the children. Study IV: This study analysed possible changes in the interview dynamics associated with repeated interviewing, the presence of a support person (related to the child), and the use of anatomically detailed (AD) dolls. Repeated interviewing, in combination with suggestive questions, has previously been found to seriously contaminate children’s accounts. In the present material, interviewers used significantly more suggestive utterances in the repeated condition, thus endangering the reliability of the children’s reports. Few studies have investigated the effects of a support person’s presence at the interview. The results of the present study showed that interviewers talked more and children provided less information when a support person was present. Supporting some earlier findings regarding the use of AD dolls, the present results showed that using AD dolls was associated with longer interviewer utterances and shorter, less responsive, and less detailed child responses. Interviewers used up to five times more unspecific suggestive utterances when dolls were used, for instance through repeatedly asking the child to show “what really happened” with the dolls. Conclusion: The results indicate that CSA interviews in Finland are not conducted in a manner that follows best practice as defined by the research community and as stated in a number of guidelines. When comparing these questioning strategies with the recommendations, which have been predominant in the field for more than ten years now, it can be concluded that the interviews analysed were conducted in a manner that undermines the possibility to elicit an uncontaminated and accurate narrative from the children. A particularly worrying finding was the fact that interviewers did not follow up relevant information by the children in an adequate way. A number of clinical implications can be drawn from the results, particularly concerning the need for improvement in the quality of CSA interviews. There is convincing research regarding how to improve CSA interviews, notably through training forensic child interviewers to use a structured interviewing protocol, and providing them with continuous supervision and feedback. Allocating appropriate resources to improve the quality of forensic child interviews is a matter of protecting the rights of all persons involved in CSA investigations, in particular those of the children.

Survey on control and management practices of equine helminthes infection

Twenty-nine stud farms were selected in the Medium Paraíba region of the Rio de Janeiro state, Brazil. After an interview with the person responsible for the animals, faecal samples were collected from mares and analyzed via the EPG technique, faecal cultures, Sedimentation-centrifugo-flotation, and modified Ueno and Baermann techniques. The prevalence of helminths in the mares and in the stud farms was calculated. The stocking rates of pasture, change of horse bedding, absence of pasture rotation, absence of technology in the property, and less frequent treatment of the animals were associated with a greater prevalence of helminths, showing that these variables must be considered in equine control programs. The intensity of the parasitism was also associated with the stocking rate of pasture, absence of dunghill, presence of the animals only in paddocks, lack of technology in the property, less frequent treatment of the animals, and absence of the use of rotation regarding the anthelmintic class.